CC BY
252020, Scienceline Publication
Worlds Veterinary Journal
World Vet J, 10(4): 638-652, December 25, 2020
DOI: https://dx.doi.org/10.54203/scil.2020.wv77
Incidence of Appendicular Bone Fracture in Dogs and Cats: Retrospective Study at Veterinary Hospital of Cairo University and some Private Clinics in Egypt
Abeer Ali Mahmoud Abo-Soliman, Ahmed Elsayed Ahmed and Haithem Ali Mohamed Ahmed Farghali*
Department of Surgery, Anesthesiology, and Radiology, Faculty of Veterinary Medicine, Cairo University, Egypt * Corresponding author's Email address: [email protected]; ©on : 0000-0002-3311-1335
ABSTRACT
Appendicular bone fractures in small animal practice constitute a major challenge facing veterinary orthopedic surgeons concerning affected limb and bone as well as the extent of tissue damage, site, and shape of the fracture line. Therefore, this retrospective study was designed to provide descriptive data at referral veterinary teaching hospital, faculty of veterinary medicine, Cairo University, and some private pet clinics in Cairo district, Egypt to identify and determine the prevalence of appendicular fractures arising from trauma in dogs and cats treated from January 2017 to January 2020, and emphasizing the information that characterized the population (breed, age, gender, and animal size). The investigated fractures were classified according to the specific limb (forelimbs / hind limbs), specific bone fractures (Humerus, radius and ulna, femur, tibia and fibula, and the other bones), extent of tissue damage (open or closed and incomplete or complete), site (proximal, diaphyseal or distal zones), number (single or comminuted), and the direction of the fracture line (transverse, oblique or spiral). From the obtained data, it could be concluded that there was a high incidence of the appendicular long bones concerning the different bone fractures with significantly higher records in dogs, compared to cats. The highest records of fracture were in mongrel dogs, and cats as rescued animals. Excluding mongrel dogs and cats, the highest incidence of fracture-cases in dogs was recorded in Miniature breeds and svelte breeds for cats. Male dogs and cats showed a higher incidence than females. The bone fracture mostly occurred in dogs younger than one-year-old, and cats aged one to three years. A fracture in the hindlimbs was more significant than forelimbs with the highest incidence in femoral bone among both dogs and cats. The percentage of open fractures were more common in cats than dogs. Incomplete fractures were recorded more frequently in dogs than cats. In dogs, the most common fractures in the femur, tibia/fibula, humerus, and radius/ulna were complete comminuted diaphyseal femoral, complete oblique diaphyseal tibial/fibular, complete transverse distal humoral, and complete transverse diaphyseal radial/ulnar fractures respectively. Moreover, cats were complete transverse distal femoral, complete oblique diaphyseal tibial/fibular, complete spiral diaphyseal humoral, and complete transverse distal radial/ulnar fractures. In conclusion, appendicular bone fracture among dogs and cats referred to the veterinary teaching hospital, Cairo University and some private clinics in Egypt showed high incidence (87% in dogs and 71.8% in cats) out of total fracture cases and this incidence correlated with some predisposing factors (including breeds, weight, age, and gender) and causative agents that resulted in different types of appendicular fractures.
Keywords: Cat, Dog, Femur, Fracture, Orthopedic INTRODUCTION
Orthopedic cases constitute a major percentage of surgery caseload in most of veterinary clinics and referral centers in different parts of the world (Appari et al., 2013). Bone fractures, especially in long bones, constitute a major problem in small animal practice particularly in dogs (Gadallah et al., 2009). Violent trauma with a vehicular accident or minimal trauma with a pathological condition such as neoplasia usually are the most common causes of fractures (Beale, 2004; Fossum, 2013). The diagnosis of fractures is based on a history of trauma and clinical signs. Radiography, ultrasonography, and histology have been used as the tools for fracture-healing assessment (Rrisselada et al., 2005). When regular serial radiographs are available, they aid in monitoring the progress of bone healing, and facilitate the decision-making procedure for the removal of orthopedic implants (Hobbs, 2012).
It is extremely important to carry out retrospective and prospective studies to determine the prevalence of the most common diseases in a given geographic region (Chaves et al., 2014). The incidence of bone fractures in dogs and cats have been reported in different regions of the world (Thengchaisri et al., 2006; Shiju et al., 2010; Minar et al., 2013; Rhangani, 2014; Elzomor et al., 2014; Libardoni et al., 2016 and Lovric et al., 2020).
A standardized description of a fracture is an important issue as it directs the orthopedic surgeons to classifying it very cautiously, thereby to choose the proper method of reduction, fixation and immobilization. Classification of appendicular fractures was extensively discussed (Harari, 2002; Lanz, 2002; Piermattei et al., 2006; Shales, 2008a and 2008b). Fractures could be classified according to different aspects of cause; open or closed, extent of bone damage,
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number and position of fracture lines, direction, location, forces acting on the fracture, stability, degree of soft tissue damage and age of the fracture. According to the cause of the fracture, fractures are classified into intrinsic (muscular, pathological and stress) and extrinsic (external trauma). Regarding the extent of bone damage, fractures are classified into incomplete (greenstick, fissure and depressed) and complete. According to the number and position of the fracture lines, they are classified into simple, segmental and comminuted. According to the direction of fracture lines, they are classified into transverse, oblique and spiral. According to direction of fracture location, fractures are classified into diaphyseal (proximal, mid or distal), metaphyseal, articular, condylar and physeal (classified according to the salter-harris system). Regarding the forces acting on the fracture site, fractures are classified into avulsion, impaction, compression and displacement. According to the stability, they are classified into stable (interlocking fragments may have inherent stability and be suitable for external coaptation or conservative management) and unstable (fractures are usually unstable, and they require stabilization in order to facilitate the weight-bearing and healing). Regarding the degree of age of fracture, fractures are classified into recent (having sharp fracture edges) and old (rounded edges form after 10 to 14 days or there is the callus formation) (Shales, 2008a).
Knowing the types and frequency of fractures in domestic animals, the professionals in the area of orthopedics and veterinary physiotherapy can direct their attention to the improvement of fixation techniques, correction and stabilization of fractures, thus increasing the efficiency in the treatment and repair (Vidane et al., 2014). Fossum (2013) suggested a fracture-assessment scoring system which includes three different factors; mechanical, biological, and clinical. Mechanical factors include a reducibility of the fracture, patient size and weight, and if an injury or a disease is present on other limbs. Evaluation of mechanical factors helps to evaluate how strong the fracture fixation should be for the individual patient. Biological factors take into account the age and general health of the patient, extent of the soft tissue damage around the fracture both due to high-velocity injury and the surgeon's skills during fracture repair. The biological factors play a role in estimating the healing time of the fracture. Clinical factors help to assess the fracture healing during the postoperative period. It includes the patients' and owner's compliance, the activity level of the patient, and the comfort during the fracture healing. The three factors should all be taken into account when the prognosis of a fracture and fracture surgery are assessed. Fractures with high scores generally heal with lower complication risks, whereas fractures assigned lower scores one can expect a greater risk for complications.
This retrospective study aimed to provide descriptive data at referral veterinary teaching hospital, faculty of veterinary medicine, Cairo University, and some private pet clinics in Cairo district, Egypt to identify and determine the prevalence of dogs and cats with appendicular fractures arising from a trauma treated from January 2017 to January 2020, and emphasizing the information that characterized the population (breed, age, gender, and size).
MATERIALS AND METHODS
Ethical approval
All procedures (including data collections, patients' information recording at the referral veterinary teaching hospital, Cairo University and some private clinics in Egypt and radiographs interpretations) of the current study were approved by the Institutional Animal Care and Use Committee, Cairo University (Vet CU 20022020127).
Data collection
Data were collected from patient's medical records at referral veterinary teaching hospital, faculty of veterinary medicine, Cairo University, and some private pet clinics in Cairo district, Egypt. Searches were made on all fractures during the period from January 2017 to January 2020. Dogs and cats with fractures were confirmed by the history, clinical, orthopedic, and radiographic examinations, then were submitted to osteosynthesis surgical treatment which was not included in this study.
Patients' information
Basic information about the patients included breeds, weight, age, sex, and causative agent were recorded. All dog breeds were listed according to Federation Cynologique Nationale (FCI), the World Canine Organization. Breeds not recognized by FCI were categorized as mixed-breed. Regarding dogs, 34 breeds were admitted to the hospital and clinics, while fracture was recorded in 18 dog breeds (English Bullmastiff, Saint Bernard, German Shepherd, Golden Retriever, German Rottweiler, Labrador Retriever, Siberian Husky, Alaskan Husky, American Pitbull, Mongrel (Mixed-breed), Doberman Pinscher, Grand Griffon Vendeen, Petit Basset Griffon Vendeen, English Cocker Spaniel, American Cocker Spaniel, Yorkshire Terrier, Pomeranian, and Chihuahua). Regarding cats, six breeds were admitted to the hospital and clinics, while the fracture was recorded in five cat breeds (Persian, Mongrel (Mixed-breed), Himalayan, Siamese, and Egyptian Mau).
The dog breeds were categorized according to body size or weight into Giant (more than 45 kg), Large (22-45 kg), Medium (12-22 kg), Small (5-12 kg), and Mini or toy breeds (less than 5 kg) (American Kennel Club, 2006; Fogle, 2009).
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Cat breeds were categorized according to body conformation types to three general groups: cobby, such as the Persian and Himalayan cat breeds; svelte, such as the Siamese, Egyptian Mau, and Sphynx cat breeds, and moderate such as the mongrel cat breed. The cobby's body design is short and compact, deep-chested, and broad across the shoulders and rump. The head is also large and round, and the tail is often shorter and blunt at the tip. In contrast, the svelte type is very slim and lithe with long tapering lines. The head is narrow and forms a wedge shape, and the tail is usually long, slender, and pointed at the tip. The moderate lies are between these two types, and is neither cobby nor svelte; several breeds are moderate in conformation (Helgren, 2013). Dogs' and cats' gender were recorded to study the relations between the incidence of fracture and gender of affected cases._Regarding the age, the animals were distributed into four age groups: Juvenile, puppies or kitten (less than 1 year), young adult (1-3 years), mature adult (3-10 years), and elder (over 10 years old) according to the methodology used in a case study (Shearer, 2011). Data about different causes of fracture were collected from the owners to evaluate the relations between the incidence of fracture and their causes.
Establishment of the types and frequency of bone fractures' occurrence
Fractures were classified according to Shales (2008b):
Classification of bone fracture based on the body parts, the incidence of specific limb and specific bone fractures which includes
a- Incidence of specific limb (forelimbs / hind limbs) fractures
b- Incidence of specific appendicular bone fractures. Forelimb (Humerus, radius and ulna), Hindlimb (Femur, tibia and fibula.), and the number of the other bone fractures were recorded.
Frequency of the different types of appendicular bone fracture based on the extent of tissue damage, site, and shape of the fracture line
a- The extent of tissue damage: 1) Open or closed fracture; 2) Incomplete or complete fracture.
b- Fracture location: Proximal, diaphyseal or distal zones
c- Fracture line: 1) The number of fracture line (single or comminuted); 2) The direction of fracture line (transverse, oblique or spiral)
Statistical analysis
Data that were collected about age, sex, and breeds were collected, and they were added to the Microsoft Excel 2010R spreadsheet, stored separately and exported to analytical software using the Chi-square test. Values of < 0.05 were considered as statistically significant.
RESULTS
Patients' information
Breeds, weight, age, gender, and causative agent
Out of 4625 cases of dogs (table 1) and 3712 cats (table 2) admitted to the hospital and clinics, a total of 324 (7.01%) records of dogs and 149 (4.01%) of cats were diagnosed with fractures which were selected from X-ray records at referral veterinary teaching hospital, faculty of veterinary medicine, Cairo University and some private pet clinics in Cairo district, Egypt; covering the period from January 2017 to January 2020.
Regarding dog breeds, the fracture was recorded in 18 breeds. The distribution of appendicular fractures among the different breeds of dogs in the present study is presented in table 3. The most affected breeds were Mongrel (Mixed-breed, 61.74%), Pomeranian (22.22%), Chihuahua (13.33%), Yorkshire Terrier (7.41%), Siberian Husky (5.56%), Golden Retriever (5.36%), German Shepherd (5.19%), American Cocker Spaniel (4.08%), German Rottweiler (3.90%), Alaskan Husky (3.26%) and Grand Griffon Vendéen (3.26%). Regarding cat breeds, the fracture was recorded in five breeds. The distribution of appendicular fractures among the different breeds of cats in the currents study is presented in table 4. The most affected breeds were Mongrel (Mixed-breed, 14.01%), Siamese (3.17%), Persian (1.99%), Himalayan (1.85%), and Egyptian Mau (1.47%). According to the body size or weight, the dog breeds were categorized into five groups; Giant, Large, Medium, Small, and Mini breeds (Table 5). The most affected breed according to the size was medium (26.84%), followed by mini (13.33%), large (4.83%), small (2.73%), and giant (1.89%) breeds. According to the body conformation, the cat breeds were categorized into three groups; Cobby, Moderate, and Svelte breeds (Table 6). The most affected breed according to the body conformation was moderate (14.01%), followed by svelte (2.58%) and cobby (1.98%) breeds. Regarding the gender (table 7), the incidence of fractures in male dogs was 65.43% out of total fracture cases; 7.61% out of total admitted male dogs and 4.58% out of total admitted (male and female) dogs, and the incidence of fractures in female dogs was 34.57% out of total fracture cases; 6.08% out of total admitted female dogs and 2.42% out of total admitted (male and female) dogs. Meanwhile, in cats, the incidence of fractures in male cats was
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66.44% out of total fracture cases; 6.81% out of total admitted male cats and 2.67% out of total admitted (male and female) cats, while the incidence of fractures in female cats was 33.56% out of total fracture cases; 2.21% out of total admitted female cats and 1.35% out of total admitted (male and female) cats.
Regarding the age (table 8), the incidence of the fracture in dogs were 54.94%, 29.63%, 12.96%, and 2.47% out of dog fracture cases; 10.72%, 6.93%, 3.09%, and 3.64% out of total admitted dogs of related age and 3.85%, 2.08%, 0.91%, and 0.17% out of total admitted dogs, distributing among ages (Juvenile (< 1 year), young adult (1-3 years), mature adult (3-10 years) and Elder (> 10 years)), respectively. Meanwhile, in cats, the incidence of bone fracture was 32.89%, 34.23%, 24.83%, and 8.05% out of cat fracture cases; 3.94%, 5.99%, 3.84%, and 1.83% out of total admitted cats of related age and 1.32%, 1.37%, 1.00%, and 0.32% out of total admitted cats, distributing among ages (Juvenile (< 1 year), young adult (1-3 years), mature adult (3-10 years) and Elder (> 10 years)), respectively.
The obtained results (table 9) showed that the causes of presented fracture cases in dogs and cats were trauma due to traffic accidents (141 dogs, 43.5% and 74 cats, 49.7%), falling from a height (63 dogs, 19.4% and 54 cats, 36.2%), indoor trauma (18 dogs, 5.6% and 8 cats, 5.4%), pathological conditions (12 dogs, 3.7% and 2 cats, 1.3%), animal bite (10 dogs, 3.1%) and human abuse (9 dogs, 2.8%), respectively. The cause which cannot be defined in 82 cases of fractures (71 dogs, 25.6%, and 11 cats, 8.7%) was because the owners had not witnessed the moment of the event.
Table 1. The total admitted dog cases to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020._
Routine works Surgical cases
Dog breeds (Vaccinations, deworming, Medicinal Soft tissue Orthopedic surgical cases Total
external parasite control, cases surgical cases Fracture Joint affected
etc.) cases cases
1. German Shepherd 428 282 126 62 296 1194
2. Golden Retriever 206 141 116 36 173 672
3. German Rottweiler 123 104 80 18 136 461
4. American Pit bull 112 87 82 4 28 313
5. Mongrel (Mixed-breed) 16 13 66 163 6 264
6. Grand Griffon Vendéen 68 55 72 7 13 215
7. Labrador Retriever 52 46 18 5 48 169
8. Petit Basset Griffon 62 48 27 2 8 147
Vendéen
9. French Bullmastiff 42 48 13 0 44 147
10. Siberian Husky 49 42 12 7 16 126
11. Maltese 55 18 29 0 7 109
12. English Cocker Spaniel 47 37 11 3 3 101
13. Alaskan Husky 42 28 7 3 12 92
14. English Bullmastiff 36 22 11 1 19 89
15. Saint Bernard 20 18 11 2 19 70
16. Neapolitan Mastiff 22 16 13 0 9 60
17. French Bulldog 27 19 2 0 3 51
18. American Cocker Spaniel 34 7 4 2 2 49
19. Doberman Pinscher 28 12 6 1 2 49
20. Cane Corso 31 9 2 0 1 43
21. Caucasian Shepherd 13 7 0 0 11 31
22. Yorkshire Terrier 16 2 3 2 4 27
23. German Boxer 11 7 6 0 0 24
24. Great Dane 10 6 0 0 7 23
25. Pekingese 12 2 6 0 1 21
26. Pomeranian 7 5 0 4 2 18
27. Chihuahua 8 2 0 2 3 15
28. Alabai (Central Asian 6 2 0 0 5 13
Shepherd)
29. Chinese Pug 4 1 1 0 2 8
30. Rhodesian Ridgeback 6 0 0 0 1 7
31. Chow-Chow 5 0 0 0 2 7
32. Belgian Malinois 5 0 0 0 0 5
33. Basset Hound 1 0 0 0 2 3
34. Dalmatian 2 0 0 0 0 2
Total 1606 1086 724 324 885 4625
% 34.72% 23.48% 15.65% 7.01% 19.14% 100%
Table 2. The total admitted cat cases to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020._
Routine works Surgical cases
Cat breeds (V accinations, deworming, external parasite control, etc.) Medicinal Soft tissue Orthopedic surgical cases Total
cases surgical cases Fracture cases Joint affected cases
35. Persian 638 1543 478 54 2 2715
36. Mongrel (Mixed-breed) 112 107 315 87 0 621
37. Himalayan 38 104 16 3 1 162
38. Siamese 26 87 7 4 2 126
39. Egyptian Mau 7 38 22 1 0 68
40. Sphynx 11 6 3 0 0 20
Total 832 1885 841 149 5 3712
% 22.41% 50.78% 22.66% 4.01% 0.14% 100%
Table 3. Number and percentage of fracture cases out of total cases admitted to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020 in relation to different dog breeds._
Dog breeds Total admitted cases Fracture cases Percentage out of the total number of admitted breed cases
1. Mongrel (Mixed-breed) 264 163 61.74%
2. Pomeranian 18 4 22.22%
3. Chihuahua 15 2 13.33%
4. Yorkshire Terrier 27 2 7.41%
5. Siberian Husky 126 7 5.56%
6. Golden Retriever 672 36 5.36%
7. German Shepherd 1194 62 5.19%
8. American Cocker Spaniel 49 2 4.08%
9. German Rottweiler 461 18 3.90%
10. Alaskan Husky 92 3 3.26%
11. Grand Griffon Vendéen 215 7 3.26%
12. English Cocker Spaniel 101 3 2.97%
13. Labrador Retriever 169 5 2.96%
14. Saint Bernard 70 2 2.86%
15. Doberman Pinscher 49 1 2.04%
16. Petit Basset Griffon Vendéen 147 2 1.36%
17. American Pitbull 313 4 1.28%
18. English Bullmastiff 89 1 1.12%
Total 4071 324 7.96%
Table 4. Number and percentage of fracture cases out of total cases admitted to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020 in relation to different cat breeds.
Cat breeds Total admitted cases Fracture cases Percentage out of the total number of admitted breed cases
19. Persian 2715 54 1.99%
20. Mongrel (Mixed-breed) 621 87 14.01%
21. Himalayan 162 3 1.85%
22. Siamese 126 4 3.17%
23. Egyptian Mau 68 1 1.47%
Total 3692 149 4.04%
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Table 5. Incidence of the fracture among affected dog breeds (Classified according to the body weight).
Dog breeds Fracture cases The percentage from admitted breed
Giant breeds Over 45kg English Bullmastiff Saint Bernard 1 2 1.12% 2.86%
Total 3 1.89%
German Shepherd 62 5.19%
Golden Retriever 36 5.36%
Large breeds 22-45 kg German Rottweiler Labrador Retriever Siberian Husky 18 5 7 3.90% 2.96% 5.56%
Alaskan Husky 3 3.26%
Total 131 4.83%
American Pitbull 4 1.28%
Medium Mongrel (Mixed-breed) 163 61.74%
breeds12-22kg Doberman Pinscher 1 2.04%
Total 168 26.84%
Grand Griffon Vendéen 7 3.26%
Small breeds 512kg Petit Basset Griffon Vendéen English Cocker Spaniel 2 3 1.36% 2.97%
American Cocker Spaniel 2 4.08%
Total 14 2.73%
Yorkshire Terrier 2 7.41%
Mini breeds less Pomeranian 4 22.22%
than 5kg Chihuahua 2 13.33%
Total 8 13.33%
Total 324 7.96%
Table 6. Incidence of the fracture among affected cat breeds (Classified according to the body conformation).
Cat breeds Fracture cases The percentage from admitted breed
Persian 54 1.99%
Cobby Himalayan 3 1.85%
Total 57 1.98%
Moderate Mongrel 87 14.01%
Total 87 14.01%
Siamese 4 3.17%
Svelte Egyptian Mau 1 1.47%
Total 5 2.58%
Total 149 4.04%
Table 7. Incidence of the fracture among affected dogs and cats (Classified according to the gender)
Species Fracture cases Total admitted cases
Male Female Total Male Female Total
No. 212 112 324 2784 1841 4625
Dog % out of total fracture cases 65.43% 34.57% 100.00%
% out of total admitted related gender 7.61% 6.08% 7.01%
% out of total admitted cases 4.58% 2.42% 7.01% 60.19% 39.81% 100.00%
No. 99 50 149 1454 2258 3712
Cat % out of total fracture cases % out of total admitted related gender 66.44% 6.81% 33.56% 2.21% 100.00% 4.01%
% out of total admitted cases 2.67% 1.35% 4.01% 39.17% 60.83% 100.00%
No. 311 162 473 4238 4099 8337
Total % out of total fracture cases 65.75% 34.25% 100.00%
% out of total admitted related gender 7.34% 3.95% 5.67%
% out of total admitted cases 3.73% 1.94% 5.67% 50.83% 49.17% 100.00%
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Table 8. The incidence of the fracture among the affected dogs and cats (Classified according to the age).
Fracture cases Total admitted cases
Species Juvenile (< 1 year) Young adult (1-3 years) Mature adult (3-10 years) Elder (> 10 years) Total Juvenile (< 1 year) Young adult (1-3 years) Mature adult (3-10 years) Elder (> 10 years) Total
No. 178 96 42 8 324 1661 1386 1358 220 4625
% out of total fracture cases 54.94% 29.63% 12.96% 2.47% 100%
Dog % out of total admitted related age 10.72% 6.93% 3.09% 3.64% 7.01%
% out of total admitted cases 3.85% 2.08% 0.91% 0.17% 7.01% 35.91% 29.97% 29.36% 4.76% 100%
No. 49 51 37 12 149 1244 851 963 654 3712
Cat % out of total fracture cases 32.89% 34.23% 24.83% 8.05% 100%
% out of total admitted related age 3.94% 5.99% 3.84% 1.83% 4.01%
% out of total admitted cases 1.32% 1.37% 1.00% 0.32% 4.01% 33.51% 22.93% 25.94% 17.62% 100%
No. 227 147 79 20 473 2905 2237 2321 874 8337
Total % out of total fracture cases 47.99% 31.08% 16.70% 4.23% 100%
% out of total admitted related age 7.81% 6.57% 3.40% 2.29% 5.67%
% out of total admitted cases 2.72% 1.76% 0.95% 0.24% 5.67% 34.84% 26.83% 27.84% 10.48% 100%
Table 9. The causes of fracture among the affected dogs and cats cases admitted to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020._
Cause of fracture
Species Road traffic accident Fall from height Unknown cause Indoor trauma Pathologica l conditions Animal bite Human abuse Total
Dog 141 63 71 18 12 10 9 324
43.5 % 19.4 % 21.9% 5.6 % 3.7% 3.1 % 2.8 % 100%
Cat 74 54 11 8 2 0 0 149
49.7 % 36.2 % 7.4 % 5.4 % 1.3% 0% 0% 100%
215 117 82 26 14 10 9 473
45.5 % 24.7 % 17.3 % 5.5 % 3% 2.1 % 1.9 % 100%
Table 10. The incidence of fracture among the affected dogs and cats cases admitted to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020 (Classified according to the affected skeletal part of the body).
Species
The affected skeletal part
Skull / Mandible
Axial skeleton
Vertebrae / ribs
Total
Appendicular skeleton
Forelimb
Hindlimb
Total
Total fracture cases
Dog
13
4 %
29 9 %
42 13%
88 27 %
194
60 %
282 87%
324 100%
Cat
31 20.8 %
11
7.4 %
42 28.2%
30 20.1 %
77 51.7 %
107 71.8%
149 100%
Total
44 9.3 %
40 8.5 %
84 17.8%
118 25 %
271 57.2 %
389 82.2%
473 100%
Table 11. Distribution of fractures in different appendicular bones in dogs' and cats' cases admitted to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020.
Appendicular bone
Species Femur Tibia & Fibula Humerus Radius & Ulna Other bones Total
Dog 108 38.3% 63 22.3% 14 5% 52 18.4% 45 16% 282 100%
Cat 46 43% 20 18.7% 14 13.1% 6 5.6% 21 19.6% 107 100%
Total 154 39.6% 83 21.3 28 7.2% 58 14.9% 66 17% 389 100%
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Establishment of the types and frequency of the bone fractures' occurrence
Classification of bone fractures based on the body parts, the incidence of specific limb and specific bone fractures
According to the affected skeletal part (table 10), the incidence of fracture among the affected dogs and cats were recorded as axial fractures (42 dogs, 13% and 42 cats, 28.2%) and appendicular fractures (282 dogs, 87% and 107 cats, 71.8%).
Incidence of specific limb (forelimbs / hind limbs) fractures.
Incidence of the fractures was found predominantly in hind limbs in dogs and cats, as 60% (n: 194) in dogs and 51.7% (n: 77) in cats. In turn, 27% (n: 88) of the fractures occurred in the forelimbs in dogs and 20.1% (n: 30) in cats (Table 10).
Incidence of specific appendicular bone fractures.
Concerning both forelimbs and hind limbs, in dogs, femur was the most affected bone (38.3%, n: 108), followed by the tibia/fibula (22.3%, n: 63), radius/ulna (18.4%, n: 52) and humerus (5%, n: 14). Meanwhile in cats, femur was the most affected bone (43%, n: 46), followed by the tibia/fibula (18.7%, n: 20), humerus (13.1%, n: 14) and radius/ulna (5.6%, n: 6) (Table 11).
Frequency of the different types of appendicular bone fracture based on the extent of tissue damage, site, and shape of the fracture line
The extent of tissue damage
Open or closed fracture. In the present study, closed fractures were more frequently recorded in dogs (89%, n: 282) and cats (76.6% n: 82) than open fractures (11%, n: 31) in dogs and (23.4% n: 25) in cats (Table 12). Regarding the forelimb (118 cases; 88 dogs and 30 cats), closed fractures (96 cases; 69 dogs and 27 cats) were recorded in 14, 40, and 15 dogs and 14, 3, and 10 cats in the humerus, radius & ulna and other bones representing 100%, 76.9% and 68.2% in dogs and 100%, 50% and 100% in cats out of the related bone fracture cases respectively, while open fractures (22 cases; 19 dogs and 3 cats) were recorded in 0, 12, and seven dogs and 0, three, and 0 cats in the humerus, radius & ulna and other bones representing 0%, 23.1% and 31.8% in dogs and 0%, 50% and 0% in cats out of the related bone fracture cases respectively. Regarding hindlimb (271 cases; 194 dogs and 77 cats), closed fractures (237 cases; 182 dogs and 55 cats) were recorded in 102, 57, and 23 dogs, and 30, 14, and 11 cats in the femur, tibia & fibula and other bones representing 94.4%, 90.5% and 100% in dogs and 65.2%, 70% and 100% in cats out of the related bone fracture cases respectively, while open fractures (34 cases; 12 dogs and 22 cats) were recorded in the femur, tibia & fibula and other bones representing 5.6%, 9.5% and 0% in dogs and 34.8%, 30% and 0% in cats out of the related bone (femur, tibia & fibula and other bones) fracture cases respectively.
Incomplete or complete fracture. The obtained results revealed that incomplete fractures were recorded in 42dogs and three representing 17.7% and 3.5% out of total fore and hind limbs long bone fractures (femur, tibia NS fibula, humerus and radius and ulna), while complete fractures were recorded in 195 dogs and 83 cats representing 82.3% and 96.5% out of total fore and hind limbs long bone fractures (femur, tibia and fibula, humerus and radius and ulna) (Tables 13 and 14).
Fractures' location
Proximal, diaphyseal or distal zones. Regarding the location of the fracture among the affected long bones, proximal, diaphyseal, and distal fractures were recorded in 27, 156 and 54 cases in dogs and 13, 37, and 36 cases in cats representing 11.4%, 65.8%, and 22.8%, and 15.1%, 43%, and 41.9% out of total fore and hind limbs long bone fractures (femur, tibia and fibula, humerus, and radius and ulna) in dogs and cats respectively (Tables 13 and 14).
Fractures' line
The number of fractures' line (single or comminuted). Regarding the number of the fractures' line among the affected long bones, single and comminuted fractures were recorded in 151 and 44 dogs, and 76 and 7 cats representing 63.7% and 18.6%, and 88.4% and 8.1% out of total fore and hind limbs long bone fractures (femur, tibia & fibula, humerus, and radius & ulna) in dogs and cats respectively (Tables 13 and 14).
The direction of fractures' line (transverse, oblique or spiral). Regarding the location of the fracture among the affected long bones, transverse, oblique, or spiral fractures were recorded in 75, 56, and 20 dogs, and 41, 24, and 11 cats representing 31.7%, 23.6%, and 8.4%, and 47.7%, 27.9%, and 12.8% out of total fore and hind limbs long bone fractures (femur, tibia & fibula, humerus, and radius & ulna) in dogs and cats respectively (Tables 13 and 14).
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Table 12. Incidinces of the different types of appendicular bone fracture in dogs' and cats' cases admitted to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020
based on the extent of tissue damage.
Forelimb Hindlimb
Species Fracture Humerus Radius & Other Total Femur Tibia & Other Total Total
Ulna bones Fibula bones
0 12 7 19 6 6 0 12 31
Open 0% 38.7% 22.6% 61.3% 19.4% 19.4% 0% 38.7% 100%
(0%) 14 (23.1%) 40 (31.8%) 15 (21.6%) 69 (5.6%) 102 (9.5%) 57 (0%) 23 (6.2%) 182 (11%) 251
Dog Closed 5.6% 15.9% 6% 27.5% 40.6% 22.7% 9.2% 72.5% 100%
(100%) 14 (76.9%) 52 (68.2%) 22 (78.4%) 88 (94.4%) 108 (90.5%) 63 (100%) 23 (93.8%) 194 (89%) 282
Total 5% 18.4% 7.8% 31.2% 38.3% 22.3% 8.2% 68.8% 100%
(100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%)
0 3 0 3 16 6 0 22 25
Open 0% 12% 0% 12% 64% 24% 0% 88% 100%
(0%) (50%) (0%) (10%) (34.8%) (30%) (0%) (28.6%) (23.4%)
14 3 10 27 30 14 11 55 82
Cat Closed 17.1% 3.7% 12.2% 32.9% 36.6% 17.1% 13.4% 67.1% 100%
(100%) (50%) (100%) (90%) (65.2%) (70%) (100%) (71.4%) (76.6%)
14 6 10 30 46 20 11 77 107
Total 13.1% 5.6% 9.3% 28% 43% 18.7% 10.3% 72% 100%
(100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%)
0 15 7 22 22 12 0 34 56
Open 0% 26.8% 12.5% 39.3% 39.3% 21.4% 0% 60.7% 100%
(0%) 28 (25.9%) 43 (21.9%) 25 (18.6%) 96 (14.3%) 132 (14.5%) 71 (0%) 34 (12.5%) 237 (14.4%) 333
Total Closed 8.4% 12.9% 7.5% 28.8% 42.6% 21.3% 10.2% 71.1% 100%
(100%) 28 (74.1%) 58 (78.1%) 32 (81.4%) 118 (85.7%) 154 (85.5%) 83 (100%) 34 (87.5%) 271 (85.6%) 389
Total 7.2% 14.9% 8.2% 30.3% 39.6% 21.3% 8.7% 69.6% 100%
(100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%) (100%)
Table 13. Incidince of the different types of appendicular bone fracture in dogs' cases admitted to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020 based on the extent, site, and shape of the fracture line._
Fracture type Incomplete Complete Total
Single Comminuted
Site Bone Transverse Oblique Spiral
Femur 7 3 - - - 10
70.0% 30.0% - - - 100%
(43.8%) (37.5%) - - - (37.0%)
[16.7%] [4.0%] - - - [4.2%]
Tibia & fibula 9 3 3 - - 15
60.0% 20.0% 20.0% - - 100%
(56.3%) (37.5%) (100%) - - (55.6%)
[21.4%] [4.0%] [5.4%] - - [6.3%]
Proximal Humerus - - - - - -
- - - - - -
- - - - - -
- - - - - -
Radius & ulna - 2 - - - 2
- 100% - - - 100%
- (25.0%) - - - (7.4%)
- [2.7%] - - - [0.8%]
Total 16 8 3 - - 27
59.3% 29.6% 11.1% - - 100%
(100%) (100%) (100%) - - (100%)
[38.1%] [10.7%] [5.4%] - - [11.4%]
Femur 7 3 14 20 26 70
10.0% 4.3% 20.0% 28.6% 37.1% 100%
(29.2%) (8.6%) (35.0%) (100.0%) (70.3%) (44.9%)
[16.7%] [4.0%] [25.0%] [100.0%] [59.1%] [29.5%]
Tibia & fibula 3 13 18 - 7 41
7.3% 31.7% 43.9% - 17.1% 100%
(12.5%) (37.1%) (45.0%) - (18.9%) (26.3%)
[7.1%] [17.3%] [32.1%] - [15.9%] [17.3%]
Diaphyseal Humerus 2 4 - - 1 7
28.6% 57.1% - - 14.3% 100%
(8.3%) (11.4%) - - (2.7%) (4.5%)
[4.8%] [5.3%] - - [2.3%] [3.0%]
Radius & ulna 12 15 8 - 3 38
31.6% 39.5% 21.1% - 7.9% 100%
(50.0%) (42.9%) (20.0%) - (8.1%) (24.4%)
[28.6%] [20.0%] [14.3%] - [6.8%] [16.0%]
Total 24 35 40 20 37 156
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15.4% 22.4% 25.6% 12.8% 23.7% 100%
(100%) (100%) (100%) (100%) (100%) (100%)
[57.1%] [46.7%] [71.4%] [100.0%] [84.1%] [65.8%]
Femur - 19 4 - 5 28
- 67.9% 14.3% - 17.9% 100%
- (59.4%) (30.8%) - (71.4%) (51.9%)
- [25.3%] [7.1%] - [11.4%] [11.8%]
Tibia & fibula - 3 2 - 2 7
- 42.9% 28.6% - 28.6% 100%
- (9.4%) (15.4%) - (28.6%) (13.0%)
- [4.0%] [3.6%] - [4.5%] [3.0%]
Distal Humerus - 5 2 - - 7
- 71.4% 28.6% - - 100%
- (15.6%) (15.4%) - - (13.0%)
- [6.7%] [3.6%] - - [3.0%]
Radius & ulna 2 5 5 - - 12
16.7% 41.7% 41.7% - - 100%
(100.0%) (15.6%) (38.5%) - - (22.2%)
[4.8%] [6.7%] [8.9%] - - [5.1%]
Total 2 32 13 - 7 54
3.7% 59.3% 24.1% - 13.0% 100%
(100%) (100%) (100%) - (100%) (100%)
[4.8%] [42.7%] [23.2%] - [15.9%] [22.8%]
Total 42 75 56 20 44 237
17.7% 31.7% 23.6% 8.4% 18.6% 100%
[100%] [100%] [100%] [100%] [100%] [100%]
Table 14. Incidince of the different types of appendicular bone fracture in cats' cases admitted to the Referral Veterinary Teaching Hospital, Cairo University and some Private Clinics in Egypt from January 2017 to January 2020 based on the
site, extend and shape of the fracture line.
Fracture type Incomplete Complete Total
Single Comminuted
Site Bone Transverse Oblique Spiral
Femur 1 5 6 - - 12
8.3% 41.7% 50% - - 100%
(100%) (83.3%) (100%) - - (92.3%)
[33.3%] [12.2%] [25%] - - [14%]
Tibia & fibula - - - - - -
- - - - - -
- - - - - -
- - - - - -
Proximal Humerus - - - - - -
- - - - - -
- - - - - -
- - - - - -
Radius & ulna - 1 - - - 1
- 100% - - - 100%
- (16.7%) - - - (7.7%)
- [2.4%] - - - [1.2%]
Total 1 6 6 - - 13
7.7% 46.2% 46.2% - - 100%
(100%) (100%) (100%) - - (100%)
[33.3%] [14.6%] [25%] - - [15.1%]
Femur - 1 3 6 2 12
- 8.3% 25% 50% 16.7% 100%
- (20%) (21.4%) (54.5%) (33.3%) (32.4%)
- [2.4%] [12.5%] [54.5%] [28.6%] [14%]
Tibia & fibula 1 1 8 - 4 14
7.1% 7.1% 57.1% - 28.6% 100%
(100%) (20%) (57.1%) - (66.7%) (37.8%)
[33.3%] [2.4%] [33.3%] - [57.1%] [16.3%]
Diaphyseal Humerus - 3 2 5 - 10
- 30% 20% 50% - 100%
- (60%) (14.3%) (54.5%) - (27%)
- [7.3%] [8.3%] [54.5%] - [11.6%]
Radius & ulna - - 1 - - 1
- - 100% - - 100%
- - (7.1%) - - (2.7%)
- - [4.2%] - - [1.2%]
Total 1 5 14 11 6 37
2.7% 13.5% 37.8% 29.7% 12.2% 100%
(100%) (100%) (100%) (100%) (100%) (100%)
[33.3%] [12.2%] [58.3%] [100%] [85.7%] [43%]
Femur - 21 - - 1 22
Distal - 95.5% - - 4.5% 100%
- (70%) - - (100%) (61.1%)
- [51.2%] - - [14.3%] [25.6%]
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Tibia & fibula 1 5 - - - 6
13.0% 83.3% - - - 100%
(100%) (16.7%) - - - (16.7%)
[33.3%] [12.2%] - - - [7%]
Humerus - - 4 - - 4
- - 100% - - 100%
- - (100%) - - (11.1%)
- - [16.7%] - - [4.7%]
Radius & ulna - 4 - - - 4
- 100% - - - 100%
- (13.3%) - - - (11.1%)
- [9.8%] - - - [4.7%]
Total 1 30 4 - 1 36
3.7% 83.3% 11.1% - 2.8% 100%
(100%) (100%) (100%) - (100%) (100%)
[33.3%] [73.2%] [16.7%] - [14.3%] [41.9%]
3 41 24 11 7 86
Total 3.5% 47.7% 27.9% 12.8% 8.1% 100%
[100%] [100%] [100%] [100%] [100%] [100%]
DISCUSSION
The present retrospective study provided novel descriptive data of the prevalence of dogs and cats with appendicular fractures in Egypt through the recorded cases in the referral veterinary teaching hospital, faculty of veterinary medicine, Cairo University and some private pet clinics in Cairo district, Egypt admitted from January 2017 to January 2020, and it emphasized the information that characterized the population (breed, age, gender and animal size).
The total number of the admitted cases to the hospital and the clinics during the current study period was 8337 pets (4625 dogs and 3712 cats) with a ratio of 55.5% to 44.5% respectively, which indicated that dog breeding is relatively more popular in the Egyptian society than raising cats. This may be due to the expansion of new communities with increasing numbers of compounds, resorts and villas in the regions with high social level which requires breeding guard dogs. This was clearly shown by the current findings that the most common admitted breeds were guard or outdoor dogs' breeds representing 68.8% of total admitted dogs. The results of the most common dog breeds in Egypt were in agreement with previous studies (Nouh et al., 2014; Rakha et al., 2015). More than the quarter of the admitted dogs was German Shepherd (25.8%). On the other hand, mongrel or stray dogs (representing 5.7% of total admitted dogs) were frequently admitted to the referral veterinary teaching hospital, faculty of veterinary medicine, Cairo university, through animal welfare societies and stray animal rescue persons or associations, and most of these cases were surgical injuries (representing 89% of total admitted mongrel dogs) with fracture incidence of 61.7%.
Regarding the cat breeds, relatively, there were few different breeds raised within the Egyptian society. The results were nearly similar to previously recorded ones (Farghali et al., 2020). Only six cat breeds were admitted to the hospital and the clinics during the study period with the highest admission of Persian cat breed (representing 73.1% of total admitted cats). On the other hand, mongrel cats (representing 16.7% of total admitted cats) were frequently admitted to the referral veterinary teaching hospital, faculty of veterinary medicine, Cairo university. Some of them were raised indoor, and the others were presented through animal welfare societies and stray animal rescue associations or persons, and most of these cases were surgical injuries (representing 64.7% of total admitted mongrel cats) with soft tissue surgical affections and fracture incidences (50.7% and 14% respectively).
In the present study, the incidence of fracture was higher in dogs (7%) than in cats (4%). Meanwhile, fractures observed in cats showed a similarity to those in dogs as in regard to the site of fracture. However, cats do have several advantages as orthopedic patients when compared to dogs including their light weight, straight bones, and anatomical configuration (Harasen, 2009; Singh et al., 2015). The highest incidences of the fracture cases were recorded in mongrel dogs and cats which may be due to the frequent exposure of stray animals to road traffic accidents. This result was similar to the previous study of Harasen 2003a (2004), Senn et al. (2004) and Uwagie-Ero et al. (2018).
With excluding of mongrel dogs (as anomalous fractures' incidence), the highest incidence of canine fracture cases was recorded in miniature breeds (less than 5kg, 13.33%), followed by large breeds (22-45 kg, 4.83%), small breeds (512kg, 2.73%), giant breeds (over 45kg, 1.89%) and medium breeds (12-22kg, 1.4%). These results were nearly similar to those recorded in previous studies where the most commonly affected breed was Yorkshire terrier (12%), followed by Poodle (12%) and Maltese (9%) (Minar et al., 2013). On the other side, some other previous studies have reported that German shepherds were the most affected breed (Ali, 2013; Rhangani, 2014; Libardni et al., 2016). Obviously, the variation of incidence of bone fractures in different breeds of dogs may be related to the regions/countries that the owners lived which may be different in behavior/life styles in the different countries (Minar et al., 2013). Other author mentioned that the size of the dog does not mean a condition of predisposition to fractures (Johnson, 2013). Many
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articles supported the theory that fractures were more often in smaller dogs (Brianza et al., 2006; Yu et al., 2010; De Arburn Parent et al., 2017). This may be due to the low muscle coverage in the limbs (Milovancev and Ralphs, 2004).
In cats, the highest incidence of bone fractures was recorded in mongrel breeds (14%). This was similar to previous study by Borges et al. (2016). Other factor contributing in the high incidence of fractures in mongrel cat breed rather than the road traffic accidents of stray cats, was the fact that the majority of cats recorded in the clinic were mixed breed. Regarding cat's body conformation, the highest incidence was recorded in moderate (14.01%) (Due to mongrel c ats), followed by svelte (2.58%) and cobby (1.98%) breeds. It may be due to the normal playful behavior of svelte and moderate breeds with long limbs (Siamese and Egyptian Mau) resulting in frequent trauma and falling from a height more than the lazy cobby breeds with short limbs (Persian and Himalayan) (Helgren, 2013).
From the obtained data, male dogs (60.19%) were more frequently admitted than female ones (39.81%), while the opposite was recorded in cats (39.17% male and 60.83% female). These findings may be screening the fact of preferring of dog owners to rear male dogs more than females. The result which barrels to other previous researches which added that male dogs are more sociable, dominant, territorial, playful, active, and independent than females (Hart and Hart, 2016; Scandurra et al., 2018). On the other hand, most of cat owners prefer to raise female cats more than males (as it is obvious in this work where queens were admitted about one and half times more than tomcats), may be due to the disliked behavior of much more territorial male cats during the mating season, such as spraying which is not desired by many of the owners (Farghali et al., 2020).
In the current study, gender was among the predisposing factors where remarkable higher incidence was recorded in male dogs (65.4%) and cats (66.4%), than females (34.6% and 33.6%), respectively which is nearly the same in both species. This finding was similar to the reports elsewhere (Dvorak et al., 2000; Senn et al., 2004; Rhangani, 2014). As males are known to be more aggressive, and tend to roam for longer distances, it exposes them to external etiological agents (Simpson, 2004; Kumar et al., 2007; Ben Ali, 2013; Elzomor et al., 2014). Other factors, which may be incriminated, were escaping of uncastrated tomcat from homes during the mating season and exposure to falls from windows and road accidents (Farghali et al., 2020).
In relation to the age, bone fracture was mostly occurred in dogs of less than one-year-old. This finding was similar to many previous studies (Kushwaha et al., 2011; Ali, 2013; Minar et al., 2013; Uwagie-Ero et al., 2018). This higher incidence of fracture in young dogs up to 1 year of age might be due to being playful, active nature of the young ones compared to the adult dogs, and being inexperienced to escape from the hazards. Previous study mentioned that puppies were most affected by femoral fractures due to low bone density in their development (osteogenesis) phase (Libardoni et al., 2018). This was contrary to what was reported in Kenya revealing that the incidence of appendicular fractures was higher in adults (79%) as compared to the young dogs (21%) (Rhangani, 2014).
Regarding cats, the bone fracture was mostly occurred in cats of one to three years old. It may be resulted from reduced knowledge of neutralization importance of tomcats and queens in Egyptian society resulting in bad habits such as escaping of cats from homes during the mating season, cat fighting, exposure to falls from heights and traffic accidents (Farghali et al., 2020). The findings of the present study revealed that the extrinsic factors which include motor vehicle accidents, falling from height, and dog bites were the major etiological agents of bone fractures in dogs. These findings were consistent with those in other studies elsewhere (Simpson, 2004; Kumar et al., 2007; Ben Ali, 2013; Elzomor et al., 2014; Rhangani, 2014; Vidane et al., 2014). A high incidence of car accidents was due to the high number of animals with access to public roads, and the owners who suppress the containment and protection measures in their homes and during outings (Libardoni et al., 2016). Meanwhile, in cats, traffic accidents followed by falling from heights and cat bites were also the most common causes (Denny and Butterworth, 2000; Senna et al., 2004; Piermattei et al., 2006; Lovric et al., 2020).
In the current work, there was a high incidence of the appendicular long bones concerning the different bone fractures. The same was reported in previous studies (Harasen, 2003a; Thengchaisri et al., 2006; Ali, 2013; Bennour et al., 2014; Rhangani, 2014; Libardoni et al., 2016).
On the other hand, the distribution of common orthopedic conditions in canine and feline species concerning the admitted cases revealed that the prevalence of appendicular fractures was significantly higher in dogs (87%) than in cats (71.8%). Nearly the same result was mentioned by Bennour et al. (2014) and Singh et al. (2015). Such variation may be attributed to the owners' close observation and care directed to cats comparing with dogs, as cats are kept most of the time inside the houses (Singh et al., 2015). In the current study, fractures in the hindlimbs were higher than in forelimbs in both dogs and cats which the finding was similar to the studies reported elsewhere with a different relationship (Souza et al 2011; Ben Ali, 2013; Minar et al., 2013; Bennour et al., 2014; Rhangani, 2014; Roush, 2014; Eyarefe and Oyetayo, 2016; Uwagie-Ero et al., 2018). Most of the long bone fractures in dogs and cats occurring in hindlimbs were found in the femur, followed by tibia and fibula. These results were similar to other studies in Thailand (Thengchaisri et al., 2006), India (Shiju et al., 2010), Korea (Minar et al., 2013), Kenya (Rhangani, 2014), Egypt (50.6%) (Elzomor et al., 2014), Philippines (Libardoni et al., 2016) and Austria (Lovric et al., 2020). However, in the dogs' forelimb, radius and
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ulna were the bones with the most fractures (Minar et al., 2013; Bennour et al., 2014; Libardoni et al., 2016). This may be due to the low local muscle coverage (Milovancev and Ralphs, 2004).
The fracture of the humerus in cats were the most common sites of forelimb fracture. Similar results have been reported (Chandler and Beale, 2002; Senn et al., 2004; Ben Ali, 2013). Concerning both forelimbs and hindlimbs, the femur was the most affected bone, followed by tibia or fibula, radius or ulna, and humerus in dogs. Other studies showed higher incidences of occurrence with radius, ulna, and femur (Harasen, 2003b; Beale, 2004; Elzomor et al., 2014).
In cats, the femur was also the most frequently fractured bone, but there were variations in the prevalence of fractures among tibia or fibula, humerus and radius or ulna. This was in agreement with previous results (Piermattei et al., 2006; Lovric et al., 2020). Some authors considered the fractures of the radius/ulna to be infrequent accounting for humeral fractures (Chandler and Beale, 2002). In the present study, closed fractures were more frequent than open fractures. The percentage of the open fractures were more common in cats (23.4%) than in dogs (11%). Open fractures were observed more frequently in the bones below the elbow and stifle in dogs due to poor soft-tissue coverage (Voss and Montavon, 2009). While, in cats, open fractures were more frequently recorded in supracondylar femoral fracture.
Incomplete fractures were recorded more frequently in dogs than in cats representing 17.7% and 3.5% out of the total fore and hind limbs long bone fractures. Greenstick, fissures, and folding fractures were the most common form of incomplete fractures among dogs. The results which were in agreement with previous findings described that greenstick or incomplete fractures were more commonly seen in juveniles (Jain et al., 2016). Complete fractures were recorded more frequently in cats than in dogs representing 96.5% and 82.3% out of total fore and hind limbs long bone fractures.
Regarding the number and direction of the fracture line, the most common type of fracture encountered in both fore and hind limbs in dogs was complete single transverse fracture (31.7%) followed by oblique (23.6%), comminuted (18.6%), incomplete (17.7%) and spiral (8.4%) fractures. This was similar to what has been reported in previous studies (Shiju et al., 2010; Shiju et al., 2011; Ben Ali, 2013).
In cats, the most common type of fracture encountered in both fore and hind limbs was also complete single transverse (47.7%) followed by oblique (27.9%), spiral (12.8%), comminuted (8.1%) and incomplete (3.5%) fractures. Out of 237 cases of appendicular long bone fractures in dogs, the diaphyseal fracture was the most common site of fracture (156 cases, 65.8%), followed by distal fractures (54 cases, 22.8%) and proximal fractures (27 cases, 11.4%). Out of 86 fracture cases in cats, 43% (37 cases) in the diaphyseal, 41.9% (36 cases) was in the distal part and 15.1% (13 cases) in proximal one.
CONCLUSION
From the obtained data, it could be concluded that there was a high incidence of the appendicular long bones concerning the different bone fractures with significantly higher records in dogs than in cats. The highest records of fracture were in mongrel dogs, and cats as rescued animals. With excluding of mongrel dogs and cats, the highest incidence of canine fracture cases was recorded in Miniature breeds, and feline fracture in svelte breeds. Male dogs and cats showed a higher incidence than females. The bone fracture has mostly occurred in dogs of less than one-year-old, and in cats of one to three years old. The fracture in the hindlimbs was higher than forelimbs with the highest incidence among femur in both dogs and cats. The percentage of open fractures were more common in cats than in dogs. Incomplete fractures were recorded more frequently in dogs than in cats. In dogs, the most common fracture in the femur, tibia/fibula, humerus and radius/ulna were complete comminuted diaphyseal femoral, complete oblique diaphyseal tibial/fibular, complete transverse distal humoral, and complete transverse diaphyseal radial/ulnar fractures respectively, and in cats, were complete transverse distal femoral, complete oblique diaphyseal tibial/fibular, complete spiral diaphyseal humoral, and complete transverse distal radial/ulnar fractures respectively.
DECLARATIONS
Acknowledgments
This study was supported by the department of surgery, anesthesiology and radiology, Faculty of veterinary medicine, Cairo University, Egypt. The authors would also like to thank the team of Alpha vet pet clinic, Office Building at Al-rehab Cairo, Cairo Governorate, Egypt for their assistance in data collection.
Competing interests
The authors declare that there is no conflict of interest.
Author's contribution
Ahmed Elsayed Ahmed and Haithem Ali Mohamed Ahmed Farghali designed the study and wrote the manuscript. Abeer Ali Mahmoud Abo-Soliman and Haithem Ali Mohamed Ahmed Farghali participated in data collection and analysis, writing. All authors have read and approved the final manuscript.
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REFERENCES
Ali LB (2013). Incidence, occurrence, classification and outcome of small animal fractures: A retrospective study (2005-2010). WASET, Journal of Animal Veterinary Sciences, 7: 191-196. DOI: https://doi.org/10.5281/zenodo.1082359
American Kennel Club (2006). The Complete Dog Book. 20th ed. New York: Ballantine Books, . Available at: https://www.amazon.com/Complete-Dog-Book-20th/dp/0345476263
Appari AM, Johnson E, and Anthony DL (2013). Meaningful use of electronic health record systems and process quality of care: evidence from a panel data analysis of U.S. acute-care hospitals. Health Services Research, 48(2): 354-375. DOI: https://doi.org/10.1111/j.1475-6773.2012.01448.x
Beale B (2004). Orthopedic clinical techniques femur fracture repair. Clinical Techniques in Small Animal Practice, 19(3): 134-150. DOI: https://doi.org/10.1053/j.ctsap.2004.09.006
Ben Ali LM (2013). Incidence, occurrence, classification and outcome of small animal fractures: A retrospective study (2005-2010) World Academy of Science, Engineering and Technology, 7(3): 516-521. DOI: https://doi.org/10.5281/zenodo.1082359
Bennour E, Abushhiwa M, Ben Ali L, Sawesi O, Marzok M, Abuargob O, Tmumen S, Abdelhadi J, Abushima M, and Benothman M (2014). A Retrospective study on appendicular fractures in dogs and cats in Tripoli-Libya. Journal of Veterinary Advanced, 4: 425-431. Available at: https://www.ejmanager.com/mnstemps/74/74-1391243660.pdf
Borges C, Rahal S, Agostinho F, Mamprim M, Santos R Silva FE, Carolina MA, and Monteiro FO (2016). Long bone fracture in cat. A retrospective study. Veterinaria Zootecnia, 23: 504-509. Available at: https://www.researchgate.net/publication/307598723
Brianza SZ, Delise M, Maddalena Ferraris M, D'Amelio P, and Botti P (2006). Cross-sectional geometrical properties of distal radius and ulna in large, medium and toy breed dogs. Journal of Biomechanics, 39(2): 302-311. DOI: https://doi.org/10.1016/j .jbiomech.2004.11.018
Chandler JC, and Beale BS (2002). Feline orthopedics. Clinical Techniques in Small Animal Practice, 17: 190-203. DOI: https://doi.org/10.1053/svms.2002.36607
Chaves RO (2014). Neurological diseases in dogs examined at the Veterinary Teaching Hospital of the Federal University of Santa Maria, RS: 1.184 cases (2006-2013). Pesquisa Veterinaria Brasileira,34(10): 996-1001. DOI: https://doi.org/10.1590/S0100-736X2014001000012
De Arburn Parent R, Benamou J, Gatineau M, Clerfond P, and Planté J (2017). Open reduction and cranial bone plate fixation of fractures involving the distal aspect of the radius and ulna in miniature- and toy-breed dogs: 102 cases (2008-2015). Journal of the American Veterinary Medical Association , 250(12): 1419-1426. DOI: https://doi.org/10.2460/javma.250.12.1419
Denny HR, and Butterworth SJ (2000). Classification of fractures, p.83-86. In: Ibid. (Eds). A guide to canine and feline orthopedic surgery. Wiley-Blackwell, Oxford, P. 644. Available at: https://onlinelibrary.wiley.com/doi/pdf/10.1002/9780470699027
Dvorak M, Necas A, and Zatloukal J (2000). Complications of long bone fracture healing in dogs: Functional and radiological criteria for their assessment. Acta Veterinaria Brno, 69: 107-114. DOI: https://doi.org/10.2754/avb200069020107
Elzomor ST, Sheta EME, Farghali HA, and Ashour AE (2014). Prevalence of femoral fractures in dogs and cats .The Journal of the Egyptian Medical Association, 74: 269-278. Available at:
https://www.academia.edu/download/35180585/PREVALENCE OF FEMORAL FRACTURES IN DOGS AND CATS.pdf
Eyarefe O, and Oyetayo SN (2016). Prevalence and pattern of small animal orthopaedic conditions at the Veterinary Teaching Hospital, University of Ibadan. Sokoto Journal of Veterinary Sciences, 14: 8. DOI: https://doi.org/10.4314/sokjvs.v14i2.2
Farghali HA, Senna NA, Khattab MS, and Shalaby RKI (2020). Prevalence of most common feline genital surgical affections in teaching veterinary hospital, Cairo university, Egypt and different pet clinics. Advances in Animal and Veterinary Sciences, 8(7): 709-719. DOI: https://doi.org/10.17582/journal.aavs/2020/87.709.719
Fogle B (2009). The Encyclopedia of the dog. New York: DK Publishing. Available at: https://www.amazon.com/Encyclopedia-Dog-Bruce-Fogle/dp/0756660041
Fossum TW (2013). Small Animal Surgery. 4th.ed. St. Louis Missouri: Mosby Elsevier, p. 1619. Available at: https://www.elsevier.com/books/small-animal-surgery/fossum/978-0-323-10079-3
Gadallah SM, Farghali H, and Magdy A (2009). Combined different fixation systems for reconstruction of comminuted diaphyseal femoral fractures in dogs. Journal of the Egyptian Veterinary Medical Association, 69(2): 29-44. Available at: https://www.academia.edu/5474710/
Harari J (2002). Treatment of feline long bone fractures. Veterinary Clinics North America Small Animal Practice, 32(4): 927-947. DOI: https://doi.org/10.1016/S0195-5616(02)00025-6
Harasen G (2003a). Common long bone fractures in small animal practice. Part 1: Canadian Veterinary Journal, 44: 333-334. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC372259/
Harasen G (2003b). Common long bone fractures in small animal practice. Part 2. Canadian Veterinary Journal, 44: 503-504. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC340183/
Harasen G (2004). Atraumatic proximal femoral physeal fractures in cats. Canadian Veterinary Journal, 45: 359-360. Available at: https://europepmc.org/ article/med/15144117
Harasen G (2009). Feline orthopedics. Canadian Veterinary Journal, 50(6): 669-670. Available at: https://www.ncbi .nlm.nih. gov/pmc/articles/PMC2684059/
Hart B ,and Hart L (2016). Breed and gender differences in dog behavior. 10.1017/9781139161800.007. In book: The Domestic Dog. Edition: 2nd, Chapter: 7, Publisher: Cambridge University Press, Editors: James Serpell, Pp. 118-132. DOI: https://doi.org/10.1017/9781139161800.007
Helgren JA (2013). Barron's encyclopedia of cat breeds: a complete guide to the domestic cats of North America / J. Anne Helgren; with photographs by Bob Schwartz; illustrations by Michele Earle-Bridges, 2nd edition. Copyright, text and Illustrations © 2013, 1997 by Barron's Educational Series, Inc., P. 60. Available at: https://trove .nla.gov.au/work/23422748
Hobbs SL (2012). Biological and radiological assessment of fracture healing. In Practice, 25: 26-35. DOI: https://doi .org/10.113 6/inpract. 25.1.26
Jain R, Parihar AS, Kamble S, Parihar YS, and Ganguly S (2016). Multiple Fractures in Tibia Bone of Dog: A Case Study. International Journal of Contemporary Microbiology, January-June, 2(1): 82-83. DOI: https://doi.org/10.5958/2395-1796.2016.00019.3
Kumar K, Mogha HP, Kinjavdekarp, Amarpal, Singh GR, Pawde AM, Kushwaha, and Kushwaha RB (2007). Occurrence and pattern of long bone fractures in growing dogs with normal and osteopenic bones. Journal of the American Veterinary Medical Association, 54: 484-490. DOI: https://doi.org/10.1111/j .1439-0442.2007.00969.x
Kushwaha RB, Gupta AK, Bhadwal MS, Kumar S, and Tripathi AK (2011). Incidence of fractures and their management in animals: a clinical study of 77 cases. Indian Journal of Veterinary Surgery, 32(1): 54-56. Available at:
https://www.researchgate.net/publication/333311447_Incidence_of_fracture_and_its_management_in_animals
Lanz OI (2002). Lumbosacral and pelvic injuries. The Veterinary clinics of North America. Small animal practice, 32(4): 949-962. DOI: https://doi.org/10.1016/S0195-5616(02)00029-3
651
Libardoni RDN, Serafini GMC, Oliveira CD, Schimites PI, Chaves RO, Feranti JPS, Costa CAS, Amaral ASD, Raiser AG, and Soares AV (2016). Appendicular fractures of traumatic etiology in dogs: 955 cases 2004-2013. Ciencia Rural, 46: 542-546. DOI: https://doi .org/10.1590/0103-8478cr20150219
Libardoni RDN, Da Costa D, Menezes FB, Cavalli LG, Pedr otti LF and Kohlrausch PR (2018). Classification, fixation techniques, complications and outcomes of femur fractures in dogs and cats: 61 cases (2015-2016). Ciencia Rural, 48(6): 1-6. DOI: https://doi.org/10.1590/0103-8478cr20170028
Lovric L, Kreszinger M and Pecin M (2020). Surgical Treatment of Canine Femoral Fractures - a Review. World Veterinary Journal, 10 (2): 137-145. DOI: https://dx.doi.org/10.36380/scil.2020.wvj18
Johnson AL (2013). Management of specific fractures. In: Fossum, T.W. Small animal surgery. 4th.ed. St. Louis, Missouri: Mosby Elsevier, pp. 11061214. Available at: https://www.elsevier.com/books/small-animal-surgery/fossum/978-0-323-10079-3
Milovancev M, and Ralphs SC (2004). Radius/Ulna fracture repair. Clinical Techniques in Small Animal Practice, 19(3): 128-133. DOI: https://doi.org/10.1053/j.ctsap.2004.09.005
Minar M, Hwang Y, Park M, Kim S, Oh C, Choi S, and Kim G (2013). Retrospective study on fractures in dogs. Journal of Biomedical Research, 14: 140-144. DOI: https://doi.org/10.12729/jbr.2013.14.3.140
Nouh SR, Abo-Ahmad HM, Farghali HA, and Saleh MM (2014). A Retrospective Study on Canine Hip Dysplasia in Different Breeds in Egypt. Global Veterinaria, 13(4): 503-510. Available at: http://scholar.cu.edu.eg/?q=haithem farghail/files/10.pdf
Piermattei DL, Flo G, and DeCamp C (2006). Brinker, Piermattei, and Flo's handbook of small animal orthopedics and fracture repair. 4th Edition., St. Louis, Missouri, Saunders, Elsevier, Pp. 549-553. Available at: https://www.elsevier.com/books/brinker-piermattei-and-flos-handbook-of-small-animal-orthopedics-and-fracture-repair/decamp/978-1-4377-2364-9?aaref=https%3A%2F%2Fwww.google.com%2F
Rakha GMH, Abdl-Haleem MM, Farghali HAM, and Abdel-Saeed H (2015). Prevalence of common canine digestive problems compared with other health problems at teaching. veterinary hospital, Faculty of Veterinary Medicine, Cairo University, Egypt. Veterinary World, 8(3): 403-411. DOI: https://doi.org/10.14202/vetworld.2015.403-411
Rhangani AT (2014). Incidence, classification and management of appendicular bone fractures in dogs in Nairobi country, Kenya. A retrospective study. Master thesis of veterinary surgery, university of Nairobi, Kenya. Available at: http://erepository.uonbi.ac.ke/bitstream/handle/11295/74296/Rhangani_Incidence,%20Classification%20And%20Management%20Of%20Appen dicular%20Bone%20Fractures%20In%20Dogs%20In%20Nairobi%20County,%20Kenya.%20A%20Retrospective%20Study.pdf?sequence=5&is Allowed=y
Roush (2014). Pet Health by the Numbers: Prevalence of Bone Fractures in dogs & cats at 890 Banfield Pet Hospital USA. Journal of Today's Veterinary Practice, pp.1-17. Available at: https://todaysveterinarypractice.com/pet-health-by-the-numbers-prevalence-of-bone-fractures-in-dogs-cats/
Rrisselada M, Kramer M, and van Bree H (2005). Ultrasonographic and radiographic follow up of uncomplicated secondary fracture healing of long bones in dogs and cats. Veterinary Surgery, 34: 99-107. DOI: https://doi.org/10.1111/j.1532-950X.2005.00017.x
Scandurra A, Alterisio A, Di Cosmo A, and D'Aniello B (2018). Behavioral and Perceptual Differences between Sexes in Dogs: An Overview. Animals, 8(151): 1-26. DOI: https://doi.org/10.3390/ani8090151
Senna NA, Gadallah SM, and Zabady MK (2004). Studies on some bone disorders in cats: incidence, radiological assessment and surgical management. Journal of the Egyptian Veterinary Medical Association, 64(3): 113-137. Available at: https://scholar.google.com/scholar?cluster=10334186832027713353&hl=ar&as_sdt=2005&sciodt=0,5
Shales C (2008a). Fracture management in small animal practice: 1. Triage and stabilisation. In practice, 30(6): 314-320. DOI: https://doi.org/10.113 6/inpract.30.6.314
Shales C (2008b). Fracture management in small animal practice: 2. Assessment and planning. In practice, 30(7): 374-384. DOI: https://doi.org/10.113 6/inpract.30.7.374
Shearer (2011). Epidemiology of orthopedic disease. Veterinary Focus, 21(2): 24-25. DOI: https://doi.org/10.1055/s-0034-1381849
Shiju MS, Ganesh R, Ayyappan S, Rao GD, Kumar RS, Kundave VR and Das BC (2010). Incidence of pelvic limb fractures in dogs: a survey of 478 cases. Veterinary World Journal, 3(3): 120-121. Available at:
http://www.veterinaryworld.org/Vol.3/March/Incidences%20of%20pelvic%20limb%20fractures%20in%20dogs.pdf
Shiju MS, Ganesh R, Ayyappan S, and Kumar RS (2011). Incidence of pectoral limb fractures in dogs: a survey of 331 cases. Tamilnadu Journal of Veterinary and Animal Sciences, 7 (2): 94-96. Available at: https://pdfs.semanticscholar.org/3cde/06a59f5912f6c7751b9276ce487ec55c0259.pdf
Simpson AM (2004). Fractures of the humerus. Clinical Techniques in Small Animal Practice, 19(3): 120-127. DOI: https://doi.org/10.1053/j.ctsap.2004.09.004
Singh R, Chandrapuria VP, Shahi A, Bhargava MK, Swamy M, and Shukla PC (2015). Fracture occurrence pattern in animals. Journal of Animal Research, 5(3): 611-616. DOI: https://doi.org/10.5958/2277-940X.2015.00103.5
Thengchaisri N, Chaiyakorn T, Pailin P, and Jadee T (2006). Classification of long bone fractures in dogs and cats, Proceeding of the 32th Veterinary Medicine and Livestock Development Annual Conference, Faculty of Veterinary Medicine Mahanakorn University of Technology, Bangkok, pp. 57-63. Available at:: http://www.vet.cmu.ac.th/cmvj/document/vol.17/number2/2019%2017-2%20%5B21%5D.pdf
Uwagie-Ero EA, Abiaezute CN, Okorie-Kanu OJ, Odigie EA, and Asemota OD (2018). Retrospective evaluation of canine fractures in southern Nigeria. Comparative Clinical Pathology, pp.1127-1132. DOI: https://doi.org/10.1007/s00580-018-2708-3
Vidane AS, Elias MZJ, Cardoso JMM, Come JAS., Harun M, and Ambrosio CE (2014). Incidence of fractures in the dogs and cats in Maputo (Mozambique) between 1998 and 2008. Brazilian Journal of Animal Science, 15: 490-494. DOI: https://doi.org/10.1590/1089-6891v15i424279
Voss K, and Montavon PM (2009). Fractures, p. 129-151. In: Montavon P.M., Voss K. & Langley-Hobbs S.J. (Ed.), Feline orthopedic surgery and musculoskeletal disease. Mosby Elsevier, Edinburgh, P. 582. DOI: https://doi.org/10.1016/B978-0-7020-2986-8.00022-7
Yu B, Han K, Zhan C, Zhang C, Ma H, and Su J (2010). Fibular head osteotomy: a new approach for the treatment of lateral or posterolateral tibial plateau fractures. Knee, 17(5): 313-318. DOI: https://doi.org/10.1016/j.knee.2010.01.002
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