https://doi.org/10.52973/rcfcv-e34421
Received: 22/03/2024 Accepted: 12/06/2024 Published: 04/09/2024
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Revista Científica, FCV-LUZ / Vol. XXXIV, rcfcv-e34421
ABSTRACT
This study aimed to share clinical experiences on fracture type,
treatment options and long–term results of treatment in cats with
distal humerus fractures. Within the scope of the study, 11 cats with
distal humerus fractures were evaluated. 4 of them were treated with
cross pin and 7 of them were treated with plate osteosynthesis. Plate
application in the postoperative period gave more successful results.
In cases where there is no improvement, elbow joint arthrodesis is
recommended before amputation. Distal humerus fractures can be
challenging and a perfect technique for this area is not yet possible,
but satisfactory results can be achieved despite everything.
Key words: Arthrodesis; cats; cross pin; distal humerus fractures;
plate application
RESUMEN
Este estudio tuvo como objetivo compartir experiencias clínicas
sobre el tipo de fractura, las opciones de tratamiento y los resultados
a largo plazo del tratamiento en gatos con fracturas de húmero distal.
Dentro del alcance del estudio, se evaluaron 11 gatos con fracturas
de húmero distal. 4 de ellos fueron tratados con pasador cruzado y
7 de ellos con osteosíntesis con placa. La aplicación de placas en el
postoperatorio dio resultados más exitosos. En los casos en los que
no hay mejoría, se recomienda la artrodesis de la articulación del codo
antes de la amputación. Las fracturas del húmero distal pueden ser
un desafío y aún no es posible una técnica perfecta para esta área,
pero a pesar de todo se pueden lograr resultados satisfactorios.
Palabras clave: Artrodesis; gatos; cross pin; fracturas de húmero
distal; aplicación de placas
Treatment options and prognosis for distal humerus fractures in cats
Opciones de tratamiento y pronóstico para las fracturas de húmero distal en gatos
Berna Ersöz–Kanay* , Sadık Yayla , Emine Çatalkaya , Nahit Saylak , Rojda Canli
Dicle University, Faculty of Veterinary Medicine, Department of Surgery. Diyarbakır, Türkiye.
*Corresponding Author: bersoz@dicle.edu.tr
FIGURE 1. Unilateral and bilateral examples from cases where fracture xation
was achieved with plates
Prognosis for distal humerus fractures in cats / Ersöz-Kanay et al. _________________________________________________________________
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INTRODUCTION
Feline humeral fractures have a special place in small animal
practice. The humerus accounts for approximately 4–9% of fractures
in cats (Felis catus) [1]. The majority of these fractures (75–87%) are in
the diaphysis. Condylar fractures of the humerus are much rarer than
in dogs, and this is attributed to the fact that the anatomical structure
of cats is different from dogs. This difference is due to the fact that in
cats the humeral shaft is relatively straighter, the humeral condyles
are wider and atter, and the supratrochlear foramen is absent,
whereas in dogs there is a predisposition to structural weakness in
the condylar region [1, 2, 3, 4].
Although there are not enough studies on the results of different
treatment options for distal humerus fractures in cats as in dogs,
in studies comparing cats and dogs, it has been reported that the
overall complication rates with the use of plates, screws and external
skeletal xation (ESF) are signicantly higher in cats [1, 2, 3, 5, 6, 7].
Thoracic trauma is a condition that should not be neglected in front
extremity fractures. Therefore, in these patients, the examination should
rst begin with airways–respiration–circulation (ABC) evaluation [8, 9].
This study aimed to share clinical experiences on fracture type,
treatment options and long–term results of treatment in cats with
distal humerus fractures.
MATERIAL AND METHODS
Patient selection criteria
Among the cats diagnosed with humerus fractures at Dicle
University Veterinary Faculty Animal Hospital between June 2023
and March 2024, those with distal humerus fractures were included.
For each case included in the study, gender, age, weight, etiology,
treatment method used, postoperative management and subsequent
examination ndings were recorded on the patient registration forms.
Complications were categorized as minor (not requiring treatment
or surgery to correct), major (requiring surgery to resolve), and
catastrophic (permanent arthrodesis and amputation).
Airways–respiration–circulation (ABC) was evaluated in the
cats included in the study during general examination and trauma
management. Oxygen support was provided with a mask to those who
needed oxygen. Each case was monitored and pulse rate, respiratory
rate, SpO
2
, systolic, diastolic, mean arterial blood pressures and body
temperature were measured.
Detailed clinical examination, radiological examination and clinical
laboratory tests were performed on all animals included in the study.
Complete blood count, serum biochemical analysis, blood lactate
concentration and coagulation proles were determined. Measurements
were made using ready–made commercial kits on Mindray
®
BC–28000
Vet hemogram and Fujilm NX500 biochemistry devices.
In terms of thoracic trauma, conditions such as the presence of
effusion, pneumothorax, diaphragmatic hernia, rib fractures, and
wounds on the thorax wall were examined. Oxygen support was
continued for cats showing abdominal breathing. In those with
effusion and pneumothorax, thoracocentesis was performed and
they were subjected to medical treatment before the operation.
Medical treatment: tranexamic acid (10 mg·kg
-1
, Transamin® 5%
ampoule, Teva, IV), methylprednisolone (20 mg·kg
-1
, Prednol L® 20
mg, IM, Mustafa Nevzat), furasamide (2.5 mg·kg
-1
,IM, Diuril® Vetaş),
bronchodilator, amoxicillin+clavulanic acid (Synulox®, Zoetis, Turkey,
8.75 mg·kg
-1
subcutaneously) and enrooxacin (Baytril–K® 5%, Bayer,
Turkey, 5mg·kg
-1
, subcutaneously) aurocel bronchodilators (Ventolin™
2.5 mg) Treatments that varied depending on the animal’s condition,
such as nebul (GlaxoSmithKline) were applied.
Considering the thoracic trauma, mannitol was preferred as uid
therapy and care was taken to ensure that IV uid administration did
not exceed 10 mg·kg
-1
·h
-1
.
According to clinical examination, TFAST, radiographs and
clinical laboratory results, humeral osteosynthesis was decided for
suitable cases.
Surgical procedure
All surgeries were performed by the same team and with the same
set used routinely. After xylazine (1 mg·kg
-1
IV) and ketamine (10 mg·kg
-1
IV) were given for induction, endotracheal intubation was achieved
(with tube number 3–3.5) and then anesthesia was maintained with
sevourane (Sevorane, Abbot, İstanbul, Türkiye) at 100% O
2
. Following
routine operation preparations, the cat was positioned appropriately
and a craniolateral, lateral or craniomedial approach was applied,
depending on the location of the fracture. Open reduction was used
for plate xation to the lateral or craniolateral aspect of the humerus.
Fixation was achieved with a veterinary plate (2.0 mm; Orthocat,
Istanbul Turkey), locking plate (FIG. 1) or cross pin (FIG. 2). In cases
where pin was applied, the bandage was kept for 3 weeks.
FIGURE 2. Example of cross pin application cases
FIGURE 3. A case of having to be amputated
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Postoperative management
They were kept in the intensive care unit immediately after the
operation and reanimation was provided there. After the necessary
follow–ups, those in good condition were discharged. Cat owners were
advised to limit their cats’ movements in a narrow area for at least 4
weeks. Fracture healing was based on radiographs. In the radiographic
evaluation of fracture healing, the integrity of the cortex, the presence
of callus, and the absence of gap between the fragments were
taken into consideration. Clinical follow–up was provided by control
examinations. During this process, arthrodesis was recommended
for those with major complications, while amputation was performed
for those with catastrophic complications.
RESULTS AND DISCUSSION
In this study, 11 cats were evaluated within the scope of the study.
5 of them were Tekir, 3 were British short hair, 2 were mestizo and 1
was a Van cat. All of the cats were old enough to be considered adults
and their age ranged from 1 to 4 years (mean 2.34 years). Their weight
was between 1 kg and 5 kg (average 3.45). While 7 of the cats were
female, 4 were male. It was understood that the cause of fracture in
all cases was trauma due to falling from a height, and no open fracture
was found in any of the cases.
Diaphyseal humerus fractures are common types of fractures in
cats. While this rate is 71%, it has been reported to be 27% in dogs.
Condylar fractures are much less common. While these fractures
account for only 10% of total fractures in cats, they are 40% in dogs
[1, 2, 3, 5]. Findings from many different studies suggest that there
is no advantage to choosing a particular xation system for humeral
fractures, so the surgeon’s optimal choice for the fracture will be based
on his or her own preference and experience [1, 6, 7]. Additionally, in
small animal orthopedics, cats and dogs are often considered together.
However, cats may sometimes have different anatomy, such as the
distal humerus, and this should not be ignored. Beacause, this is not
always possible due to anatomical differences, especially in the distal
humerus. For this reason, it is necessary to make a decision by taking
into account both the location and type of the fracture and the anatomy
of the region. In cats, treatment of comminuted fractures of the distal
humerus or Salter Harris type I, type II and III fractures is more dicult.
Therefore, this study aimed to share clinical experiences regarding
fracture type, treatment options, and long–term results of treatment
in cats with distal humerus fractures.
As with other fractures, treatment options may vary depending
on the direction of the fracture line, whether there is damage to the
surrounding soft tissues, or the time that has passed since the fracture.
In addition, humeral fractures are also important in terms of thoracic
trauma. Distal humerus fractures are more dicult to repair than other
fractures of the humerus [1, 3, 6, 10]. Since this study was a clinical
study and distal humerus fractures were rare, the cases comprising
the study were evaluated together in terms of distal humerus fractures.
There were no open fractures among our cases, but soft tissue damage
varied between cases. The time since the fracture differed between
cases because not all animals could be operated on immediately due
to thoracic trauma. While medical treatment and thoracocentesis and
other interventions in thorax trauma management were applied, the
animal was waited for the general condition to stabilize. These details
were ignored within the scope of the study.
Stabilization with external xation, intramedullary nailing techniques
or plate osteosynthesis techniques are used in humerus fractures (11,
12, 13). Additionally, the humerus bone may be suitable for combined
techniques such as “tie–in”. However, the situation is more serious in the
distal humerus. Because both the fracture line and the techniques to
be used are limited [14, 15, 16, 17, 18]. In this study, cross pin application
was performed in 4 cats, but the results were not good, 3 of them were
amputated and elbow joint arthrodesis was performed in 1 of them.
But later, a decision was made to amputate (FIG. 3) this animal as well.
After the arthrodesis procedure, a much longer period of
immobilization is required compared to fracture repair. For this
reason, a procedure such as a plaster bandage is not very desirable
due to the complications associated with the bandage. There is
no anatomically suitable material to lock the elbow joint. However,
pantarsal or pan carpal arthrodesis is easier using a at or V plate
[7]. In this study, arthrodesis was performed in only 2 of the cases
where plaque was applied (FIG. 4). In one of the cats that underwent
arthrodesis, the plate broke, there was no improvement in the area
after repeated surgery, and eventually amputation was performed
(TABLE I). In addition, a condition considered functionally and
aesthetically important was achieved in cases where arthrodesis was
performed on the joint using a locking plate. Patient owners initially
worry about amputation. Therefore, if the arthrodesis procedure
does not yield a successful result, amputation may be recommended.
FIGURE 4. A case in which arthrodesis was performed
TABLE I
A combination of applied techniques and complications
Complications
Minor Major
Catastrophic
Arthrodesis Amputated
Cross pin (n=4) 1 3
Plaque (n=7) 5 – 2 1*
*: It was a cat that underwent arthrodesis.
Prognosis for distal humerus fractures in cats / Ersöz-Kanay et al. _________________________________________________________________
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It may be dicult to determine the incidence of distal humerus
fractures in this study, because we are a faculty hospital and we
have mostly referred patients that general practitioners or private
clinics cannot intervene in, so it was not possible to capture other
fractures of the humerus. For this reason, selected cases of distal
humerus fracture were given.
In cases of cat forearm fractures and therefore humerus fractures,
the thorax should be evaluated for thoracic trauma. It has been
reported that effusion is observed at a rate of 60% or more in a cat
with a forearm fracture. This gure is quite large and vital. For this
reason, additional practices for rst aid and thorax emergency should
not be neglected (17, 19, 20, 21, 22). In all cases within the scope of
this study,) was evaluated rst. Oxygenation was supported and the
primary goal was to keep the animal alive. Surgeries were performed
after the clinical condition was stabilized.
CONCLUSION
Humerus fractures are known to be less common in cats than in
dogs, but distal humerus fractures are more common in cats and
fracture stabilization is more dicult due to the anatomical structure.
Experience from this study shows that attention should be paid to
thorax trauma management in humerus fractures. Secondly, we
recommend locking plate osteosynthesis for fracture stabilization.
However, if recovery is not possible, arthrodesis should be tried and
if the condition is still bad, amputation may be required.
Availability of data and materials
The data that support the ndings of this study are available on
request from the corresponding author (BEK).
Conict interests statement
The authors declare that they have no conicting interests.
Financial Support
This study was supported by Dicle University Scientic Research
Projects (DUBAP) Coordination Oce (Project no: Veterinary 24.015).
Ethical approval
All methods and procedures used in this study comply with the
guidelines of the Turkiye and EU directive (Directive 2010/63/EU) on
the protection of animals used for scientic purposes. This study did
not require approval from the authorities or the ethics committee
of the institution. However, the patients’ owners were informed and
their permission to use the date was obtained.
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