Ankanı Univ Veı Fak Derg 46, 199-2()S. 1999
THE CLINICAL STUDIES ON THE TREATMENT OF PELVIC
FRACTURES OF CATS AND SMALL BREED DOGS WITH
MINI TITANIUM PLATES AND SCREWS
Ümit KAYA/
Doğa TEMIZSOYLUı
Arkun CANDAŞ]
Kedi ve küçük yapılı köpek ırklamıda pelvis kırıklarmm mini tita1lyum plak ve
vidalarla sağaltımı üzerine klinik çalışmalar
Özet: Pelvis bölgesi güçlü kaslar ve yumuşak doku tabakası ile sarılmışfır. Bu
bijlge kemiklerindeki
kmklara
genellikle
direkt travmalar
neden olur. Pelvis
kmklan11l/1 sa[!,altımında ,çirurjikal prosedürün
amacı. pelvis kanalını daralta/1
Fagmanlarııı
redüksiyonunu
saj!lamak ve sacroiliac eklem. ilium ve acetabulum
gibi yüklenme bölgelerini stabilize etmektir.
Bu klinik
çalı,ı'mada. kedi
ve küçük
ırk köpeklerin
pelvü
kmklanııın
sa[!,altımında jikzasyon
materyali olarak mini titanyum plak ve vidalar kullal1lldı.
Çalışma
mateıyalini.
Ankara
Üniversitesi
Veteriner
Fakültesi
Ortopedi
ve
Travmatoloji Bilim Dalı Klini[!,ine 1996-1999 tarihlerinde muayene için getirilen
de[!,i,çik ırk. yaş ve cinsiyet/eki
6 kedi ve 3 küçük yapılı ırk kijpek o{u,çfurdu.
Operatir
sa[!,altım klinik
ve
radyolojik
muayenelere
göre
de[!,erlendirildi.
Radyografik
muayene
sonu~:larına göre olguların
5'inde ilium.
2'sinde ischii.
i 'inde acetabulum ve l' inde de multiple pelvis km[!,ı tespit edildi. Gruptaki pelvis
km[!,ı bulunan 3 olguda ayl1l zamanda sacroiliac lükzasyo/1 vardı. Dört veya be,ç
delikli.
o.
Rmm kalınlıkta mini tilanyum plaklar. km[!,l/1 tipine ve lokalizasyonU/w
gijre bm-lı ve barsız olarak seçildi. Vidalann
uz.unluklan ise 7-11mm arasl/1da
belirlendi. Tüm olguların klinik ve radyolojik muayeneleri düzenli olarak yapıldı
ve postoperatir komplikasyon görülmedi. Bulguların do[!'rultusUlıda mini titanyum
plaklal'llı ve vidalann
kü~'ük olmalan.
kolayca ,çekillendirilmeleri
ve operasYO/1
sırasında
rahat
kullal1lmlan
nedeniyle
kedi
ve küçük
ırk kiipeklerin
pelvis
kmklannııı
sa[!,altımll1da tercih edilebilir bir.tikz.asyon materyali
oldu[!,u kanısııw
v({ 1'1 {/l1I ,I'tlr.
Anahtar
kelimeler:
Kedi. küçük yapılı köpek. mini titmıyum pl({k. pelvis
k ml< L((1'1.
Summary: As the pelvic regio/1 is well covered with muscles and .lot; tissues.
the Factures or the bones ol this structure. are generally caused by direct trau/lws.
The (lim olperlorming
a surgical procedure to treat a pelvicFacture
is fo reduce
the Fagments
which narrows the pelvic uınal and to stabilize the weigth bearing
segments like sacroiliacjoint,
ilium and acetabulum.
i Dr. Anbra University. Faeulty of Veterinary Medicine, Dept. of Orthopedics and Trauınatology. ()611 () Dı~bpı/I\nbra. 2 Res. Assist. Akdeniz University, Faculty of Veterinary Medicine. Dept. of Surgery. Burdur.
3. Prof. Dr. Ankara Universily. Faculty of Veterinary Medicine. Dept. of Orthopcdjes and Trauınatology. ()61 i ()Dı~kapı/ Ankara.
2()() Ü. KA YA, D. TEMIZSOYLU, A CANDAŞ
117 this clinical study, mini titanium plates and screws were used as jixatioıı
materials j(ıı' the treatment of pelvic ./i"actures of cats and small breed do~s. The
study ~mup was performed by 6 cats and 3 small breed dORS in dUTerent breeds.
ages and sexes which were examined in the clinics of the Department of
Traumatology and Orthopedics, Faculty of Veterinary Medicine, Ankam
University, between the years of
1996-1999
and sur~ical treatments ıverecoıısidered ([(:cordin~ to the clinical and radioloRical examinatioııs. In the
radiogmphic evaluations of these cases revealed that
5
of the aninwls had itium./i"acıure. 2 animalshad ischii./i"actures, I animal had acetabular./i"acture and oııe
animal had multiple pelvic ./i"actures . Three of these animals had ili/mı ./i"actııres
accompwıied by sacmiliac luxation. The mini titanium plaıes Yı'hich have
0.8
miLLin thickness aııd 4 or 5 holes were selected with or without bars accordin~ to the
Iype aııd the localization of the fiw;tures. The screws rwwed between 7 and
i
I miLLin length. The clinical and radioloKic:al examinations ofall cases were periodical!.v
perl(Jlmed and no postoperatİve complications were observed. From the .IindİIlKs,
iı was concluded that minİ titanium plates and screws are recommended as
lixolioıı materials j()r the sUlXical treatments of pelvic/i'actures in ('(LLS and snUlll
breed dORS because these materials are small in size, easy to shape and use iıı the
operatİons.
Key words:
Cat, small breed dOR. mini tiranium plates. pelvic .Iiw:tures.Introduction
Pdvic girdIe is formed hy articulation of
os coxae, composed of os ilium, os pubis and os
ischii with each other in the ventral and sacrum
in cranio-dorsal (9). Fracturcs at this osteoid
matrix which is surwunded by strong and thick
musclc stratum are caused hy direct traumas
such as getting hit by motorized vehides,
fall-İng down from high places, being shot and
wounded by fire-arım 0,4,5,6,15). Pathological
fractures which are caused by bone tumors and
results of methobolical diseases are ra re in
in-cidence (5). These fractures also have multiple
characteristİcs duc to the rectangular
conligura-ıion of bones involvcd (I ,3,6, i5).
Pelvis provides support for rare
extrem-itİes. attachments for manyol' the muscle
gwups and a large canal for important nerves,
blood vessels and the othcr sort tissue
(uro-genital and gastrointestinal). It is reported that
[lelvic !"ractures compromise the functions of
those structurcs mentioncd above, thus risking
any involvcd 0,5,6,15). Apart from the traumas
of the organs in that part, other Icsions such as
pulmonary contusions, rib fractures,
pneu-mothorax, nerve lesions, spinal or extrcmite
fractures could be observcd (3,4,5, i5).
External and internal (rectal) examinations
make it possible to locate fractures or pelvis
and functional defaults of rarc Iimbs, and
pos-sihle further complications. Uro n cxtcmal
pal-pation when wings of ilium, the greater
tro-chanter, the ischial tuherosity, and the dorsal
spinal proceses of sacrum are taken as rderanee
points, deplacement and instability or pelvis
can he determined as well as crepitation and
symptomatic pains (lS).
Internal examination allows an evaluation
of palpation of fractures, the rate of constriction
of pelvic canal, the locatio n of fractured
trag-mcnts, the functions of anal sphincter and
per-foration of rectum. The examination or anal
sphincter is important in order to specify
le-sions which could he formed at pudental ncrve
in pelvic fractures cspecially when sacrum i~
in-volved (1,15). In neurological examinations or
the extremity involved, anus and perineal
re-gions should be performed before the treatment
protocol ıs applied in pelvic rracturcs
THE CLl:'\lCAL STUDIES ON THE TREATMENT OF PELYIC FRACTURES OFCATS AND SM ALL BREED DOGS WITH MINI TITANIUM PLATES AND SCREWS
2(JI
Taking two way plane roentgenograms
hclps verify the pelvic fractures and other
le-sions radiologically as the last stage of
ex-aminations (I ,3,4, iS).
The trcatments of pelvie fractures are
sub-eatcgürized as surgical and nonsurgical
inter-ventions (3,6, iS). Nonsurgical management
method relies on the principlc that the muscle
gmups of pelvis and soft tissues such as
sac-rotuberous ligaments will have internal spIint
and suporort role in the pelvie !"ractures (15). In
ordcr to proceed with this treatment protocal,
there ımıst hc very littlc or no deplaeement
among thc fragments. Having the patients rest
in a limited space, minimizing their activities
and regular ohservation of urination and
defeca-tion constitute and important part of this
treat-ment protocol (3,5,7,15).
Surgical treatment is eonsidered under the
rol1owing situations.
I. Fractures and luxations involving
sac-roiliac articulations (4, iO).
2. Bilateral corpus ilium fracture and its
evident deplacement (5,15).
3. Acetahular fraetures aecompanied by
deplaeement whieh are observed on the surfacc
01
the joints(S,7, IS).4. Coxa-femoral luxations or fractures of
extremities involved due to single or douhle
sided sacroiliac stabilization loss (1,3,6,7,15).
5. A significant stabilization loss in hips
(e.g. singk or douhle sided ilium, ischii and
pu-his lraeture) (I
,S,6, 7).
6. Fraetures eausing signifieant
constric-tion of diametcr of pelvic canal (1,5,6,7,1 I).
7. Fractures or luxations which will cause
posture, walking and stepping defects (5,7).
The general aim of surgical intervention is
rcmoving the fragments which apply pressure
on pclvic canal and stahilizing pelvis segments
on whieh physical foree is transferred during
stepping (14). Weight-bearing areas of the
pel-vis are sacroiliac joint, ilium and acetabulum.
Fractures of this area requires surgical
inter-vention. However, puhis and ischii are not
wcight-bearing areas and generally do not
re-quire a surgical tixation (4,6,7,10,15). In
multi-ple fractures, the litarcture reveals that with the
reduction of stepping areas, the spantenOlIS
re-duction of ise hi i and puhis fractures are
pos-sible (7).
In pelvic fractures, a preoperative waiting
period for thc patient to stand up makc it
pos-sible for a detailed evaIuation of the case
(3,5,7, I 5). But spastic contractions of musclc
duc to long waiting period may Icad to
elif-ficulties in surgical reductions in young animals
and large breeds of dogs with significant
de-placement fractures. Therefore, pelvie hactures
must be surgieally intcrvcned within 3-5 day s
following the trauma (1,3,7,10,15).
Different fixation techniques are defined
for different pelvic hactures. These are screws,
plates and pins implementations for sacroiliac
fractures (S,6,H,12,14); plates for ilium
frac-tures (4,6,7,R,IS); pin, cerclage
imple-mentations for same ilium fraetures (4,15,16);
plates for aeetabulum fraetures (2,6,R, 13, I 5).
This studyaimed at contributing to the
clinical studies related to the implcmcntation of
mini titanium plates and screws in pclvic
frac-tures of cats and smail hreed dogs.
Materials and Methods
Six ca ts and three smail breed dogs of
dif-ferent ages, breeds and sexes whieh were
brought to the clinics of Department of
Or-thopedics and Traumatology, Faculty of
Vet-erinary Medicine, Ankara University, between
the years of 1996-1999, eonstituted the study
group of this study.
Two way plane radiographyeal evaluations
of these cases revealed that 5 of them had ilium
fraeture (cases no: 1,3,5,6,8), two eases had
is-chii fractures (cases no: 4,9) one case had
ac-etabular fracture( case no: 2) and one easc had
multiple pelvic fractures (case no: 7) Three
cases had ilium fractures aceompanied by
sae-roiliac luxation (case: 3,5,8).
The mini tİtanium plates were selected
localization of the fraetures. The plates were
0.8 mm in thickness and had 4 or 5 holes. In
implementation of the plates, titanium serews
of 2 mm in diameter and 7- i 1 mm in length
\\Iere used.
Animals were operated under the general
anestetic element of ketamin
hidrocloride(Ket-alar 50mg/ml, Parke-Oavis) administered
1'01-lowing xyla/in hydrochlorid (Rompun 23.32
mg/ml, Bayer) premedieation. A large area was
shaved and disinfected and the ease was
sta-bilized on the operation tabk in lateral position.
After exposition of the fraeture, reduction
was achieved through the traetion, elevatian
and roıation of the fragments, through the
ra-diographical findings, eaeh fragmant was
im-pkmented and stabilized with pre-bended, 4 or
5 holcd mini tiıanium plates with the use of at
!east 2 screws, after pasitioning.
The Inlıseks which were transversally
in-cised al the operation stage were sutured with
?ı/O or 4/0 ehrome catgut and the ski n sutured
wiıh non-absorhable suture materiai. A
pro-ıective dressing and Robert-Jones bandage were
applied on ıhe area and extremite involved. The
patients recevied parenteral lineoein+
spee-tinomysine (Lineo-speetine, 50mg/ml,
Ec-zacıba~J) for six days post-operatively
The eases were evaluated with i
O
daysin-lervals hy clinical and radiologieal
examina-tions
Findings
The history of ıhe patients and clinical
ex-aminaıions revealed that 5 animals received the
trauma ıhrough falling from high places (cases
no 2.3,4.5,8) and 3 animals from traffic
ac-cidents (cases no: i ,6,7) and one animal from
direct traııma (case no: 9). None of animals had
defecaıed for 3 days following the trauma. Two
animals had hemaıuria (cases no: 2,6), 1 animal
had hloody vomit eontent (ease no: 7), one
an-imal (eıse no: 8) had a cleft palate of 3 cm in
Icngth. Another animal had (ease no: 2) left
ra-dius-ulna in shah fracture. All the animals
re-Ü. KA YA. D TEMIZSOYU!. ;\ C\NDi\Ş
sponded positively to treatment altemps, and
urination and defeeation were regular shorıly
af ter the operation.
Robert-Jones bandage was applicd on the
extrcmite involved and the patients were asked
to be brought in on the iaılıday for the removal
of the sutures and bandage for clinical and
ra-diologieal examinations. No operaıional
com-plieations were deteeted during those
examina-tions. Af ter the removal of the sutures and
bandage, all the patients were radiologically
ex-amined under the anestheties and no
post-operative eomplications were observed.
Mini-titanium plates and serews used as
osteosynthesis material remained intacı and no
relevant eomplieaıions were observed.
Finding of the cases are presented in ıab1c
1 and radiographie result are shown ın figures
1,2,3,4,5,6,7,8.
Discussion and Conclusinn
Literature review reveals thaı serious
trau-mas such as traffie aceidents and falls from
high places have important roles in innincting
fraetures in the pelvis region although il is well
eovered with strong and ıhiek muscles. A
de-tailed general examination of the sofı tissues
and other areas is highly recommended in (mler
to reveal possibk !csions as well as pclvic
frac-tures, considering the extent of the lraumas
(3,4,5,6,15). In this study the traumas of the
pelvie region is reported to be eaused hy faliing
from high plaecs in 5 cases, traftic aeeidents in
3 eases and direct trauma in i case. Upon
gen-eral examination hematuria, temporary
ddeca-tion diftieulties or absenee of defceation,
eme-sis, eleft palate and fraeture of the radiııs-ulna
were observed. There were positivc responses
to the treatment attempts
It is suggestted that the extremily involved,
anus and perineal region be neurologieally
ex-amined before the applieation of a specitic
treatment protocol (i ,3,4,6, i5). All the eases in
this series were examined for nervc 1csions anel
THE CLI~ICAL STUDIES ON THE TREATMENT OF PELYIC FRACTURES OF CATS AND SMALL BREED DOGS WITH MINI TITANIUM PLATES A~D SCREWS
'1
,I
f,
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L
\i
i
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i ,r
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Fıgurc J Prc(lpCI';IIIVC !';ıdiııgrdpllie;ı! VlCWof
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~ckJJ ıOlgıı ııo-2"niıı 0perilsyoıı (iııeesi I';ıJ)llgr;ıfik gt)rUlliiııııi.
Fi~urc 2 Pnstopcraıi\'c r;ıdıogr;ırlıical vic\\' , ' casc:2 in 3rJ wcek.
Şekil 2, Olgu no:2'nilı operasyon sonra ....•ı3. hafıaLlakl radyografik görünümiL
figurt:., Prcopcr;ıtivc f;ıditlgr;ıplııcıl vicw(Li
c;\!'oc.3
Şekil 3 Olgu\l0:1"lin opcra"Yl11l ıınn'"i radyogritlik giiriiniiıııii
;.
tı
li
o
Figurc 4 Posıorcralıvc raujographıcal vicw nr (,.'a'\c:3 in 3rd',,'cek
Şckil4. Olgu no:3" ün operasyon sonrası ) hanadaki rauyografik gürünümlı.
"
','l
r
hgllfe 5, Prcopcralivc radıograplıical vicw ol ı:asc:5
Şekil5 Olgu 110:5' in opcroısynıı imcesi roıdyografik giirillliinıiı.
2114
:1~IIIL (L II,"ltıpCr;lı)\".- liıdllıgl'aplılL-;tI \iLC\\' (LI'casc:5 ın ,th week .;,d.:ı1h OJ.:;11 LLL)5"iii0PCI';ISY"Jl ••onras]i. hal'taJaki r;ILiylıgrallk giiriinülııU,
Ü. KA YA. D. TE\tIlZSOYLlj A. C'\\'DAŞ
i,1~1I1,," 1)1"-"i"'I"II)\ l i.ıd:,'.~I.qılı;, ,ıl \11,:\\,ıl ••.;1'''' ,.
:'Id,,! ~(11.~111)ı' (, 1:;11 ,'1','1.1-'\',1).'111 •. "',,, l';ıd~'tı~r;II'd.;~,,1111ı11:11ı1
h~ııı\: X p, 1.'ılllpcr:ılIVl' riıdll);;raplıIL,ıl \LL\\"iıl
cilsc:6 in -'rJ \,cek
Şekil H, Olgu1111:6'nın0pLra,)'olı .'iııma",].' hal'taliakı r<tuyografik g(irtıllilllıli
Table I. Findings and results abouı ıhe cases. Tablo I. Olgulara aiı bulgular ve sonuçlar
ease Cases of Localİzation of
Etiology Results
no Species Breed Age Sex fraeture
i
i Dog Terrier 4 F Right corpus ilium TrafTic accideıııClinically good resulı af ter 2 wecks
~
Cıı Siaıııesc 3 F Lefı acetabular Falling from highClinically good re';uiı
- place after 2 v"cck-;
:i
Cıı Turkısh 2 M Right ilium Eıllıııg from highClınically goocl resuIı
Angora plaee arter 2 \\cek"
4 Cıı Turkish 3 M Left caudal acetabulul11
Falling from high Clinıcally gool! rcstılı
Angor;ı and ischii place af ter
:i
week-.5 Cıı Mix
ı
F Left ilium Falliııg from highelinıcally good resulı
Breed place ;ırter 2 weeks
--6 Dog Terrıer i F Rıght dium TrafTic ;\ceident Clinic;llly goal! resulı ,ıfter :2 week,., f-.
7 Dng Terrıer 3 M Mulıible pelvis Traffie aceicleııt elinicdly good resııll arter .:+wceks
ıl Cıı Mix II M Right di um
Falliııg from high Clinically gool! resıılt
Breed monıh plaee after 2 \,,;ecks
9 Cal Siame.se
:i
M Right ischii Direcı trauma Clinically good resulı aher 2 weeksIllE CLINICAL STUDIES ON THE TREATMENT OF PELVIC FRACTURES OF CATS AI\D
SMALI. BREED DOGS
wını
MINI TITANIUM PLATES AND SCREWS2115
In the literatures (4,6,7,10,14), surgieal
in-ten;ention in pelvie fraetures is delined as a
means to redııce the fragments applying
pres-sure on the pclvic e,mal and the fraetures of
sac-roiliac joint, ilium and acetabulum upon which
the physical foree is transferred during the
wcight hearing. Surgical intervention is also
re-porteel to enable the fixation of the fractures of
thcse parts. All the fractures of the cases are
oh-scrved to be in the sacrailiac joint, ilium and
ac-etabulum which are weight bearing scgments of
rare Jimbs. In two cases ischii fractures is
formed in eaudal acctabular region.
The literature findings report that surgical
reduction may he dirticult to achieve in young
animals and large hreeds of dogs having
sig-nificant displacement fractures due to the
spas-tic muscle contraetions eaused by long periods
of waiting, especially beeause of the strong
muscle stnıeture of this part. Therefore, pelvie
fractures need to be surgieally treated in 3-5
days following the trauma (1,3,7,10,15). In this
study, the eases were operated after 2-3 days of
the pre-treatmenl. One of the animals (ease
no:6) had missed the operation date and had a
lameness problem and was asked to be brought
in on the 7 th day for the operation. The
re-duction was aehieved following the operation.
And the reduction was achieved at the desired
leveJ all cases.
Different fixation techniques are used for
the pelvic hane fractures in different sections.
Thcse are plates, screws and pins for sacroiliac
Juxaıions (5,6,8,12,14), plates for ilium
frae-tures (4,6,7,8,15), pins and cerclage some ilium
fractures (4,
ı
5, i6) and plate implcmentationsfor aedabular fractures (2,6,8, i3, i5).
This study aimecl at implementing mini
Lİ-tanium plates and screws in pelvic fractures to
report the results.
According to the results mıllı tİtanium
plates ancl serews are recommended as fixalİon
materials for the surgieal treatment of pelvic
fracturcs in eats and sınall breed dogs because
these ınaterials are smail in size, easy to shape
ancluse in the operations.
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Sac-miliac FraC1ure-Dis!ocuıilııl iıı i/lt:' Dog uııd Ciii
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Yazışma Adresi:
Araş. Crir Dr. Omil KA YA
Allkam Üııiversilesi Veleriııer Fakıi!les; Ortopedi ve Travma/o!o/İ Bi!i Du!ı.
