Presentation:
A 9 to 10 month old intact female, mixbreed was presented to AcaseAweek Clinic around 2:30pm after being hit by a car approximately 6:40am that morning. Owner said that the patient started biting at her vulva and so blood was seen around the vulva and mouth. The patient was in lateral recumbency and manual manipulation was painful.
Physical exam:
- Weight = 10kg,
- TPR all WNL,
- MM pink
- CRT<2 >
- EENT all normal
- Thoracic auscultation was nonremarkable.
- A mild lymphadenopathy was noted in all lymph nodes.
- When palpating the caudal vertebrae an obvious defect of the vertebrae could be felt just cranial to the sacrum.
Neurological exam: Hyperreflexia in both right and left hindlimbs. Withdrawl reflex was absent in both. Ischial groove reflex of the left hindlimb produces a reflex in the right limb that was hyperreflexive. Anus was flaccid and showed no tone.
Radiographs of lumbosacral and pelvis region were taken as shown below (Click on image to enlarge):
What are the radiographic findings and diagnosis?
What are differentials for the signs presented?
How will you treat and manage this case?
1 comment:
Radiographic Findings:
Right sacroiliac luxation
Left Ilial Wing Fracture
Vertebral segments/spinal cord L7-S1 affected, misaligned as manifested by lack of withdrawal reflexes in both hindlimbs.
Upper motor neuron spinal lesions are present as manifested by hyperreflexia of both right and left hindlimbs
Lower motor neuron spinal lesion presents as manifested by flaccid and loss of muscle tone in the anal region
Diagnostic Differentials:
Cauda Equina Syndrome
Treatment and Management:
Chest X-ray should also be done to rule out injury to the lungs caused by trauma
Assessment and treatment of any soft tissue injuries
Strict exercise restriction and cage rest
Digital rectal exam should be done to insure that sharp bone fragments within the pelvic canal have not injured the patient
Pain medications should be given i.e. butorphanol or carprofen , DMSO gel can also be given topically on affected areas
Patient should also be examined for signs of hypovolemic shock and IV fluids subsequently administered
Since the patient is still very young and is relatively not a large breed, conservative approach can be used to correct the pelvic fractures (cage rest and strict exercise restriction). However, lateral plate fixation of an ilial fracture is highly recommended. Presence of neurologic dysfunction would also warrant surgical management such as multiple lag screws and K wire placements can be made. 4-6 weeks after, pelvis will need to be radiographed again to make sure the bones are healing well
Post a Comment