DOI: https://doi.org/10.52973/rcfcv-e32161
Received: 25/05/2022 Accepted: 23/06/2022 Published: 01/08/2022
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Revista Cientíca, FCV-LUZ / Vol. XXXII, rcfcv-e32161, 1 - 8
ABSTRACT
Sacroiliac luxations constitute an important part of hip fractures.
In the treatment phase, a choice should be made between surgical
and conservative treatment. Which treatment option will yield more
effective results depends on many variable factors. In the present
study, some of these factors were mentioned and their effects on
treatment and outcomes were evaluated. A total of 61 cats, 26 female
and 35 male, of various breeds and ages, were included in the study.
The mean age of the cats included in the study was 16 months. The
mean weight of the cats was 2.87 kg. Cases were categorized as
ages, ≤6, 7-12, and ≥13 months of age. In addition, the success criteria
of etiological causes, luxation type, and concomitant traumas on
decision and outcomes were evaluated. Conservative treatment
was preferred more in all age groups and success rates were higher
than those of surgery. Conservative treatment was preferred in
both genders, and the recovery rate was higher in males than that
in females. Regardless of the cause of the trauma, more conservative
treatment was preferred, and the rate of good recovery was higher
in high-rise falls. Even if there was traumatic injury in addition to
sacroiliac luxation, conservative treatment was preferred and the rate
of good recovery was higher in cases without concomitant traumatic
injury. As a result; age, gender, luxation type and concomitant
traumatic injury were not statistically signicant on treatment choice.
However, good recovery was statistically signicant in cases without
concomitant traumatic injury.
Key words: Cat; sacroiliac luxation; surgical treatment; conservative
treatment
RESUMEN
Las luxaciones sacroilíacas constituyen una parte importante de las
fracturas de cadera. En la fase de tratamiento, se debe elegir entre
tratamiento quirúrgico y conservador. La opción de tratamiento que
producirá resultados más efectivos depende de muchos factores
variables. En el presente estudio se mencionaron algunos de estos
factores y se evaluaron sus efectos sobre el tratamiento y los
resultados. Se incluyeron en el estudio un total de 61 gatos, 26 hembras
y 35 machos, de varias razas y edades. La edad media de los gatos
incluidos en el estudio fue de 16 meses. El peso medio de los gatos
fue de 2,87 kg. Los casos se categorizaron en edades de ≤6; 7-12 y
≥13 meses de edad. Además, se evaluaron los criterios de éxito de las
causas etiológicas, el tipo de luxación y los traumas concomitantes
en la decisión y los resultados. El tratamiento conservador se prerió
más en todos los grupos de edad y las tasas de éxito fueron superiores
a las de la cirugía. Se prerió el tratamiento conservador en ambos
sexos, y la tasa de recuperación fue mayor en los machos que en las
hembras. Independientemente de la causa del trauma, se prerió
un tratamiento más conservador y la tasa de buena recuperación
fue mayor en las caídas desde gran altura. Incluso si existía lesión
traumática además de la luxación sacroilíaca, se prerió el tratamiento
conservador y la tasa de buena recuperación fue mayor en los casos
sin lesión traumática concomitante. Como resultado a la edad, el sexo,
el tipo de luxación y la lesión traumática concomitante, no fueron
estadísticamente signicativos en la elección del tratamiento. Sin
embargo, la buena recuperación fue estadísticamente signicativa
en los casos sin lesión traumática concomitante.
Palabras clave: Gato; luxación sacroilíaca; tratamiento quirúrgico;
tratamiento conservador
Sacroiliac luxations in cats: Surgery or conservative treatment?
Luxación sacroilíaca en gatos: cirugía o tratamiento conservador?
Ziya Yurtal
1
* , Muhammed Enes Altuğ
1
, Cafer Tayer İşler
1
, Mehmet Zeki Yılmaz Deveci
1
, İbrahim Alakuş
1
, Ömer Kırgız
1
,
Halil Alakuş
1
and Ufuk Kaya
2
1
Hatay Mustafa Kemal University, Veterinary Faculty, Department of Veterinary Surgery. Hatay, Turkey.
2
Hatay Mustafa Kemal University, Veterinary Faculty, Department of Biostatistics. Hatay, Turkey.
*Email: ziyayurtal@gmail.com
Sacroiliac luxations in cats / Yurtal et al. _________________________________________________________________________________________
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INTRODUCTION
Hip consists of ilium, ischii, pubis, sacrum and rst coccygeal
vertebras [26]. The medial surface of the ilium articulates with the
sacrum and forms the sacroiliac joint, which is one of the weight-
bearing structures of the pelvis [8]. Sacroiliac joint injuries in cats
(Felis catus) generally occur together with fractures in other bones
forming the pelvis and hind extremity fractures [4, 8]. Although pelvic
fractures are common in cats, they account for approximately 32%
of all bone fractures. 59-93% of pelvic fractures in cats are sacroiliac
luxation (SIL) and 27-46% of them are bilateral [3, 18, 26]. From an
etiological point of view, hip fractures occur mostly due to high-rise
falls, trac accidents, gunshot wounds, bite-related injuries and
tumoral formations [1, 14, 25]. The standard diagnostic method for
evaluating cases with suspected trauma is radiographic examination.
X-ray images are taken in laterolateral, ventrodorsal and oblique
positions. Since the hip is similar to a box in structure, it is highly
likely that more than one bone will be affected in case of a trauma
[1, 14, 26]. Treatment options are conservative treatment (CT) or
surgical treatment (ST) [8, 24]. At the decision stage, the patient
should be evaluated clinically and radiographically, and the selection
of these cases is very important [8, 18]. While CT is recommended
in SIL where there is no or minimal displacement, no neurological
damage, no narrowing of the pelvic canal, and minimal pain [2, 16,
18]. ST can be recommended for displaced luxations that narrow the
pelvic canal [8]. Various methods such as lag screw, tension band,
transiliac pin/screw and transiliosacral pin stabilization are used as
surgical methods [18]. CT consists of cage rest for 2-4 weeks (wk),
analgesia, and monitoring of urination and defecation. Complications
that may be encountered in CT are narrowing of the pelvic canal as a
result of displacement of pelvic fragments and prolongation of the
recovery period [3].
The current study, investigated the effects of the treatment option
on the outcome regardless of the surgical technique used in cats
diagnosed with SIL, and also evaluated the effects of age, gender,
etiology, luxation type and concomitant traumatic injury on the
outcome. Thus, it was revealed whether variable factors contribute
to the decision-making process for ST and CT in SIL.
MATERIALS AND METHODS
The study was carried out at Hatay Mustafa Kemal University
Veterinary, Health, Practice and Research Hospital. A total of 61 cats
of various breeds and different age groups, 26 female and 35 male,
were included in the study. The mean weight of the cases was 2.87
kilograms (kg). The cases were categorized according to their ages
as ≥6, 7-12, and ≥13 months. While the cases were etiologically were
classied as high-rise falls, motor vehicle accidents and unknown
causes, they were categorized as as unilateral and bilateral in
terms of luxation type. Concomitant traumatic injuries are listed in
TABLE I, but the cases were categorized as present or absent in the
statistical evaluation. Treatment options were determined as ST and
CT regardless of the surgical technique applied. In the evaluation
of the outcome, it was used a modied version of classication by
Ergin et al. and classifed cases as good, moderate and poor [8].
The patients were followed-up for 4-6 wk, taking into account the
fracture healing process [3,20]. The cats with the complaint of hind
limb lameness or inability to use their hind limbs were examined
clinically and radiographically. Cats diagnosed with SIL as a result of
radiographic examination (Intermedical, Basic 100-30®, Italy) were
included in the study. While forming the hypothesis, it was emphasized
whether ST and CT should be preferred primarily in cases with SIL
included in the study. In addition, the effects of variable factors such
as age, gender, etiology, concomitant traumatic injury and luxation
type on the outcome were evaluated (TABLE I).
Statistical analysis
All statistical analyzes and Figures were performed using Stata 12/
MP4 and GraphPad Prism 7. Descriptive statistics were presented as
“Frequency (Percentage)”. Chi-square test was performed to determine
the relationship between SIL healing status, age, gender, etiology,
luxation type, concomitant traumatic injury and treatment variables.
In addition, the relationships between the treatment status of the cats,
age, gender, etiology, luxation type and concomitant traumatic injury
variables were also evaluated by chi-square analysis. Relationships
between treatment status and other variables were presented
graphically. P<0.05 was considered as signicant in all analyses.
TABLE I
Data about cats with sacroiliac luxation
Case Gender
Age|
Weight
Etiology
Luxation
type (B/U)
Concomitant traumatic injury Treatment Outcome
1 F 6.0 m|2.1 kg High-rise fall B Acetabulum fracture Surgery Good
2 M 5.0 m|2.2 kg MVA* B Acetabulum fracture Conservative Good
3 M 30.0 m|3.7 kg MVA* B None Conservative Good
4 M 24.0 m|4.1 kg Unknown U İlium + multiple femur fracture Surgery Moderate
5 M 9 m|3.5 kg Unknown B İschii + acetabulum + pubic fracture Surgery Moderate
6 M 42 m|4.3 kg High-rise fall B None Surgery Good
7 M 8 m|3.0 kg High-rise fall U None Conservative Good
8 M 8.0 m|2.9 kg High-rise fall U None Conservative Good
9 M 6.0 m|2.4 kg Unknown B Ilium + acetabulum fracture Surgery Moderate
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10 F 12.0 m|5.2 kg Unknown U Acetabulum fracture + hernia diaphragmatica Conservative Good
11 M 12.0 m|3.6 kg MVA* U Acetabulum + collum femoris + ilium fracture Surgery Poor
12 F 12.0 m|3.7 kg Unknown U Ilium fracture Surgery Good
13 F 1.5 m|0.5 kg Unknown B Acetabulum fracture Conservative Good
14 F 2.0 m|0.7 kg MVA* U Acetabulum + Monoplegia Conservative Poor
15 F 4.0 m|1.3 kg MVA* U Ilium + supracondylar femur fracture Conservative Moderate
16 F 11.0 m|2.9 kg Unknown U Ischii + pubic fracture Conservative Good
17 M 24.0 m|6.0 kg MVA* B Acetabulum fracture Conservative Good
18 F 1.5 m|0.4 kg MVA* B Hernia diaphragmatica Conservative Good
19 F 12.0 m|3.9 kg High-rise fall B None Conservative Good
20 M 7.0 m|2.0 kg High-rise fall U Collum femoris fracture Surgery Good
21 F 36.0 m|4.5 kg MVA* B None Surgery Good
22 M 36.0 m|3.8 kg High-rise fall U None Conservative Good
23 M 12.0 m|3 4 kg High-rise fall U None Conservative Good
24 M 12.0 m|3.0 kg Unknown U Femur fracture Conservative Good
25 M 12.0 m|2.7 kg Unknown B İschii fracture Conservative Moderate
26 F 180.0 m|4.6 kg Unknown U None Conservative Good
27 F 3.0 m|0.9 kg High-rise fall U
Ilium fracture + collum femoris fracture
+ monoparesis
Conservative Poor
28 F 60.0 m|5.7 kg High-rise fall U Humerus + pubic fracture Conservative Moderate
29 M 4.0 m|1.1 kg High-rise fall U Bilateral tibia + ischii fracture Conservative Moderate
30 F 9.0 m|2.0 kg MVA* B
Caudal vertebral fracture + symphysis pubis fracture
+ paraplegia
Surgery Poor
31 F 7.0 m|1.4 kg MVA* U Bilateral ischii fracture Conservative Good
32 F 7.0 m|1.6 kg High-rise fall U Ilium + bula + bilateral tibia + ischii fracture Surgery Moderate
33 M 12.0 m|2.8 kg MVA* B None Conservative Good
34 F 24.0 m|3.7 kg High-rise fall U Ilium + tibia fracture Conservative Good
35 F 12.0 m|3.9 kg Unknown B Acetabulum fracture Surgery Good
36 F 4.0 m|1.3 kg Unknown U Acetabulum fracture + inguinal hernia Conservative Moderate
37 F 8.0 m|2.1 kg MVA* B T10-11 level bullet core Conservative Poor
38 F 6.0 m|1.8 kg MVA* B None Conservative Moderate
39 M 12.0 m|4.7 kg MVA* U Ilium fracture Conservative Good
40 M 12.0 m|3.2 kg MVA* B Ilium + femur fracture Conservative Moderate
41 M 12.0 m|3.0 kg Unknown U None Conservative Good
42 M 6.0 m|2.3 kg MVA* U None Conservative Good
43 M 10.0 m|3.0 kg MVA* U Femur + collum femoris + acetabulum fracture Surgery Good
44 M 10.0 m|4.2 kg High-rise fall U None Conservative Good
TABLE I (cont...)
Data about cats with sacroiliac luxation
Case Gender
Age|
Weight
Etiology
Luxation
type (B/U)
Concomitant traumatic injury Treatment Outcome
Sacroiliac luxations in cats / Yurtal et al. _________________________________________________________________________________________
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45 M 24.0 m|3.0 kg Unknown B Ischii fracture Conservative Good
46 M 1.0 m|0.3 kg High-rise fall B Acetabulum fracture Conservative Good
47 M 3.0 m|0.6 kg High-rise fall U Pubic fracture Conservative Good
48 M 12.0 m|3.5 kg Unknown U None Conservative Good
49 M 36.0 m|3.2 kg High-rise fall U Sacrum + neurological damage Conservative Poor
50 M 24.0 m|6.1 kg High-rise fall U Bilateral tibial fracture Surgery Good
51 M 4.0 m|1.1 kg MVA* U None Conservative Good
52 M 48.0 m|4.3 kg MVA* B None Surgery Good
53 M 5.0 m|1.9 kg MVA* B Ilium + acetabulum fracture Surgery Moderate
54 F 3.0 m|1.0 kg MVA* B Acetabulum fracture Conservative Good
55 F 11.0 m|4.3 kg MVA* U None Conservative Good
56 F 9.0 m|2.8 kg High-rise fall U Ilium fracture Surgery Good
57 F 12.0 m|3.9 kg Unknown U Pubic fracture Surgery Good
58 M 12.0 m|2.9 kg Unknown U Femur fracture Surgery Good
59 F 6.0 m|2.1 kg High-rise fall U Ilium fracture Surgery Good
60 M 12.0 m|2.2 kg High-rise fall U Ilium fracture + neurological damage Conservative Poor
61 M 12.0 m|2.7 kg High-rise fall B Sacrum fracture Conservative Good
F: Female, M: Male, m: Months, kg: Kilograms, B: Bilateral, U: Unilateral, *: Motor vehicle accident
TABLE I (cont...)
Data about cats with sacroiliac luxation
Case Gender
Age|
Weight
Etiology
Luxation
type (B/U)
Concomitant traumatic injury Treatment Outcome
RESULTS AND DISCUSSION
A total of 61 cats, 26 females and 35 males, of various ages and
breeds were included in the study. In general, the cases brought to
the hospital reported anamnesis of high-rise fall and trac accident.
In some cases, the cause of the lameness or inability to use his feet
was unknown.
ST was applied to 34.6% (9 cases) of female cats with SIL, and
conservative treatment was applied to 65.4% (17 cases). For the
female cats, who underwent ST, the results were good in 77.8% (7
cases) of female cats, moderate in 11.1% (1 case), and poor in 11.1%
(1 case). Of the female cats treated conservatively, 58.8% (10 cases)
had good results, 23.5% had moderate results, and 17.7% (3 cases)
had poor results. ST was applied to 31.4% (11 cases) of male cats with
SIL, and CT was applied to 68.6% (24 cases) (FIG. 1). Of the surgically
treated male cats, 54.5% (6 cases) had good results, 36.4% had
moderate results, and 9.1% (1 case) had poor results. Results were
good in 79.2% (19 cases) of male cats treated conservatively, moderate
in 12.5% (3 cases), and poor in 8.3% (2 cases). When these data were
evaluated, ST was found to be more successful in female cats, while
the success rate of CT was found to be higher in male cats.
There was no signicant difference in terms of species among
the cats included in the study, and the mean age was 16.04 months
(1-180 months). Cats were divided into three categories as 6, 7-12
and ≥ 13 months old. ST was applied in 22.2% (4 cases) and CT was
applied in 77.8% (14 cases) of cats under 6 months of age with SIL.
Good results were obtained in 50% (2 cases) and moderate results in
50% (2 cases) of cats under 6 months of age who underwent ST. The
results were good in 57.1% (8 cases), moderate in 28.6% (4 cases), and
poor in 14.3% (2 cases) of cats under 6 months of age treated with
CT. According to these results, the success of CT seems to be higher
in cats younger than 6 months with SIL. ST was applied to 36.6% (11
cases) of cats with SIL between 7-12 months, and CT was applied
to 63.4% (19 cases). Good results were obtained in 63.6% (7 cases)
of cats aged 7-12 months who underwent ST, moderate in 18.2% (2
cases), and poor in 18.2% (2 cases). Good results were obtained in
79% of cats aged 7-12 months who received CT, moderate in 10.5%
(2 cases), and poor in 10.5% (2 cases). In this case, it can be said that
the success of CT is higher in cases with SIL between 7-12 months.
ST was applied in 38.5% (5 cases) of cats older than 13 months of
age with SIL, and CT was applied in 61.5% (8 cases). Good results
were obtained in 80% (4 cases) and moderate results in 20% (1 case)
of cats older than 13 months who underwent ST. Good results were
obtained in 75% (6 cases) of cats older than 13 months of age who
received CT, moderate results in 12.5% (1 case), and poor results in
12.5% (1 case). According to these data, the success of ST seems to
be higher in cats older than 13 months of age with SIL.
FIGURE 1. Graphical representation of the relationships between dierent parameters and treatment
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Of the SIL in cats, 36.1% (22 cases) were caused by falling from a
height, 36.1% (22 cases) were caused by motor vehicle accidents, and
27.8% (17 cases) were due to an unknown reason. ST was applied to
31.9% (7 cases) of cases with SIL as a result of falling from a height,
and CT was applied to 68.1% (15 cases). Good results were obtained
in 85.7% (6 cases) of cases that fell from a height and underwent ST,
and moderate results were obtained in 14.3% (1 case). Good results
were obtained in 66.7% (10 cases) of the cases that fell from a height
and were treated with CT, moderate in 13.3% (2 cases), and poor in
20% (3 cases). In this case, the success of ST seems to be higher
in SIL caused by falling from a height. ST was applied to 27.3% (6
cases) of the cases with SIL as a result of a motor vehicle accident,
and CT was applied to 72.7% (16 cases). Good results were obtained
in 50% (3 cases) of the cases who had a motor vehicle accident and
underwent ST, moderate in 16.6% (1 case), and poor in 33.3% (2 cases).
Good results were obtained in 68.8% (11 cases) of the cases who had
a motor vehicle accident and were treated with CT, moderate results
were obtained in 18.7% (3 cases) and poor results in 12.5% (2 cases)
of the cases.
According to these results, the success of CT seems to be higher
in SIL occuring as a result of motor vehicle accident. ST was applied
to 41.1% (7 cases) of the cases that developed SIL due to unknown
reasons, and CT was applied to 58.9% (10 cases). Good results were
obtained in 57.1% (4 cases) and moderate results in 42.9% (3 cases) of
the patients who underwent ST in SIL that occured due to unknown
reasons. In SIL of unknown cause, good results were obtained in
80% (8 cases) and moderate results in 20% (2 cases) of the cases
that were treated by CT (TABLE I).
Unilateral SIL occurred in 37 and bilateral SIL in 24 of the cases
exposed to trauma. It was decided to operate on 37.5% (9 cases) of
cases with bilateral SIL, and performed CT in 62.5% (15 cases). Good
results were obtained in 55.5% (5 cases) of cases treated by ST in
bilateral SIL, moderate in 33.3% (3 cases), and poor in 11.2% (1 case).
In bilateral SIL, good results were obtained in 73.3% (11 cases) of the
cases treated by CT, moderate in 20% (3 cases), and poor in 6.7%
(1 case). ST was decided in 29.8% (11 cases) and CT was decided in
70.2% (26 cases) of unilateral SIL cases. In unilateral SIL, results were
good in 72.7% (8 cases), moderate in 18.2% (2 cases), and poor in 9.1%
(1 case) of cases treated by ST. In unilateral SIL, good results were
obtained in 69.2% (18 cases) of the cases treated by CT, moderate in
15.4% (4 cases), and poor in 15.4% (4 cases). When the results of ST
cases in unilateral and bilateral SIL are compared, success seems
to be higher in unilateral SIL. On the other hand, when it is compared
with the results of cases treated by CT in unilateral and bilateral SIL,
the effects on the outcome were similar (TABLE I).
While there was at least one concomitant traumatic injury
(TI) in 70.4% (43 cases) of a total of 61 cases with SIL, there was
no accompanying TI in 29.6% (18 cases). There was a signicant
correlation between the TI accompanying SIL and the outcome
(P<0.05, TABLE II). ST was applied to 39.5% (17 cases) of cases with
TI accompanying SIL, and CT was applied to 60.5% (26 cases). Good
results were obtained in 58.8% (10 cases) of cases with concomitant