What Is Your Diagnosis?

Shelly A. Marquardt Department of Small Animal Clinical Sciences, Boren Veterinary Medical Teaching Hospital, Oklahoma State University, Stillwater, OK 74078.

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Mark C. Rochat Department of Small Animal Clinical Sciences, Boren Veterinary Medical Teaching Hospital, Oklahoma State University, Stillwater, OK 74078.

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 DVM, MS, DACVS

History

A young female (age and reproductive status unknown) Labrador Retriever–type dog was referred for evaluation of fractures of the left radius and ulna. The dog had been hit by a car earlier in the day, and the referring veterinarian had bandaged the limb with a soft-padded bandage. Soft tissue swelling was observed in the right manus. Signs of pain were elicited from the left hip joint when the limb was extended. Results of a neurologic examination, a CBC, and serum biochemical analyses were unremarkable. Radiography revealed a closed, linear, transverse diaphyseal fracture of the left radius and ulna. Radiographs of the pelvis were also obtained (Figure 1).

Figure 1—
Figure 1—

Lateral (A), ventrodorsal (B), and flexed ventrodorsal (C) radiographic views of the pelvis of a young female (age and reproductive status unknown) Labrador Retriever–type dog referred for evaluation of fractures of the left radius and ulna; pain was elicited on extension of the left hip joint.

Citation: Journal of the American Veterinary Medical Association 232, 11; 10.2460/javma.232.11.1637

Determine whether additional imaging studies are required, or make your diagnosis from Figure 1—then turn the page →

Radiographic Findings and Interpretation

A Salter-Harris type I fracture of the left capital femoral physis with approximately 3 mm of medial displacement is evident (Figure 2). In the flexed ventrodorsal (frog-legged) view, there is minor caudal displacement of the distal fragment. Subluxation of the left femoral head is visible with widening of the joint space and incongruity.

Figure 2—
Figure 2—

Same ventrodorsal and flexed ventrodorsal radiographic views as in Figure 1. Notice the medial displacement of the left capital femoral physis with widening of the joint space (white arrow), which is reduced in the flexed ventrodorsal view (black arrow).

Citation: Journal of the American Veterinary Medical Association 232, 11; 10.2460/javma.232.11.1637

Comments

Capital physeal fracture (CPF) is a common injury in dogs. Skeletally immature dogs (usually < 10 months old) are most often affected because of the fragile nature of the open physis. Ninety-five percent of the growth that occurs at the capital physis will be completed by 7 months of age, but the physis can remain open until 1 year of age.1,2 On the basis of the open physes detected during radiographic imaging, this dog's age was placed between 9 and 12 months. Capital physeal fracture is usually related to trauma and induces a Salter-Harris type I fracture; type II fractures are rare.1,2 Dogs usually have acute non–weight-bearing lameness. Signs of pain can be elicited, and crepitus can be felt with manipulation of the hip joint; however, lack of signs of pain does not eliminate the potential for CPF. Weight bearing also does not eliminate the potential for CPF injury because dogs with minimal displacement can be weight bearing. Differential diagnoses include severe hip joint sprain, femoral neck fracture, and acetabular fracture.3 Because of the insidious nature of CPF and the serious consequences of failing to identify and treat the condition, a high index of suspicion for CPF must be maintained when evaluating young dogs with signs of pain in the hip joint following trauma.

Ventrodorsal and lateral radiographic views should be obtained for complete evaluation of the pelvis, although the lateral view is not critical to the diagnosis of CPF. To better visualize the fracture, a flexed ventrodorsal view may be helpful to displace the fracture, which is usually nondisplaced or minimally displaced. Interestingly, in the dog of this report, the flexed ventrodorsal view further reduced the fracture and did not aid in diagnosis as much as expected.

Surgical repair is the treatment of choice unless comminution or chronic remodeling is evident. Anatomic reduction is critical for optimal repair and can be accomplished with multiple Kirschner wires or small-diameter Steinmann pins.2 Other treatment options include femoral head and neck ostectomy and total hip arthroplasty.4 Complications associated with reduction include implant-related problems, infection, and degenerative changes. Resorption and remodeling of the femoral neck can develop between 3 and 6 weeks after surgery because of the increased vascularity to the epiphysis as the fracture heals. The resorption is often described as creating an “apple coring” appearance. The resorption is usually self-limiting, and complete neck collapse is rare. The fracture in the dog of this report was reduced and stabilized with 4 Kirschner wires.

Long-term outcome will vary because most dogs that have undergone repair of a capital physeal fracture will develop various clinical signs and radiographic evidence of degenerative joint disease.1 Clinical signs tend to be more severe in dogs injured before 6 months of age because the physis is more actively growing during this period.1 The time between surgical repair and radiographic evaluation as well as the degree of fracture reduction will affect the amount of degenerative change that can be detected radiographically.5 Four weeks after surgery, the dog of this report was doing well and had no apparent lameness. Radiography revealed healing of the capital physeal fracture and stable implants.

  • 1.

    Gibson KL, vanEe RT, Pechman RD. Femoral capital physeal fracture in dogs: 34 cases (1979–1989). J Am Vet Med Assoc 1991;198:886890.

  • 2.

    Slatter D. Femoral physeal fractures. In: Slatter D, ed. Textbook of small animal surgery. 3rd ed. Philadelphia: WB Saunders Co, 2003;9961004.

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  • 3.

    Simpson DJ, Lewis DD. Fractures of the femur. In: Fossum TW, ed. Small animal surgery. 2nd ed. St Louis: Mosby, 2002;20592089.

  • 4.

    Beale B. Orthopedic clinical techniques femur fracture repair. Clin Tech Small Anim Pract 2004;19:134150.

  • 5.

    DeCamp CE, Probst CW, Thomas MW. Internal fixation of femoral capital physeal injuries in dogs: 40 cases (1979–1987). J Am Vet Med Assoc 1989;194:17501754.

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  • Figure 1—

    Lateral (A), ventrodorsal (B), and flexed ventrodorsal (C) radiographic views of the pelvis of a young female (age and reproductive status unknown) Labrador Retriever–type dog referred for evaluation of fractures of the left radius and ulna; pain was elicited on extension of the left hip joint.

  • Figure 2—

    Same ventrodorsal and flexed ventrodorsal radiographic views as in Figure 1. Notice the medial displacement of the left capital femoral physis with widening of the joint space (white arrow), which is reduced in the flexed ventrodorsal view (black arrow).

  • 1.

    Gibson KL, vanEe RT, Pechman RD. Femoral capital physeal fracture in dogs: 34 cases (1979–1989). J Am Vet Med Assoc 1991;198:886890.

  • 2.

    Slatter D. Femoral physeal fractures. In: Slatter D, ed. Textbook of small animal surgery. 3rd ed. Philadelphia: WB Saunders Co, 2003;9961004.

    • Search Google Scholar
    • Export Citation
  • 3.

    Simpson DJ, Lewis DD. Fractures of the femur. In: Fossum TW, ed. Small animal surgery. 2nd ed. St Louis: Mosby, 2002;20592089.

  • 4.

    Beale B. Orthopedic clinical techniques femur fracture repair. Clin Tech Small Anim Pract 2004;19:134150.

  • 5.

    DeCamp CE, Probst CW, Thomas MW. Internal fixation of femoral capital physeal injuries in dogs: 40 cases (1979–1987). J Am Vet Med Assoc 1989;194:17501754.

    • Search Google Scholar
    • Export Citation

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