- The pelvis consists of two symmetrical sets of bones that are fused together to form a solid bone. The pelvis is attached to the lower part of the spine, called the sacrum, by a a left and right sacroiliac joints. Unlike the hip, knee, elbow and other joints, the sacroiliac joints have limited movement.
- The sacrum consists of three spinal bones that are fused together
- Anatomy key:
- large arrow = sacroiliac joint
- S = sacrum (fused lower spine bones)
- I = ilium (shaft of the pelvis)
- A = acetabulum (hip socket)
- Is = ischium
- The sciatic nerve runs immediately below the sacroiliac joint, thus this nerve is susceptible to damage
- Sacroiliac luxation (luxation = dislocation in layman's terms) usually is caused by a very traumatic blow to the hind end of an animal (i.e. hit by a motor vehicle).
- Varying degrees of lameness on the side of the luxation.
- Pain is noted when the sacroiliac joint is palpated.
- The pelvis may feel crunchy (crepitant) when a force is applied to the front of the pelvis.
- If the sciatic nerve was also injured, no or decreased sensation to the outside toe of the affected hindlimb will be noted; complete evaluation of the sciatic nerve may be difficult due to bruising of muscles and the nerve itself.
- Prior to surgery the following tests are usually performed:
- Bloodwork such as CBC and chemistry profile
- Radiographs (x-rays) of the chest to rule out trauma to the lungs or ribs
- Radiographs or ultrasound of the abdomen to rule out internal organ damage and internal bleeding
- Radiographs of the pelvis; the unfractured pelvis should fit within an imaginary box and if it does not, there is a fracture +/- dislocation the sacroiliac joint (put your cursor on radiograph below left) a part of the pelvis will be shifted outside this box. In this case, take note of the sacroiliac luxation and fractures of the pubis and ischium of the pelvis.
- There are three options for treatment of a sacroiliac luxation
- Conservative treatment is acceptable if only one side of the pelvis has been damaged, and minimal displacement of the sacroiliac joint is present. These patients will be painful for a much greater time versus having the luxation surgically repaired.
- Traditional surgery involves making a sizeable incision along the side of the pelvis and peeling the muscles off the bones to expose the dislocated joint (photo right). Screws are used to secure the dislocated joint in place.
- Minimally invasive surgery involves manually reducing the joint back into place from the outside, making a small incision (about 1 to 1.5 cm) over the side of the pelvis in the location of the sacroiliac joint and securing the sacroiliac joint in place with screws with the aide of fluoroscopy or digital radiography.
- The details: The patient is placed on the x-ray table with the affected pelvis up. Digital radiographs are made (or fluoroscopy used) to assist the surgeon in the placement of the screws. The ilium is manually pushed back into place and a small pin is inserted. Next, a hole is drilled over sacral body and the position of the drill bit is radiographed. If the positioning is good, the drill bit is advanced deeply into the sacrum. The drill bit is removed and a screw (premeasured screw length from the radiographs) is seated into the bones to hold the sacroiliac joint in place. Another screw is placed just behind the first screw using the same method.
- The benefits of this minimally invasive approach is that a very small incision is used and there is minimal dissection of the soft tissues, resulting in less pain. In addition, the surgeon can very accurately place the screws into the body of the sacrum, thereby preventing damage to the nerves that are located in the spinal canal of the sacrum. The length of time that it takes to perform the minimally invasive versus traditional surgery is similar.
- The radiographs below were taken during surgery. Place your cursor over images to see additional images.
- Limit activity until the fractures have healed
- Provide a soft bed to prevent bed sores
- Turn your pet from side to side, if your pet is very weak and cannot do this
- Check the incision for infection
- Use a towel as a sling to take your pet outside for elimination purposes
- Sciatic nerve damage
- Nonhealing of the fractures
- Breakage of the screws
- Anesthetic death
- Pregnancy should be avoided as natural delivery of the puppies may not be possible due to scar tissue or callus formation in the pelvic canal (C-section is also an option if breeding is a must)
- Chronic constipation if a lot of callus or scar tissue develops in the pelvic canal
- Entrapment of the urethra (tube from the bladder for urination) by fracture fragments
- Most patients heal well following surgical repair. It may take about 2 months for full recovery.
- Patients that have sciatic nerve injury frequently will regain normal or near normal function; occasionally the function of the nerve does not come back and the pet does not have any useful function of the limb.
Frequently Asked Questions After Surgery
When should my dog have the first bowel movement after surgery?
- Many dogs will not have a bowel movement for the first 4 to 5 days after surgery
- Reasons that a dog will not have regular bowel movements after surgery include:
- The dog has been fasted prior to surgery
- Dogs do not eat well during the hospital stay
- They frequently do not eat well when they go home
- They are fed highly digestible food that produces little stool
- Pain medication that contain narcotics (such as morphine, fentanyl patches, and tramadol) can be constipating
- If a pet does not have a bowel movement on the 5th day of being home, a stool softener such as metamucil can be fed
- Dose of metamucil is 1 tsp per 25 Kg mixed in with each meal (canned dog food); feed immediately after mixing, as the metamucil will gel the food and may make it less palatable
My pet had surgery and will not eat. What can be done?
- Most pets will not eat their regular dog food after surgery, especially if it is kibble.
- Offer a cooked diet having a 1:1 ratio of a protein source and carbohydrate source. The protein source can be any meat (example: chicken breast, turkey breast, lean hamburger) that is low in fat and should be cooked (drain off all fat after the meat has been cooked). The carbohydrate can be pasta, potato or white rice.
- Try canned dog food; to enhance the flavor sprinkle a very small amount of garlic powder or chicken or beef broth (Chicken-in-a- MugTM or Beef-in-a-MugTM products)
- Try Gerber strained meats for babies such as the chicken, beef, turkey, or veal
- Try Hill's A/D diet available at most veterinary hospitals
- Hand feeding: place a small amount of food in the mouth so that your dog gets the flavor
- Warm the food slightly in a microwave, as the food will be more aromatic; stir the food before feeding and test the temperature on the bottom side of your wrist; it should only be luke warm.
- Remember that most pets will not eat the first day or two after they get home from surgery
- Offer smelly foods that contain fish such as tuna or smelly cat foods
- Try Gerber strained meats for babies such as the chicken, beef, turkey or veal
- Hand feeding: with your finger place a small amount of food on the roof of your cat's mouth; use a syringe to get soft food into the mouth
- Warm the food slightly in a microwave as the food will be more aromatic; remember to stir the food before feeding and test the temperature; it should be only luke-warm
- Some cats will only eat dry food, try kibble if your cat normally has been fed that food
- Petting and stroking your cat frequently will help to stimulate appetite
- Remember that most pets will not eat the first day or two after they get home from surgery
- Appetite stimulants such as cyproheptadine may be helpful
- If your cat refuses to eat anything for 7 days a stomach tube or nasogastric tube should be placed to provide nutrition so that a serious liver problem (hepatic lipidosis) does not develop
My pet is vomiting. What can be done?
- The first thing for you to discern is whether your pet is vomiting or regurgitating. Both will result in fluid or food being brought up. Vomiting always will have heaving or retching of the abdomen prior to expulsion of the vomitus. Regurgitation is not associated with heaving and the pet usually just opens the mouth and fluid or food will be expelled. Usually the regurgited material will be clear or brown colored fluid.
- Next is to identify the cause of the vomiting or regurgitation.
- Causes and treatment of vomiting after surgery
- When some pets return home after a stay in the hospital they may drink excessive amounts of water at one time and then vomit; if this appears to be the case, the water should be limited to frequent smaller amounts.
- Medications such as antibiotics, narcotics or nonsteroidal anti-inflammatory medication commonly cause vomiting after surgery. In order to see which medication is causing the problem, the administration of each drug should be separated 2 hours apart. Usually the pet will vomit or appear nauseated (drooling and sick look) within 1 hour of administration of the medication that they are sensitive to. The antibiotic in some cases may be changed to a different one, or may be discontinued.
- Stomach upset from anesthesia is a potential cause of vomiting and will pass within a couple of days.
- An uncommon cause of vomiting after surgery is internal organ failure. Blood testing will confirm this problem. For this reason vomiting should not be ignored if it persists for more than 24 hours.
- If your pet had surgery of the bowels or stomach, vomiting is always a concern, as it may indicate that infection of the abdominal cavity, called peritonitis, is present. Do not ignore this sign.
- Symptomatic treatment of vomiting involves withholding food for 12 to 24 hours, then introducing small amounts of bland food such as rice and lean cooked hamburger, if your pet does not vomit after that then gradually wean him/her back onto the regular diet after 3 days. In order to decrease the acidity of the stomach, Pepcid AC 0.5 mg/kg can be given by mouth twice daily for 5 days. Metoclopramide and Cerenia are good anti-vomiting medications for dogs and cats. You should always consult a veterinary healthcare professional before administering medication.
- Causes and treatment of regurgitation after surgery
- The most common cause of regurgitation is reflux of acid from the stomach into the esophagus while your pet is under anesthesia. Acidic fluid from the stomach can cause a chemical burn of the esophagus and result in a bad case of heart burn, called esophagitis. This results in poor motility of the esophagus, therefore water and food will accumulate in this structure. In most cases, esphagitis is self-eliminating and will resolve within two or three days.
- If the esophagitis is severe the esophagus may develop one or more strictures. A stricture is a narrowing or stenosis of the esophagus and does not allow passage of food down the esophagus, in regurgitation that lasts longer than one week. This problem should be brought to the attention of your pet's doctor within the first two weeks so that it can be treated by ballooning the stricture (minimally invasive procedure, as it is done with the aide of an endoscope). If an esophageal stricture is chronic surgery is needed.
- Symptomatic treatment of regurgitation caused by esophagitis includes feeding bland food, and administering a coating agent (sucralfate) and an acid blocker (omeprazole or other). Consult a veterinary health care professional if the regurgitation continues for more than a couple of days.
How do I know that my dog is in pain following surgery?
- Signs of pain include
- biting if you get near the surgical site
- grimacing (lips are pulled back and the the dog looks anxious)
- tragic facial expression
- restlessness and unable to sleep; pacing
- if abdominal surgery was done the pet will not lie down on the incision, or will continually sit up in spite of appearing very tired
- the worst pain will be for the first 2 to 3 days after surgery
What can I do to control my dog's pain?
- Narcotic medications that control pain: tramadol, butorphanol, Duragesic (fentanyl patch)
- Anti-inflammatories used to control pain: Deramaxx, Rimadyl, Previcox, or Etogesic
- If an orthopedic surgery has been done cold packing the surgical site may be helpful
- A cold pack may be a pack of frozen peas, crushed ice in a Ziploc bag, or a cold gel pack; place a thin barrier between the skin and the cold pack. An alternative to a cold pack is to freeze water in a styrofoam cup; after frozen cut the bottom of the styrofoam cup out. Cool the surgical site around the incision by rubbing the exposed ice directly on the skin in a circular pattern. Cooling the surgical site helps to numb the area.
How do I know that my cat is in pain following surgery?
- Pain is more difficult to assess in cats versus dogs, as signs can be more subtle and they usually do not vocalize when in pain
- Signs of pain in a cat include the following:
- biting if you get near the surgical site
- growling or deep cry
- not wanting to eat
- hiding and not wanting to be near owner (remember that this could also be caused by the cat just being upset about leaving home and coming back)
What can be done for pain at home for my cat?
- Pain medication such as buprenorphine or a Duragesic (fentanyl) patch
- Tylenol will kill a cat as they lack abundant glutathione enzyme in the liver
- Anti-inflammatories can be used, but the dose is much less than dogs
Is it okay for my pet to lick the incision?
- If a dog licks the incision, the healing process may be delayed.
- Licking can remove stitches and cause the incision to open
- Licking can become a severe habit that is difficult to break
- Licking can cause infection as the mouth has many bacteria
- Dogs will frequently lick the incision when the owner is not watching such as at night time; if the skin looks red or excoriated the most common cause is from licking.
- To stop your pet from licking the following can be tried:
- Elizabethan collar can be placed on the neck; this will not help stop your pet from scratching at the region
- Cervical collar (bite not collar) is a less awkward device and can be effective at stopping a pet from licking the surgical site
- A tee shirt can be used to cover an incision on the chest or front part of the abdomen; gather the waist of the shirt up over the dog's back and wrap an elastic band around this part of the shirt.
- A bandage or sock can be used to cover an incision on a limb; fasten the top of the sock to the dog's limb with tape.
- Bitter apple can be applied around the incision; many dogs will continue to lick after application of this topical
- Bitter Apple and Liquid HeetTM (obtain this from a drugstore...it is used for sore muscles) mixed in a 2:1 ratio can be applied around the skin incision
- Antipsychotic medication in some cases is needed