Feline Femoral Fracture Fixation: What are the options?

Abstract

Practical relevance: The femur is the most commonly fractured bone in cats. Femoral fractures usually result from high-velocity trauma such as a road traffic accident or fall from a height and, as such, are associated with a wide variety of concurrent injuries. The initial focus of treatment should always be on assessment and stabilisation of the major body systems. Once any concurrent injuries have been addressed, all femoral fractures need surgical stabilisation, with the notable exception of greenstick fractures in very young cats, which can heal with cage rest alone. A number of different surgical options are available depending on the fracture type, location, equipment, surgeon experience and owner finances. Clinical challenges: Femoral fractures can vary hugely in complexity and the small size of feline bones can limit the choice of implants. Furthermore, cats can present unique challenges in the postoperative period due to their active nature and the limited means to control their exercise level. Audience: This review is aimed at general and feline-specific practitioners who have some experience of feline orthopaedics, as well as those simply wishing to expand their knowledge. Aims: The aim of this review is to help clinicians assess, plan and manage feline femoral fractures. It provides an overview of diagnostic imaging and a discussion of a range of suitable surgical options, including the principles of different types of fixation. It also highlights cat-specific issues, approaches and implants pertinent to the management of these cases. Evidence base: A number of original articles and textbook chapters covering many aspects of femoral fractures in cats and dogs have been published. Where possible, this review draws on information from key feline research and, where necessary, extrapolates from relevant canine literature. The authors also offer practical guidance based on their own clinical experience.

Use of a Modified Intramedullary Pinning Technique for Distal Femoral Physeal Salter–Harris Type I and II Fracture Management: A Retrospective Study of 31 Cats

“…In addition, when an open approach is needed, cross-pinning and dynamic crosspinning required soft tissue dissection on the lateral and medial aspects of the distal femur to place accurately the implants. 19,20 This type of situation is encountered when fluoroscopy is not available or when the patient is not a good candidate for a minimally invasive approach. 18 A possible negative point of this technique is that it could cause articular cartilage damage if the intramedullary implant migrates distally.…”

“…[17][18][19] With an open approach, cross or Rush pinning requires both a lateral parapatellar and a small medial approach to the stifle joint achievable through a single skin incision made lateral to the articulation. 19,20 Therefore, we assumed that surgical repair of distal physeal femoral fractures in cats using an intramedullary pin inserted normograde from the distal epiphysis and augmented with a laterally applied antirotational Kirschner wire would provide adequate stability to achieve satisfactory bone healing with limited risk for complications. This technique was first described by Parker in 1984 in a case series of 11 dogs and cats.…”