Long term outcome and quality of life in cats and dogs suffering from pelvic fractures

Sammanfattning: Pelvic fractures are a common injury in cats and dogs, mostly due to hit by car or falling from heights. There are several components that determine what treatment is the best in each case. Literature and leading surgeons suggest fractures of the weight bearing axis (iliosacral joint (SI joint), ilium body and acetabulum) should be treated surgically, but there are few studies comparing surgical and conservative treatment. Fractures of the pelvic floor (os pubis, pelvic symphysis and os ischium) and fractures of the ilium wing are rarely treated surgically. This study aims to describe what fractures were the most common, what treatment was chosen and to evaluate long term prognosis and quality of life in dogs and cats after suffering from a pelvic fracture. The study consists of review of patient records, owner-based questionnaires and a clinical part with long term follow up of clinical outcome. A total of 196 cats and dogs suffering from pelvic fractures during the years 2007 to 2017 were treated at the University animal hospital of the Swedish University of Agricultural Sciences. Questionnaires used were the Feline Musculoskeletal and Pain Index (FMPI) and the ACVS Canine Orthopedic Index (COI), the result of each questionnaire was calculated into a percentage that was comparable between the questionnaires. Twenty-one cat owners and 16 dog owners answered the questionnaire. Thirteen cats and 11 dogs participated in the clinical study and were subjected to a thorough orthopedic and neurological examination. Review of patient records showed that the most common fractures in cats were fractures of the SI joint and amongst dogs the most common fractures were fractures of the pelvic floor. Multiple fractures occurred more often than fractures in one or two sites in both cats and dogs. Treatment of pelvic fractures differed between cats and dogs, cats were euthanized to a greater extent than dogs due to their pelvic fracture. Dogs were more commonly treated surgically compared to cats. In cats 46,4% were treated conservatively, 9,3% were treated surgically and 44,4% were euthanized. In dogs 41,3% were treated conservatively, 39,1% were treated surgically and 19,6% were euthanized. The questionnaire showed with statistical significance, and 95% certainty, that cats recover better and have a better quality of life than dogs after suffering from a pelvic fracture. 57,1% of the cats recovered completely and 6,9% of the dogs recovered completely, according to the questionnaires. The clinical examination showed that the most common complication to pelvic fracture was decreased range of motion in the hip joint. Lameness in one or both of the hind limbs occurred in 25% of the cats and dogs. None of those who had neurological deficits reported on initial clinical presentation had remaining neurological deficits at follow up examination, although, 16,7% of the dogs had neurological deficits at follow up examination. Unfortunately, the population was too small and heterogenous to make comparison and draw conclusions about whether surgical or conservative treatment is the ultimate treatment for the different types of pelvic fractures. Further studies are needed in the subject of treatment and long-term prognosis of pelvic fractures.