My most challenging feline fracture case

Cats are frequently involved in traumas caused by traffic accident or high rise syndrome. While diaphyseal fractures of one or several long bones, which count for the majority of feline fractures, can be easily treated, Grad 3 open fractures or highly comminuted articular or juxta-articular fractures are the most challenging ones. Meticulous reconstruction of the joint surfaces and an anatomical correct and stable fixation of the fragments is mandatory.

I would like to present a comminuted, femoral neck and intertrochanteric fracture which was fixed with a 2.0 LCP plate. In order to stabilize the femoral head/neck/trochanteric fragment, the fragments were reduced and fixed with two small pointed reduction forceps, and a 1.0 mm pilot pin was inserted from lateral into the femoral neck and head. The correct placement of the pin was controlled fluoroscopically. Then the plate with a drill guide inserted into the desired plate hole was contoured to the proximal shape of the bone to allow the pin passing the drill guide. The plate was further contoured to the distal fragment. The pin was removed and the pilot hole was widened with a 1.2 mm pin, which was removed as well. The pilot hole was widened with a 1,5 mm drill bit to fit for the 2.0 mm screws. Then a long 2.0 locking screw was set through the desired plate hole and tightened. Before the screw head locked in the plate the plate was pressed against the fragments and finally the screw was locked. The greater trochanter, which was still loose, was reduced against the plate with one reduction forceps and fixed with a further locking screw through the trochanter into the femoral neck. Finally, the head/neck/trochanter/plate composition was reduced with the distal shaft fragment and reduction forceps. The correct rotational axis was controlled fluoroscopically and the distal part of the femur was fixed to the plate with non-locking 2.0mm screws. Following 10 weeks of cage rest the cat was free of lameness, gained full range of motion, and radiographically the fracture healed without complications. [...]