Moriarty Coffey

Background

Moriarty, a four year old Tonkinese cat was referred to Fitzpatrick Referrals on 13th July 2010 having been involved in a suspected road traffic accident. He was missing for a day and then discovered non-ambulatory and in pain.

Condition on Presentation

On presentation Moriarty was subdued and non-ambulatory. Although pain perception was present to both pelvic limbs it was difficult to fully assess his neurological status as he was not able to stand.

Diagnosis

Radiography

Radiographs revealed a minimally displaced right-sided sacro-iliac luxation and a comminuted fracture of the caudal aspect of the ilium with suspected involvement of the acetabulum on the left side. Concurrent ischial and public fractures were also present.

A CT scan revealed that the acetabulum itself appeared not to be involved. However, there were areas of comminution over the dorsal, medial and ventral aspects of the acetabulum.

Treatment

Moriarty was given opioid analgesia and intravenous fluids overnight and surgery was planned for the following day.

Surgery

The fractures were reduced and stabilised using a customised external skeletal fixator and postoperative radiographs revealed satisfactory fracture alignment and implant positioning. 

Subsequent to the surgery Moriarty's blood levels were constantly monitored and he began to show subtle signs of jaundice. Various blood tests were submitted with regard to the suspicion of post-traumatic haemolytic anaemia which is not uncommon in oriental breeds following significant trauma. But fortunately initial concerns with regard to potential post-traumatic haemolytic anaemia were discounted and testing of haematological parameters including a Coombs test revealed no significant abnormality.

Rehabilitation

Moriarty was assessed by our physiotherapy team two days post-operatively. He was obviously uncomfortable with the external skeletal fixator with no active movement of the hind limbs at this stage. However he was able to weightbear on the right hind and could weightbear with support on the left hind limb. The left hind limb was treated with limb placement exercises, supported stands and bounces. Massage was used on the left hind limb to reduce swelling and improve circulation. He was then allowed home for a few days with strict instructions for confinement.

Condition on Presentation (2)

Moriarty was seen again on 27th July and on presentation he was making a good improvement, albeit that there were still marked neurological deficits, particularly on the left side. The skin sutures were removed.

Rehabilitation

Moriarty was re-assessed by our physiotherapy team and due to significant neurological deficits and generalised weakness proprioceptive exercises and limb stretches were performed and shown to the owner in the hope that these could be carried out at home. However Moriarty was not highly motivated to move so the exercises were difficult to do as not well tolerated by him. His owners were given advice and a home exercise programme was set up for him with instructions with regard to specific exercises to stretch the quadriceps and hamstrings and coxofemoral joints. The owners were then asked to return for re-assessment in one week to progress the exercises and introduce an obstacle course.

Condition on Presentation (3)

Moriarty was seen again by the veterinary team on 10th August. On presentation Moriarty appeared relatively bright and alert. However, there were still marked neurological deficits noted, particularly on the left side, and there was a reduced range of motion of the coxofemoral joints. The owners were nevertheless adamant that they were seeing relatively good progression in Moriarty's mobility at home. Continuing judicious physiotherapy was advised for the next two weeks when follow up radiographs were scheduled and the external skeletal fixator possibly removed.

Rehabilitation

Physiotherapy treatments continued with more advanced exercises, stretches to quads and hamstrings and hip mobilization exercises. Muscle stimulation was also introduced. Moriarty seemed to be much more perky and alert and there was some appropriate limb placing.

Condition on Presentation (4)

Moriarty was seen by the veterinary team again on 26th August. On presentation Moriarty appeared bright and alert and the owners reported that he had now begun to eat well again at home. Marked sciatic deficits were still noted affecting the left pelvic limb but sensation was now present to the majority of the limb but marked sensory deficits were still noted to approximately the distal 5 cm. Orthogonal radiographs revealed evidence of osseous fusion at all fracture sites. The external frame was subsequently removed in its entirety.

Rehabilitation

Following removal of the frame, Moriarty started to walk independently and use the left hind limb. However when moving the left hind limb, Moriarty persisted in knuckling the paw. Further home exercises were introduced to assist with muscle wastage in the gluteal, quad and hamstrings. Pad and paw stimulation was encouraged, bounces, weight shifts, 3 leg stands and electric muscle stimulation continued. Hydrotherapy was advised.

Ongoing rehabilitation at this point was critical to the success of this case.

Hydrotherapy

Although it is believed that cats hate water, we do have many cats that have coped admirably with hydrotherapy and have made great progress because of it. Moriarty started hydrotherapy to increase the range of motion in his hind legs and to increase muscle mass. He came for a short course of sessions. He progressed so well at this stage particularly with his land exercises that we decided to stop the hydrotherapy as he did not like it very much.

Condition on Presentation (5)

Moriarty was seen again on 9th December and on the day of presentation was walking normally. Muscle mass had returned and there was no pain on manipulation of either coxofemoral joint or on palpation over the pelvis. Moriarty was discharged and the owners told that he could be returned to normal exercise.

The owners were called on 14th June 2011 for a six month telephone update and everyone was pleased to learn that Moriarty continues to do well. He is back to being a normal cat.

Moriarty’s Owner

“Moriarty is doing fantastically well. We are really pleased. However, now he is back to normal he eyes his travelling basket with suspicion as for many months he travelled to the practice on a regular basis to endure lengthy and persistent rehabilitation. Swimming really wasn’t his thing!”

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