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762.e2 Patellar Fracture and Dental Anomaly Syndrome in Cats

Patellar Fracture and Dental Anomaly Syndrome in Cats Client Education
Sheet
VetBooks.ir Advanced or Confirmatory Testing

BASIC INFORMATION
• Onset of lameness may precede radiographic
evidence of patellar fractures and may • No genetic screening is currently available.
Definition manifest as swelling and pain of the distal • Vitamin D, parathyroid hormone levels
Association of developmental dental abnor- quadriceps musculature. usually normal
malities, various degrees of osteosclerosis, • Other fractures suggested by pain/dysfunc- • Histopathology of maxilla or mandible may
nontraumatic patellar fractures, and other tion of the affected part disclose proliferative osteomyelitis.
pathologic fractures • Culture bone associated with osteomyelitis
Etiology and Pathophysiology of the jaw for Actinomyces sp (e.g., lumpy
Synonyms • This syndrome may be the manifestation of jaw) in addition to other pathogens
Feline knees and teeth syndrome; feline K&T an osteosclerotic disorder.
syndrome; patellar fracture and dental anomaly • It is likely a dysregulation of osteoclast/ TREATMENT
syndrome (PADS) osteoblast function.
Treatment Overview
Epidemiology Treatment goals are to minimize pain, treat
SPECIES, AGE, SEX DIAGNOSIS fractures appropriately, and aggressively manage
• Cats typically become lame at ≈2 years of Diagnostic Overview dental disease.
age. Initial presentation is often for lameness, but
• Males are more often affected than females as the teeth and other bones may be involved, Acute General Treatment
(2 : 1). the finding of a patellar fracture should prompt • Multimodal management of pain associated
survey radiography and careful examination of with patellar fractures
GENETICS, BREED PREDISPOSITION the dentition. • Conservative therapy of nontraumatic
• No breed predisposition is recognized. patellar fractures is recommended because
• Siblings can be affected. Differential Diagnosis there is a high rate of failure after surgical
• A genetic cause is suspected but has yet to • Osteogenesis/dentinogenesis imperfecta repair.
be proven. • Traumatic (patellar) fractures • When surgery is elected, circumferential
• Supernumerary teeth wiring of patellar fractures may work better
GEOGRAPHY AND SEASONALITY • Oral neoplasia than pin-tension band repair.
Reported in the Americas and Europe, this • Long-term bisphosphonate therapy • Excision of proximally retracted patellar
syndrome is likely underrecognized worldwide. fracture fragments has been performed but
Initial Database is not recommended.
Clinical Presentation • Physical and dental exam • Fractures of other bones should be treated
DISEASE FORMS/SUBTYPES • Radiographic exam as recommended for traumatic injuries.
• Nontraumatic patellar fractures (transverse, ○ Transverse patellar fractures, usually • Extractions (p. 1089) of persistent decidu-
often bilateral) accompanied by patellar sclerosis (often ous teeth or impacted adult teeth should be
• Persistent deciduous teeth also present in contralateral unfractured addressed promptly but not before 7 months
• Impacted adult teeth patella) of age.
• Secondary periodontal disease ○ Multifocal areas of sclerosis may be present
• Proliferative osteomyelitis of the jaw in other bones; fractures in other bones Chronic Treatment
• Variable osteosclerosis often typical of stress fractures • Pain relief as necessary
• Other (usually nontraumatic) fractures (in ○ Dental radiography: impacted adult teeth, • Meticulous semiannual dental care (p. 1090)
tibia, pelvis, humerus, and femur especially) periodontitis, or osteomyelitis may be • Hemimandibulectomy may be necessary if
can occur years after patellar fracture; chronic present severe osteomyelitis develops.
patellar fracture often an incidental finding
HISTORY, CHIEF COMPLAINT
• Persistent deciduous teeth should be evident
on routine exam, but clinically, most affected
cats are identified only after patellar fracture.
• Acute onset of lameness associated with
patellar (or other) fractures
• Later presentation may be associated with
progressive dental disease sequelae.
• Anorexia or hyporexia as a result of dental
disease
PHYSICAL EXAM FINDINGS
• Co-eruption of adult and deciduous teeth
needs to be distinguished from supernumer-
ary teeth.
• Missing adult dentition may suggest impacted
adult teeth.
• Secondary periodontal disease
• Proliferative osteomyelitis of the jaw can
cause palpable lumpy, painful jaw swelling. PATELLAR FRACTURES IN CATS Gross image of the left mandibular dentition.
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