Management of Multiple Orthopedic Injuries Secondary to Vehicular Trauma in an 8 year old Cat

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An approximately 8 year old female spayed Persian cat presented to Cornell University Hospital for Animals’ Emergency Service after being run over by a car in the driveway. Immediately afterwards, she was observed to be ambulatory in the forelimbs but dragging her hindlimbs and crying in pain. Her owners brought her directly to Cornell.
Upon presentation, the patient was in respiratory distress with decreased bronchovesicular lung sounds bilaterally. She was painful in the hindlimbs and pelvis. Oxygen supplementation was started and the patient was given hydromorphone intravenously for pain. Her respiratory rate and effort significantly improved. A diagnostic thoracocentesis was negative for free air in the pleural space. A flash ultrasound of the chest was negative for pleural or pericardial fluid and a flash ultrasound of the abdomen was negative for free abdominal fluid and showed an intact bladder. Her heart rate, respiratory rate, and temperature were normal and strong synchronous femoral pulses were present. On neurologic examination, the patient was bright, alert, and responsive with normal cranial nerves. On the forelimbs, normal motor function, hopping, proprioception, and withdrawal reflexes were present bilaterally. On the hindlimbs, motor function was observed bilaterally but full neurologic examination was not performed due to patient discomfort. Digital rectal and abdominal palpation examinations were unremarkable. Point of care blood work showed a mild to moderate azotemia (AZO stick 30-40 mg/dL), and high normal pH (7.384 (7.32-7.38)) with a respiratory alkalosis (pCO2 33.6 mmHg (38-46)), mild metabolic acidosis (BE -5.4 (-4-0)) which fell into the range of compensation for acute primary respiratory alkalosis, and low anion gap (16.8 mmol/L (17-29)). Packed cell volume, total solids, and electrolyte values were within normal range. Two-view thoracic radiographs showed no abnormalities. Two-view pelvic radiographs showed multiple acute traumatic fractures including a comminuted articular right iliac fracture, several pelvic floor fractures, and a luxation of the left sacroiliac joint.
At this time, the patient’s problem list included multiple acute traumatic pelvic fractures, respiratory distress (resolved), decreased bronchovesicular lung sounds bilaterally, high normal pH with respiratory alkalosis and appropriate metabolic compensation, and moderate azotemia. This case report will focus on pelvic fractures, associated secondary complications, and surgical management of comminuted articular iliac fractures and sacroiliac luxations, including preoperative and postoperative care.

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Feline pelvic fractures, secondary concerns, surgical vs medical management


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