A Case Study of Pelvic and Tibiofibular Fractures in a Stray Dog

Pelvic and long bone fractures are among the most distressing injuries for both pet owners and their animals. Many fractures, however, are preventable, often resulting from owner negligence or oversight. Pelvic fractures, due to their complex anatomy and location, present unique challenges in stabilization and recovery, differing significantly from long bone fractures. This case study details the management of a complex fracture in a stray dog, involving a pelvic fracture and concurrent tibiofibular fracture.

I. Overview

Pelvic fractures frequently result from traumatic events such as road accidents or falls from significant heights. Fracture sites can vary, including fractures of the ilium, sacroiliac joint dislocation, pubic symphysis fracture, and acetabular fracture. A typical presentation involves fractures of the ilium, ischium, and pubis, collectively disrupting the normal weight-bearing mechanism from the limbs to the spine, resulting in instability and significant pain. Soft tissue injuries often accompany pelvic fractures, necessitating careful assessment of the affected animal. The possibility of concurrent urinary tract injuries, such as bladder or urethral rupture, especially when the bladder is full, must be considered. Separation or avulsion of the rectus abdominis muscle attached to the fractured bone can also lead to abdominal hernias. Without prompt treatment, organ herniation can result in ischemia and necrosis. Iliac fractures may additionally cause sensory and motor deficits in the lumbosacral plexus or damage to the sciatic nerve. Isolated ischial and pubic fractures are relatively uncommon and typically occur in conjunction with other pelvic fractures. Surgical intervention for isolated ischial and pubic fractures is primarily indicated in cases of associated hernias.

II. Diagnosis

Clinical Presentation: Pelvic fractures can occur in any breed of dog. Affected animals typically exhibit lameness in the affected limb, often accompanied by soft tissue swelling and bruising.

Clinical Examination: A thorough physical examination is crucial. Pre-surgical evaluation must assess for urethral damage, sciatic nerve function, and the integrity of the abdominal wall musculature. Careful palpation of the pelvis should be performed, noting any crepitus or instability.

Radiographic Imaging: Radiographic imaging, including orthogonal (lateral and ventrodorsal) views, is essential for evaluating the extent of pelvic damage and identifying fracture lines. Additional radiographs (urograms and cystograms) are necessary to rule out bladder and urethral rupture. In this specific case study, radiographs clearly revealed a fracture of the ilium and a displaced tibiofibular fracture in the left hindlimb.

III. Treatment

The choice between conservative and surgical treatment depends on several factors, including the severity of the fracture, the degree of displacement, the presence of associated injuries, and the owner’s financial resources.

Conservative Management: Conservative management may be considered for minimally displaced or relatively stable ilial fractures in cases where surgical intervention is financially prohibitive. However, the inherent instability of the fracture and continued weight-bearing can lead to progressive displacement, persistent pain, and further fracture complications. Conservative management might be appropriate for isolated ischial and pubic fractures with intact abdominal wall musculature. If these fractures coexist with other pelvic fractures, it’s often easier to reduce the weight-bearing bones (ilium and acetabulum) first, followed by the ischium and pubis. Conservative treatment involves strict rest and confinement for 3–4 weeks, coupled with non-steroidal anti-inflammatory drugs (NSAIDs) to manage pain and inflammation. Meticulous monitoring for complications such as decubitus ulcers is essential, requiring a clean and comfortable environment.

Surgical Management: Surgical intervention is indicated for ilial fractures with significant displacement, severe pain, or associated soft tissue hernias. Appropriate surgical repair allows for rapid return to ambulation and typically requires less stringent post-operative care. Reconstruction plates are uniquely suited for the curved anatomy of the ilial wing, providing robust fixation and maintaining the restored shape. This prevents pelvic collapse. Simple ischial and pubic fractures can be stabilized using Kirschner wires or cerclage wiring. In our case study, the ilial fracture was surgically repaired using a reconstruction plate, while the tibiofibular fracture was managed using external coaptation.

IV. Prognosis

The prognosis for isolated ischial and pubic fractures is generally excellent. The prognosis for fractures involving other pelvic elements depends on the successful reduction and stabilization of those fractures. Most uncomplicated ilial fractures result in a good functional outcome. Concurrent urinary tract injuries (bladder or urethral rupture) carry the risk of peritonitis and septic shock, significantly impacting the prognosis.

V. Conclusion

This case study highlights the complex nature of pelvic and long bone fractures in animals. Prompt diagnosis, thorough assessment, and appropriate treatment, whether conservative or surgical, are crucial for optimizing outcomes. Careful post-operative monitoring and management are vital to prevent complications and ensure successful recovery. The successful management of this stray dog’s injuries underscores the importance of providing appropriate veterinary care, even for animals without traditional owners. Further research into improved surgical techniques and post-operative management could further enhance the treatment and recovery of these challenging fractures.