Short-Term Clinical and Radiographic Outcome after Stabilization of Femoral Capital Physeal Fractures with Cortical Positional Screws in 39 Cats

Abstract

Objective The aim of this study was to report the short-term clinical and radiographic outcome for the treatment of femoral capital physeal fractures with cortical positional screws in cats. Study Design Medical records and radiographs of cats with femoral capital physeal fractures stabilized with cortical positional screws were retrospectively reviewed. Signalment, bodyweight, femoral head affected, fracture classification, fracture reduction, implants, concurrent orthopaedic injuries, osteoarthritis, femoral neck osteolysis, complications and 6-week follow-up clinical results were recorded. A short- to long-term follow-up was performed by telephone questionnaire with the owners. Results Forty-six fractures in 39 cats met the inclusion criteria. In 45/46 fractures, radiographic signs of bone healing were present and 35/39 cats were assessed as walking normally by a veterinarian at 6-week follow-up. There was a significant increase in radiographic signs of osteoarthritis (p=0.037) and femoral neck osteolysis (p=0.001) on 6-week follow-up radiographs. Pre- and postoperative osteoarthritis and femoral neck osteolysis were not associated with clinical outcome. The mean follow-up period for the telephone questionnaire was 48 months (range, 5–147 months). Seven out of 25 owners reported a gait abnormality in the short- to long-term. Conclusion Femoral capital physeal fractures in cats can be treated successfully with the use of cortical positional screws. This technique may be considered as an alternative to other primary fixation techniques and salvage procedures for the treatment of femoral capital physeal injuries in cats. This technique seemed successful in cats with a low-grade preoperative femoral neck osteolysis.

Stabilisation of femoral capital physeal fractures using transcervical pinning in cats: 19 cases (2014‐2022)

“…Our study sample predominantly consisted of Maine Coons which is in line with previous reports of breed predisposition by Borak et al (2017) showing Maine Coons having 12 times higher risk of developing a slipped capital femoral epiphysis than other cats (Borak et al, 2017). Although a precise diagnosis is not possible without histological analysis, it is likely that this condition represents a proportion of the lesions seen in our study population and supports the hypothesis of Vink et al (2022) that slipped capital femoral epiphysis fixation with good results is possible in cats.…”

“…Preoperative and 4‐week postoperative radiographs were evaluated for the presence of osteoarthritis and femoral neck osteolysis using scoring systems established by Vink et al . (2022) and based on previous publications (Hardie et al ., 2002; Keller et al ., 1999; McNicholas et al ., 2002) to facilitate comparison (Table 1). The postoperative radiographs were evaluated for the quality of fracture reduction using the classification system reported by Fischer et al .…”

“…Three evaluators, blinded to timeframe and patients' clinical outcomes, assessed all available radiographs. Preoperative and 4-week postoperative radiographs were evaluated for the presence of osteoarthritis and femoral neck osteolysis using scoring systems established by Vink et al (2022) and based on previous publications (Hardie et al, 2002;Keller et al, 1999;McNicholas et al, 2002) to facilitate comparison (Table 1). The postoperative radiographs were evaluated for the quality of fracture reduction using the classification system reported by Fischer et al (2004), which ranged from 1 to 4 (anatomic reduction, good reduction with favourable outcome expected, malalignment with the possibility of revision surgery and inadequate reduction).…”

“…However, a recent study revealed long‐term residual gait abnormalities after using this technique (Schnabl‐Feichter et al ., 2021). Other surgical alternatives include total hip replacement (Borak et al ., 2017; Liska et al ., 2009; Witte et al ., 2010) and osteosynthesis using transcervical Kirschner‐wires (K‐wires) (Borak et al ., 2017; Culvenor et al ., 1996; Fischer et al ., 2004; Jeffery, 1989) or screws (Vink et al ., 2022). FCPF osteosynthesis is widely used in humans and dogs but is less frequently used in cats.…”

“…Results of the radiographic assessment, based onVink et al (2022) Osteoarthritis grade 0=no evidence of osteoarthritis, grade 1=mild osteophyte formation on craniodorsal margin of the acetabulum without subchondral sclerosis, grade 2=moderate osteophyte formation on craniodorsal margin of the acetabulum with or without subchondral sclerosis; osteolysis grade 0=no osteolysis, grade 1=blunting and early remodelling or resorption of the femoral neck, grade 2=resorption of the dorsal or ventral aspect of the femoral neck, grade 3=resorption of the dorsal and ventral aspect of the femoral neck; fracture reduction grade 1=anatomic reduction, grade 2=good reduction with favourable outcome expected; implant reduction grade 1=adequate depth and good K-wires spacing, grade 2=adequate depth with poor spacing or use of three K-wires, grade 3=inadequate depth…”