Fractures of the pelvis are the most common fractures seen in dogs. These fractures are usually the result of major trauma.
Generally, pelvic fractures cause acute, non-weight bearing lameness of the hind legs. These fractures are usually found in mature bones; young animals with trauma to the pelvis commonly will have other structures break before the pelvis. Because of the shape of the pelvis, these fractures normally occur in several locations at once including both the left and right sides at the same time.
Depending on the nature of the fracture, different methods of management may be indicated in each situation. Pelvic fractures can have serious complications if not repaired or if the repair fails.
A thorough physical examination can help determine which tests to perform. Although no laboratory tests are required to make the diagnosis, your veterinarian may recommend the following:
Emergency care for concurrent problems caused by the trauma is paramount. Once stabilized, additional treatments can begin.
Take your dog to the veterinarian as soon as possible after any trauma for immediate attention. If your animal does not need surgical stabilization or if surgery is decided against, strict exercise restriction may be the only required course of action.
If surgical repair of the fracture is performed, the animal will be kept restricted from activity for several weeks and the skin incision will be monitored while healing.
Recheck appointment with the veterinarian will occur in several weeks to evaluate how the bone is healing (with new radiographs), to monitor the animal's progress, and to make sure it is safe to increase the dog's activity level.
Many traumatic events are true accidents and thus unavoidable. Avoid the chance for motor vehicle trauma by keeping your dog confined to a fenced in area or by leash walking only.
Of all of the fractures seen in small animal hospitals, fractures of the pelvis are the most common. Motor vehicle trauma is the most frequent cause of pelvic fractures. These animals tend to be young, non-neutered males who roam away from home and get hit by a car. Dogs of both sexes and of any age are susceptible to this type of trauma if not kept restrained.
The left and right halves of the pelvis are actually several bones that fuse together as the animal matures. Each half is composed of the ilium, ischium and pubis. Both halves are then fused together in the middle to create a boxlike shape. Because of this configuration, trauma to the whole box usually results in many fractures at once. The pelvis forms a “socket” (acetabulum) of the hip joint and connects to the spine through the sacroiliac joints. These joints frequently become involved (fractured acetabulum or sacroiliac luxation) with trauma to the pelvis and may complicate the method of treatment and the animal's prognosis.
Each case of pelvic fractures needs to be evaluated in its entirety, including the severity of the fractures, age of the dog, experience of the surgeon, and financial concerns of the owner, to determine the most appropriate and best form of treatment.
Inappropriate case management, inadequate surgical stabilization, or poor aftercare can lead to complications such as non-unions (fractures that will not heal), malunions (fractures that heal in an abnormal direction or orientation). These can result in compromise of the width of the pelvic canal, osteomyelitis (bone infection), arthritis of the hip joint, or a non-functional leg.
No laboratory tests are required to make the diagnosis, but your veterinarian may recommend the following for your dog:
For most situations of pelvic fractures that do not involve the acetabulum, a bone plate and screws are usually used to support the fractured ilium. Fractures of the ischium and pubis are usually not repaired. Fractures that do involve the acetabulum may need to have the acetabulum carefully reconstructed and stabilized or a procedure in which the femoral head and neck are cut off the shaft of the femur might be recommended. This procedure is done in order to minimize the chance for the animal to have long-term problems associated with a hip joint that heals in an abnormal way leading to future arthritis. If a sacroiliac luxation is also present, the luxation may require repair and stabilization as well. When both sides of the pelvis are broken, only one or both sides may require surgical repair.
If it is determined that surgery is not required for your pet or if it is not necessary to pursue the surgical option, you must strictly confine your dog to allow the pelvis to heal and prevent excessive pain. Because the bone fragments are not stabilized when this course of treatment is followed, excessive motion or activity can prevent the fracture from healing at all or cause it to heal in a location that interferes with motion of the leg or with structures that pass through the pelvic canal like the colon, urethra and uterus.
After surgery and discharge from the hospital, the animal must be restricted from activity to allow the fracture to heal properly. Activity must be restricted for several weeks after surgery (the duration will vary depending on the severity of the injury, the type of fixation that was used, and the age of the animal). Restricted activity means that the animal should be kept confined to a carrier, crate, or small room whenever he cannot be supervised, the animal cannot play or rough-house, even if he appears to be feeling well. In addition, the use of stairs should be limited and outdoor walks should be just long enough for the dog to relieve himself and then should be returned indoors for more rest.
Analgesics (pain medications), such as butorphanol (Torbugesic®), or anti-inflammatories, such as deracoxib, aspirin or carprofen (Rimadyl®), should be given as directed by the veterinarian.
The skin incision needs to be monitored daily for signs of excessive swelling or discharge. These can indicate problems with the incision or possibly infection. Contact your veterinarian if these occur.
If at any point prior to the recheck radiographs your pet stops using the leg again after some improvement following surgery, there could be a problem. Again, the veterinarian should be notified.
Several weeks after surgery, the pelvis will need to be radiographed again to make sure the bones are healing well. If the healing has occurred as expected, the dog's activity level will be allowed to increase slowly back up to normal over the next few weeks.
In general, any other implants that were used in the repair will be left in place unless they cause the animal a problem at some point in the future. Potential problems can include migration (movement) or infection of the implant.