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Fractures of the Pelvis 365

TREATMENT • If a splint, cast, or external fixator is the • Recheck radiographs after surgery and then
primary method of fixation, it can be every 4-6 weeks until union has occurred.
Treatment Overview
VetBooks.ir Choice of external coaptation versus internal weeks in younger animals, longer in older PROGNOSIS & OUTCOME Diseases and Disorders
removed after clinical union (average 6-8
animals).
fixation depends on the fracture type and
patient size and activity. However, reported
regardless of the number of bones fractured
may be removed in 3-4 weeks.
outcomes for surgery and external coaptation • Splints used to supplement internal fixation • Good for most MC and MT fractures,
are similar, regardless of the number of bones • Bone plates and intramedullary pins penetrat- or the treatment modality selected
fractured. ing the proximal or distal cortex should be • Guarded for fractures with varus or valgus
removed after healing. Bone screws, wires, instability or severe articular damage
Acute General Treatment and toggled intramedullary pins usually can
• A fitted cast or molded palmer splint provides be left in place. PEARLS & CONSIDERATIONS
more support than a preformed splint,
especially if multiple bones are fractured. Possible Complications Comments
• Surgical repair affords greater fracture stability • Unstable or highly comminuted fractures Splints and bandages require thorough client
but risks disrupting the local blood supply. A are at risk for delayed union, malunion, and education and diligent monitoring to prevent
minimally invasive approach is recommended synostoses. iatrogenic skin injury.
whenever possible. Indications include • Nonunions are uncommon but may result
○ Proximal or distal fractures with joint from inadequate stabilization, infection, or Technician Tips
instability or articular involvement, inadequate blood supply. Follow-up radiographs should replicate the
using lag screws or tension-band wire or • Intraarticular fractures or incorrect pin initial post-reduction positioning and technique
intramedullary/external skeletal fixator placement can damage the articular cartilage to best monitor fracture healing.
constructs and interfere with joint motion, resulting
○ Shaft fractures involving the central in degenerative joint disease and chronic SUGGESTED READING
weight-bearing bones, using small plates, lameness. DeCamp CE, et al: Fractures and other orthopedic
slot IM or dowel pins, or external fixators conditions of the carpus, metacarpus, and phalan-
○ In most cases, a molded splint or cast is Recommended Monitoring ges. In DeCamp CE, editor: Brinker, Piermattei,
applied postoperatively for added support. When external coaptation is used alone: and Flo’s Handbook of small animal orthopedics
• Regular splint checks/changes and fracture treatment, ed 5, St. Louis, 2015,
Chronic Treatment • Recheck radiographs post-reduction and then Elsevier, pp 418-425.
These fractures often heal without the abundant every 3-4 weeks until union has occurred AUTHOR: Elizabeth J. Laing, DVM, DVSc, DACVS
callus seen with other fractures. Exercise is With surgical repair: EDITOR: Kathleen Linn, DVM, MS, DACVS
restricted for several weeks after radiographic • Regular splint checks/changes until coapta-
confirmation of bony union. tion is removed.

Fractures of the Pelvis Client Education
Sheet

Clinical Presentation
BASIC INFORMATION • Normal boxlike pelvic structure accounts for
DISEASE FORMS/SUBTYPES frequency of injuries affecting two or more
Definition • Blunt force trauma: all animals sites in the pelvis.
Pelvic fractures include ilial, ischial, pubic, • Racing injury (acetabular fracture) in • Concurrent injuries are common.
and acetabular fractures; sacroiliac luxation greyhounds • Direct blows to the greater trochanter of
and sacral fractures are also often included. the femur may cause an isolated impaction
HISTORY, CHIEF COMPLAINT fracture of the adjacent acetabulum, with
Epidemiology Severe hindlimb trauma from motor vehicle displacement of the femoral head through
SPECIES, AGE, SEX accident or fall, inability to walk with one or the medial acetabular wall into the pelvic
Active, outdoor, sexually intact, roaming animals both hindlimbs, pain canal.
are most likely to be injured by motor vehicles.
Dogs lying in driveways may be inadvertently PHYSICAL EXAM FINDINGS DIAGNOSIS
run over. • Lameness in one or both pelvic limbs; pos-
sibly non-ambulatory Diagnostic Overview
RISK FACTORS • Palpable crepitus and/or pain on manipula- Diagnosis is based on history and results of
• Motor vehicle trauma and falling injuries tion of rear leg(s) physical and radiographic exams.
(e.g., high-rise apartment buildings) • Palpable deformity of the pelvic canal during
• Racing greyhounds are prone to spontaneous rectal exam Differential Diagnosis
stress acetabular fractures. • Contusion (bruising) of skin overlying site(s) • Spinal fracture/luxation and spinal cord
of injury injury
ASSOCIATED DISORDERS • Long-bone fracture in pelvic limb
Multisystemic polytrauma: concurrent ortho- Etiology and Pathophysiology • Coxofemoral luxation(s)
pedic, thoracic, urologic, and neurologic • Very common sequela to blunt force injury • Concurrent orthopedic and soft-tissue
injuries caused by vehicular trauma injuries

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