Pelvic, spinal and sacrococcygeal fractures and luxations

Question 1

Describe what tail pull ( sacrococcygeal luxation) injuries can result in

Answer 1

Neuro deficits- with UMN or LMN deficits
resulting in spastic or atonic bladder

Question 2

Describe inital assessment after RTA

Answer 2

ABC- airway, breathing and circulation
Radiograph or TFAST/TPOCUS chest
deterimine integrity of urinary tract
Neuro deficits
finally radiograph the pelvis

Question 3

List some considerations conservative management of pelvic fracture

Answer 3

less invasive
less expensive
outcome less predictable (poorer?)
recovery more prolonged

Question 4

what is the general principle regarding whether to manage pelvis fracture surgically

Answer 4

usually operate on ilial, acetabular and bilateral fractures

Question 5

What makes up the weight bearing axis of the pelvis

Answer 5

1. the ilial shaf and wing
2. the iliosacral articulation
3. the acetabulum

Question 6

Describe a RTA ‘shunting injury’

Answer 6

Sacral fracture and sacroiliac luxation
often have neuro abnormalities- including sciatic neuropathies and urinary incontinence
can be bilateral- very painful if they are
always look for other pelvic fractures

Question 7

when can sacral fracture and sacroiliac luxation be managed conservatively

Answer 7

if greater than 50% of articular surfaces are in contact

Question 8

what do you need to do when placing screw to fix sacral fracture and sacroiliac luxation

Answer 8

This screw should engage at least 60% of the width of the sacral body

Question 9

What generally happens in ilial shaft fractures

Answer 9

caudal fragment often displaces medially narrowing the pelvic canal diameter

Question 10

List 3 potential complications of ilial shaft fractures

Answer 10

1. Reduction can be difficult especially if the injury is chronic (greater than 5 days old)
2. Iatrogenic damage to the sciatic nerve is a real risk
3. Management of these fractures requires considerable experience

Question 11

What should we do with acetabular fractures

Answer 11

Refer
Can do:
- Plate fixation
- screws

Question 12

why are acetabular fractures difficult to manage

Answer 12

Weight bearing is mainly on the dorsocranial aspect of acetabulum

Failing to reconstruct fractures of the caudal third can result in poor outcome despite apparent reduced weight bearing in this area

Question 13

Describe how to manage pubic fractures

Answer 13

generally pubic fractures require no treatment

Question 14

Describe spinal fractures

Answer 14

uncommon
often associated with neuro deficits
are very painful
are potentially life threatening

Question 15

Describe the initial management of spinal fractures

Answer 15

these patients are unstable
ABC
support the back at all times
give analgesia but avoid anaesthesia or deep sedation

Question 16

where do spinal fractures tend to occur

Answer 16

occur where rigid section of the spine meets a more flexible area
e.g.
T/L junction (the most common site)
L/S junction
C spine

Question 17

why should you not place animal with spinal fracture under anaesthesia or deep sedation

Answer 17

the muscle spasm and tone provide local support over the fracture site

Question 18

Describe neuro exam in cases of spinal fractures

Answer 18

assess tone in limbs and tail
where is most marked muscle spasm
is there a perineal reflex
is the patient showing Schiff-Sherrrington

Question 19

what is Schiff-Sherrington suggestive of

Answer 19

suggestive of cord transection between the fore and hind limbs

Question 20

what is the most important part of neuro exam in cases of spinal fractures

Answer 20

is there conscious pain perception in the animal

If there is no deep pain sensation the prognosis for the animal is poor

Question 21

Describe how to approach radiographical evaluation in cases of spinal fractures

Answer 21

Simple lateral views taken of the conscious animal maybe all that is required to determine the nature and significance of the injury

Question 22

why are fractures involving sacrum significant

Answer 22

because they could have a big effect on urinary and faecal continence

Question 23

why is the 3 component model used when assessing spinal fractures

Answer 23

If more than one of these components is damaged then the fracture is deemed to be unstable

Question 24

which spinal fractures can be managed conservatively

Answer 24

Relatively stable fractures and those occurring in the lumbosacral region

Question 25

describe conservative management of spinal fractures

Answer 25

cage rest for 6-8 weeks
careful nursing
analgesia

Question 26

Describe the prognosis for spinal fractures

Answer 26

The prognosis for animals with spinal cord injuries is good if conscious nociception is preserved
If not then prognosis is poor

Question 27

Describe how sacrococcygeal luxations present

Answer 27

Present with a flaccid tail, urinary retention or occasional a flaccid bladder and overflow

Question 28

Describe how to diagnose sacrococcygeal luxations

Answer 28

Usually fairly straight forward

Distended bladder and flaccid tail with no or little sensation

Always radiograph the chest and pelvis to detect concurrent injuries

Question 29

Describe how to treat sacrococcygeal luxations

Answer 29

manual expressing of bladder
medications to encourage micturition e.g.
- bethanachol to increase detrusor tone
- Phenoxybenzamine or prazosin to reduce striated muscle tone and dantrolene to reduce smooth muscle tone in the urethra

Question 30

Describe the prognosis of sacrococcygeal luxations

Answer 30

The prognosis for this injury is good to fair but if there is no improvement after four weeks the prognosis worsens