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High-rise syndrome was diagnosed in 119 cats over a 4-year period. 59.6% of cats were younger than one year, and the average height of the fall was four stories. High-rise syndrome was more frequent during the warmer period of the year. 96.5% of the presented cats, survived after the fall. 46.2% of cats had fractured limbs; 38.5% of fractures were of the forelimb, 61.5% of the hindlimb. The tibia was fractured most often (36.4%), followed by the femur (23.6%). 78.6% of femoral fractures were distal. The mean age of patients with femoral fractures was 9.1 months, and with tibial fractures 29.2 months. Thoracic trauma was diagnosed in 33.6% of cats. Pneumothorax was diagnosed in 20% of cats, and pulmonary contusions in 13.4%. Falls from the seventh or higher stories, are associated with more severe injuries and with a higher incidence of thoracic trauma.
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Feline high-rise syndrome: 119 cases
(1998e2001)
D. Vnuk
a,
), B. Pirkic
´
a
, D. Matic
ˇic
´
a
, B. Radis
ˇic
´
a
, M. Stejskal
a
,
T. Babic
´
a
, M. Kreszinger
a
, N. Lemo
b
a
Clinic of Surgery, Orthopaedics and Ophthalmology, Veterinary Faculty, University of Zagreb,
Heinzelova 55, 10000 Zagreb, Croatia
b
Clinic of Internal Medicine, Veterinary Faculty, University of Zagreb, Heinzelova 55,
10000 Zagreb, Croatia
Revised 18 June 2003; accepted 18 July 2003
Summary High-rise syndrome was diagnosed in 119 cats over a 4-year period.
59.6% of cats were younger than one year, and the average height of the fall was four
stories. High-rise syndrome was more frequent during the warmer period of the year.
96.5% of the presented cats, survived after the fall. 46.2% of cats had fractured
limbs; 38.5% of fractures were of the forelimb, 61.5% of the hindlimb. The tibia
was fractured most often (36.4%), followed by the femur (23.6%). 78.6% of femoral
fractures were distal. The mean age of patients with femoral fractures was 9.1
months, and with tibial fractures 29.2 months. Thoracic trauma was diagnosed in
33.6% of cats. Pneumothorax was diagnosed in 20% of cats, and pulmonary contu-
sions in 13.4%. Falls from the seventh or higher stories, are associated with more
severe injuries and with a higher incidence of thoracic trauma.
Ó2003 ESFM and AAFP. Published by Elsevier Ltd. All rights reserved.
Introduction
High-rise syndrome is the term used in cases of cats
falling from balconies or windows of highrise build-
ings in urban areas, the minimal height of the fall
being the second storey. The cause of the fall in
most cases is related to play when the animal
jumps from the window or over the balcony, when
chasing a bird or insect, or slipping whilst walking
on the edge of the balcony railing or window.
High-rise syndrome has also been described in dogs
(Gordon et al., 1993) and humans, when the terms
‘‘high-flyer syndrome’’ or ‘‘jumpers syndrome’’
are also used (Reynolds et al., 1971;Smith et al.,
1975).
Feline high-rise syndrome has been described by
several workers (Barth, 1990,Dupre et al., 1995;
Flagstad et al., 1998;Papazoglou et al., 2001;
Whitney and Mehlhaff, 1987). Some workers have
reported that the relationship between the height
of fall and the severity of the injuries follows a cur-
vilinear pattern (Flagstad et al., 1998;Papazoglou
)Corresponding author.
E-mail address: dvnuk@vef.hr (D. Vnuk).
Journal of Feline Medicine and Surgery (2004) 6, 305e312
www.elsevier.com/locate/jfms
1098-612X/$30.00/0 Ó2003 ESFM and AAFP. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.jfms.2003.07.001
et al., 2001;Whitney and Mehlhaff, 1987), while
others argue that the severity of injuries increases
linearly with the height of the fall (Dupre et al.,
1995).
The object of this study was to statistically eval-
uate 119 cats with this syndrome admitted during
a 4 year period. The cats fell from at least the sec-
ond storey, all in greater Zagreb. The injuries of all
the cats were documented. We wanted to exam-
ine any association between the height of the fall,
severity of injuries, and the type of injury.
Materials and methods
In the period between January 1, 1998 and
December 12, 2001 at the Clinic of Surgery, Ortho-
paedics and Ophthalmology of the Veterinary
Faculty, 119 cats were treated after a fall or jump
from a balcony or window, where the owners saw
the fall, or where there was a reasonable suspicion
that a fall had occurred. Only those cats that fell
from the second or higher stories were included.
The owners brought the cats for treatment within
varying periods of time after the fall (from 30 min
to over a month). Each animal was examined, and
radiographical, haematological and biochemical
examinations were performed depending on the
results of the clinical examination. After the diag-
nosis was made, and in consultation with the
owners, conservative or surgical treatment was
undertaken in most cases. Some owners requested
euthanasia of the animal.
In evaluating the severity of the injuries the fol-
lowing criteria were used:
Contusions, abrasions, wounds, lacerations, pul-
monary contusions, haematuria, epistaxis,
dental fracturesdscore: 1.
Limb fractures, limb luxations, hard palate
fractures, mandibular fractures, pelvic frac-
tures, temporomandibular joint luxations,
haemothorax, pneumothorax, abdominal
wall rupture, diaphragmatic rupture, rupture
of urinary bladder, vertebral fractures/
luxationsdscore: 2.
If an animal had several injuries, the points for
each injury were summed up. For example, if
a cat had a fracture of both radius and ulna, the
score was 4; if there was a fractured radius and
ulna and fractured tibia, the score was 6; if a cat
had a limb fracture with some skin contusions on
the same limb, the score was 2C1Z3.
The statistical data processing was performed
using the programme Statistica, ’99 edition,
version 5,5, StatSoft, Inc. The programme was also
used to make charts. The Student’s t-test was used
for the age comparison between cats with frac-
tured tibia and fractured femur.
Results
During the defined period, 1402 cats were admitted
to the clinic, and in 8.5% (119) of them high-rise
syndrome was diagnosed. 96.5% (115/119) cats sur-
vived after the fall. The mean age of the cats was
1.8G2.2 years (MGSD) (range, 2.5 months to 10
years). The age of 5 cats was unknown. 59.6%
(68/114) of cats were under one year (Fig. 1).
53.8% (64/119) were female, 42.0% (50/119) were
male, 3.4% (4/119) were male neutered, and the
sex was undetermined in 1 cat (Fig. 2). The mean
storey from which the cat fell was 4.0G0.2 (range,
2 to 16). The median was the fourth storey (Fig. 3).
65% (77/119) of cases occurred in the period
from April 1 to September 30 (Fig. 4).
Injuries of the cats are listed in Table 1. In 6 cats
euthanasia was carried out; in 2 cases because of
the poor prognosis (vertebral fractures/luxations),
and in 4 cases because of the cost of treatment. Of
the remaining 113 cats, 4 died within the first 36 h
following the fall (3.5%). The age range of the cats
that died was between 8 months and 5 years, and
the fall occurred from between the second and
the ninth storey.
46.2% (55/119) of cats had fractures of limbs,
excluding pelvic fractures. The mean age of pa-
tients with fractures was 1.8G2.1 years. Multiple
metacarpal or metatarsal bone fractures of the
same limb were counted as 1 fracture. A single
fracture of the forelimb was found in 18 cats, and
a single fracture of the hindlimb was found in 28
cats. That is, 83.6% (46/55) of the cats had only
one fracture. The other 9 cats had multiple frac-
tures. So, 55 cats had 65 fractures. Of 65 fractures,
38.5% (25/65) were in the forelimb, while 61.5%
(40/65) were in the hindlimb.
The tibia was the most frequently fractured
bone (20 cats), and two cats had fractures of both
tibia. Thus 22 of a total of 65 fractures (33.8%) were
tibial. The femur was the next most frequently
fractured bone, comprising 21.5% (14/65) of all
fractures. 13 cats had femoral fractures as one
had fractures of both femurs. Of the 14 fractures,
78.6% (11/14) were in the distal bone, and of these
82% (9/11) were distal physeal fractures (these
fractures occurred in immature animals). The
mean age of the patients with fractured femur
was 9.1G6.3 months, while the mean age of the
306 D. Vnuk et al.
patients with fractured tibia was 29.2G30.7
months.
In the forelimb, the humerus was fractured in 8
cats and the radius and ulna in 8 cats. Open frac-
tures were recorded in four cats, all of the tibia.
In 30 cats, surgical repair was performed, whilst
in 25 cats fractures were treated conservatively
either because it was the most appropriate, or be-
cause the cost of surgery was prohibitive. In 3 cats
luxation was diagnosed; one case of coxofemoral
and 2 cases of talocrural luxation. The coxofemoral
luxation was treated by closed reduction, and the
talocrural luxations were managed surgically.
9% (11/119) of cats had pelvic fractures, all of
which were treated conservatively. In 3 cats verte-
bral fracture/luxation was presentdin one cat the
thoracic column was injured, in two cats the lum-
bar spine was injured. Of those three cats, one
died, and two were euthanized.
Fractures of the mandible were diagnosed in 4
cats, and all were fractures of the symphisis. These
fractures were stabilized with cerclage wire. Hard
palate fractures were recorded in 6 cats. These
were repaired by suturing the mucous membrane
of the hard palate. In one cat we recorded tempo-
romandibular joint ankylosisdthe owner brought
the animal to the clinic one month after the fall
because the cat could not open its mouth.
In two cats a diaphragmatic rupture was diag-
nosed. In one cat urine was aspirated during
abdominocentesis and during an exploratory lapa-
rotomy rupture of the bladder was confirmed.
Traumatic abdominal rupture was recorded in two
cats. Repair of the rupture was performed between
the 3rd and the 5th day after trauma. In 5% (6/119)
of cats a perineal wound was found.
In cats with abnormal respiration (a rapid respi-
ratory rate) and tachycardia, decreased respira-
tory sounds and possible cyanosis, thoracic
radiography was carried out. Thoracic trauma was
diagnosed in 33.6% (40/119) of cats. Pneumothorax
was present in 60% (24/40) of these cats. Pulmo-
nary contusions were diagnosed in 40% (16/40) of
cats with thoracic trauma, and haemothorax in
Figure 1 Age distribution of cats with high-rise syndrome.
Figure 2 Sex distribution of cats with high-rise
syndrome.
Feline high-rise syndrome 307
10% (4/40) of cats. Haemothorax was diagnosed by
thoracentesis, after the thoracic radiographs had
shown the presence of fluid. Thoracentesis was
carried out in 8 cats. Epistaxis was found in 8.4%
(10/119) of cats.
Shock was diagnosed in 10.9% (13/119) of cats.
The shock state was recognized by clinical evalua-
tion. The clinical signs of the shock syndrome were:
increased heart rate, weak pulse quality, pale
mucous membrane, prolonged capillary refill time,
increased respiratory rate and decreased core
and peripheral temperature. Shock was treated
with intravenous fluids and corticosteroids.
The cats that fell from the second storey
had an average injury score 1.98G0.92, those
which fell from the third storey 2.71G1.23,
from the fourth 2.70G1.31, from the fifth
2.52G1.28, from the sixth 2.62G1.06, and from
the seventh and higher stories 3.50G2.27
(Fig. 5).
Figure 3 Monthly incidence of high-rise syndrome.
Figure 4 Histogram showing number of cats falling from different heights.
308 D. Vnuk et al.
Discussion
High-rise syndrome occurs in urban areas with
tall buildings (Barth, 1990;Dupre et al., 1995;
Flagstad et al., 1998;Papazoglou et al., 2001;
Whitney and Mehlhaff, 1987). High-rise syndrome
is seen mostly in younger cats, mainly the result
of behavioral differences between younger and
older animals. Younger cats fall from balconies
and windows whilst playing (chasing a bird, a but-
terfly, or playing with other kittens), or they slip
and fall whilst walking on the window or balcony
rim. The mean age of the cats in our study
was 1.8 years. 59.6% of cats were under one year.
Whitney and Mehlhaff (1987) reported that 65% of
cats were under 3 years. The mean age of the cats
in our study is lower than that reported by Dupre
et al. (1995)d2.5 years, Flagstad et al. (1998)d
2.3 years, and Whitney and Mehlhaff (1987)d2.7,
but higher compared to the work of Papazoglou
et al. (2001), where it was 1.2 years. The mean
age of dogs is higher, reported as 3.2 years by
Gordon et al. (1993), and in man most falls
involve children (Reynolds et al., 1971).
Papazoglou et al. (2001) reported 51% males,
46% females, 1% castrated males, 1% spayed males
and 1% unrecorded gender status. Whitney and
Mehlhaff (1987)reported 48% males, 48% females
and 4% unrecorded gender status. In their studies
23% of the males were castrated and 27% of the fe-
males were spayed. In the USA where neutering and
spaying are routine, the ratio of castrated and
spayed cats with high-rise syndrome is higher. The
routine castration and spaying of cats in Croatia is
not common. Therefore, some of injuries may be
‘sexually motivated’.
The mean fall in our study was four stories. Most
cats fell from between the second and the sixth
storey (92%). Most buildings in Zagreb are not high-
er than six stories. Papazoglou et al. (2001) re-
ported mean fall of 3.7 stories, Whitney and
Mehlhaff (1987) reported 5.5 stories, and Flagstad
et al. (1998) 3.1 stories. In the latter work the
average is lower because cats which fell from
the first storey were also included. For the dogs,
the mean fall is reported as 2.8 stories (Gordon
et al., 1993). High-rise syndrome describes trau-
matic injuries in cats resulting after falls of two
or more stories. Only Flagstad et al. (1998) includ-
ed cats after falls of the first or higher stories. In
our study, we have not recorded cats with any se-
rious clinical signs after falls from first storey. Most
falls occurr during the warmer months; 65% of cats
fell in the period between April 1 and September
30. Papazoglou et al. (2001) reports that 84% of
cats fell between March and November. Flagstad
et al. (1998) found a correlation between average
daily temperature and the number of falls. Cats
fall mostly from balconies and open windows and
since owners keep windows open during warmer
weather, the correlation between increased
temperature and increased number of falls is not
surprising.
Table 1 Results of clinical assesment in 119 cats
with high-rise syndrome
Injury Number of
cats
Limb fractures 65
Forelimb 25
Scapula 3
Humerus 8
Radius, ulna 8
Metacarpus 5
Phalangeal fracture 1
Hind limb 40
Closed fractures 36
Open fractures 4
Femur 14
Tibia 22
Metatarsus 3
Talus 1
Open fracture 4
Limb luxations 3
Hip joint 1
Talocrural joint 2
Contusions
(not associated with fractures)
28
Facial (including epistaxis) 12
Extremity 8
Truncal 8
Abrasions, wounds, lacerations
(not associated with fractures)
11
Facial 1
Extremity 4
Truncal 6
Hard palate fractures 6
Dental fractures 1
Mandibular fractures 4
Pelvic fractures 11
Vertebral fractures/luxations 3
Intervertebral disc protrusion 1
Temporomandibular joint ankylosis 1
Sacroiliac luxations/fractures 3
Rupture of urinary bladder 1
Traumatic abdominal rupture 2
Diaphragmatic rupture 2
Pneumothorax 24
Haemothorax 4
Pulmonary contusion 16
Shock 13
Feline high-rise syndrome 309
Robinson (1976) characterized high-rise syn-
drome by the following triad of injuries:
1. epistaxis
2. hard palate fracture
3. pneumothorax.
This triad of injuries was found in only 33% of
cats in our study. Since, in our study the incidence
of limb fractures in the high-rise syndrome cats
was significantly higher than the incidence of
Robinson’s triad, we suggest the inclusion of limb
fractures in the injuries which characterize the
high-rise syndrome, turning the triad into the
high-rise tetralogy.
In our study, epistaxis was found in 8.4% of cats.
Papazoglou et al. (2001) reported epistaxis in 2% of
cats, Flagstad et al. (1998) in 13.5%, and Barth
(1990) in 64.4% of cats.
Hard palate fractures were found in 5% of cats in
our study. Papazoglou et al. (2001) reported hard
palate fracures in 3% of cats, Flagstad et al.
(1998) and Dupre et al. (1995) in 11% and Whitney
and Mehlhaff (1987) in 17% of cats.
Thoracic trauma was present in 33.6% of cats.
Pneumothorax was diagnosed in 20% of cats, pul-
monary contusions in 13.4%, and haemothorax in
3.4%. Barth (1990) found pneumothorax in 62%,
and pulmonary contusions in 58% of cats. Whitney
and Mehlhaff (1987) diagnosed thoracic trauma in
90% of cats, pulmonary contusions in 68%, and pneu-
mothorax in 63% of cats. Papazoglou et al. (2001)
reported thoracic trauma in only 13% of cats, pneu-
mothorax in 4%, and pulmonary contusions in 6.8%.
Flagstad et al. (1998) diagnosed pneumothorax in
only 7.1% of cats. Whitney and Mehlhaff (1987)
recommended thoracic radiography in all cats and
thoracic radiography was performed on 69% of the
cats. Papazoglou et al. (2001) reported that tho-
racic radiography was carried out in all cats. The
differences between the studies might be ex-
plained by different protocols in assessing thoracic
trauma. Also, such differences could be explained
by the length of time between the fall and the ad-
mission to a clinic. Dyspnea and tachypnea may be
due to pneumothorax or be the result of shock and
acute pain. The breathing pattern may improve
with time as acute pain and shock diminish. In this
case thoracic trauma may not be suspected and ra-
diography will not be performed. Because in our
study, thoracic radiography was only carried out
on those cats showing the abnormal respiration,
and that may explain why the incidence of thoracic
trauma was perhaps significantly lower. Some ani-
mals with thoracic trauma may have minimal clini-
cal signs, or even none (Aron and Roberts, 1993). In
these animals, possible thoracic trauma was not
diagnosed.
In addition to the triad of injuries reported by
Robinson (1976), limb fractures are also very com-
mon. In our study, 46% of patients had limb frac-
tures. Papazoglou et al. (2001) found fractures in
50% of patients, Whitney and Mehlhaff (1987) in
39%, and Flagstad et al. (1998) in 50% of patients,
but they also included pelvic fractures. The lower
percentage of limb fractures reported by Whitney
and Mehlhaff (1987) may be due to a greater fall
height, where the animals are not falling with their
extremities extended. In our study, the ratio
Figure 5 Graph showing the relationship between injury score and height of fall.
310 D. Vnuk et al.
between forelimb and hindlimb fractures is 1:1.6.
In the study by Papazoglou et al. (2001) this ratio
is 1:2, while Whitney and Mehlhaff (1987) and
Flagstad et al. (1998) state equal numbers of fore-
limb and hindlimb fracture. Gordon et al. (1993)
reported that forelimb fractures are more common
in dogs since dogs initially land on the forelimbs.
Femoral fractures in our study were found in 24%
of cats with fractures. Papazoglou et al. (2001)
diagnosed femoral fractures in 40% of cats with frac-
tures, Whitney and Mehlhaff (1987) in 46%, and
Flagstad et al. (1998) in 18%. Whitney and Mehlhaff
(1987) found that 93% of patients with femoral frac-
ture were under one year. In our study the tibia was
fractured in 36% of cats. All of the four open frac-
tures were at the tibia. In 79% of cats the femur
was fractured in its distal part. The mean age of pa-
tients with a fractured femur was 9 months, but 29
months in the case of the fractured tibia. This can
be explained by the fact that femoral fractures
were mainly in distal part, near the growth zone.
Papazoglou et al. (2001) and Whitney and
Mehlhaff (1987) excluded pelvic fractures from
hindlimb fractures. If 11 pelvic fractures are added
to the limb fractures, 33% (25/76) fractures are in
the forelimb, and 67% (51/76) are in the hindlimb.
With this correction, however, the ratio of
hindlimbs fracture was not significantly changed.
The relatively low incidence of abdominal inju-
ries in our study can be explained by the fact that
forelimbs absorb most of the impact force at
landing.
Papazoglou et al. (2001) suggests the large num-
ber of vertebral injuries in their study is due to the
fact that most cats fell from below the fifth storey
and did not have time to achieve a feet-first land-
ing. Another reason why cats may not land on their
feet maybe the various barriers, which they might
encounter during the fall (e.g. metal structures
for hanging laundry, potted plants on balcony rail-
ings, etc.).
Kapatkin and Matthiesen (1991) suggest that the
type of injury depends upon the height of the fall
and the landing surface. The severity of injuries
rises linearly up to the seventh storey. After that
height, the severity of injuries does not rise and
and the incidence of fractures decreases. Of 22 cats
that fell more than seven stories only one died, and
among 13 cats that fell more than nine stories only
one fracture was diagnosed. One cat that fell 32 sto-
ries suffered only mild pneumothorax and a chipped
tooth (Whitney and Mehlhaff, 1987). Robinson
(1976) stated that the maximum recorded heights
for survival were 18 stories on to a hard surface,
20 stories on to shrubbery, and 28 stories on to
awning. Gordon et al. (1993) states that dogs
cannot survive falls from distances higher than
six stories. During free fall, cats have a unique
ability to quickly change the position of their body
and maintain a feet-first landing position. Cats
behave like parachutists, achieving a maximum
velocity during free fall. An average-sized cat
(4 kg), in a horizontal position, maximizes drag
and achieves a maximum velocity of approximately
100 km/h after falling five stories. At the beginning
of the fall the cat instinctively extends its limbs
and if the impact occurs at that moment the
most common injuries are limb fractures. After
the maximum velocity has been achieved, the
vestibular system is no longer stimulated and the
cat orients its limbs horizontally. This horizontal
position could explain the decreased number of
limb fractures, but since the impact is more evenly
distributed throughout the body, the incidence of
thoracic injuries increases.
Papazoglou et al. (2001) determined the total
number of injuries and only orthopaedic injuries.
Whitney and Mehlhaff (1987) determined the total
number of injuries, the number of thoracic inju-
ries, the number of fractures and the number of
split palates. In our study, the injury score is a
sum of injuries. We formed two groups considering
the severity of injury.
In our study, the injury score increased with falls
from between the second and the third storey, it
was variable in falls from the third and the sixth
storey, and increased sharply from the seventh sto-
rey upwards (Fig. 5). Our findings differ from those
of the study by Dupre et al. (1995) where the injury
score increased linearly with the height of fall.
Flagstad et al. (1998),Whitney and Mehlhaff
(1987) and Papazoglou et al. (2001) state that the
curve has a curvilinear pattern. Our curve does
not reveal any definite pattern. When falling from
distances up to the sixth storey, where maximum
velocity is not reached, the animal falls with ex-
tended limbs, so that the severity of injury does
not only depend upon the height, but also on the
surface, dexterity of the animal, etc. When falling
from the seventh and higher stories, the animal ori-
ents its limbs horizontally after achieving maximum
velocity so that the impact is more evenly distribut-
ed throughout its body. The body hits the surface
first, followed by the head. Fig. 6 shows the per-
centage of cats falling from specific stories in which
fractures, thoracic trauma and hard palate frac-
tures were diagnosed. The incidence of fractures
decreases with falls from heights above the third
storey, while the occurence of thoracic trauma in-
creases sharply with falls of more than six stories.
80% of cats falling from the third storey had frac-
tures of limbs or pelvis, while 80% of cats falling
Feline high-rise syndrome 311
from the seventh or higher stories suffered thoracic
trauma. This substantiates the theory that cats
falling at least seven stories flex their limbs so that
truncal injuries are more common, while cats fall-
ing from distances lower than seven stories extend
their limbs, the consequence being a greater inci-
dence of limb fractures.
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Figure 6 Graph showing the percentage of cats with particular injuries when falling from different heights.
312 D. Vnuk et al.
... When we consider the animal's capacity to land safely from great heights, the phrase "cats have nine lives" seems appropriate. Several examples have been documented in which the fatality rate of cats recorded when falling from great heights is <10% (16). Vnuk further went on to discover that when a feline fell from a great height, there was a 96.5% chance of survival. ...
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... High rise syndrome may cause limb fracture in 46.2% of fallen cats, of which 38.5% of fractures are in forelimbs and 61.5% were in the hind limbs are. Tibiae are most commonly fractured followed by the femur (Vnuk et al., 2004). The treatment cost of bone fractures in companion animals can procure several million Vietnam Dong per case. ...
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Bone fracture is a common health problem in humans and animals, and the healing of the bone fracture is a complicated process. Several drugs may be used concurrently with the treatment of fractures, but they may interfere with the healing process of the bone. The present research reviewed previously published studies with the objective to enhance the understandings of the effects of different drugs on bone healing. There is clear evidence that antibiotics, corticosteroids, non-steroidal inflammatory drugs, and chemotherapeutic drugs all affect bone healing. By contrast, the effect of anticoagulants on bone healing is controversial, so more research is needed to determine its efficacy. In addition, there is no direct evidence to approve the effect of anesthetics on bone healing, so this is another area in need of further research.
... Unfortunately, there were not enough cats per trauma category to analyse them separately in this study; nevertheless, this relationship appeared to be driven by the most severe injuries (RTAs, fractures/dislocations, falls from height). Approximately a quarter of sustained trauma in this study comprised of severe injuries which have been shown to result in direct joint trauma; indeed, skeletal fractures/dislocations were reported in 60% and 68.9% of cats that were alive on arrival following RTAs (Rochlitz, 2004) or falls from height (Vnuk et al., 2004), respectively. Cat and dog bites and/or resulting abscesses accounted for approximately half of this study's traumatic injuries and could have contributed to the development of early signs of DJD in two manners. ...
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Degenerative joint disease (DJD) is one of the most common causes of chronic pain in cats. Two studies were designed to identify risk factors for DJD in 6-year-old cats by examining prospective data from a longitudinal cohort study, and compare the activity profiles and quality of life of cats with (cases) and without (controls) early owner-reported signs of impaired mobility using orthopaedic examination, accelerometry and owner-completed questionnaires (Feline Musculoskeletal Pain Index (FMPI), VetMetrica). Binomial logistic regression using backwards elimination identified four risk factors for increased owner- reported mobility impairment score in 6-year-old cats: entire neuter status at six months of age (OR=1.97, 95%CI 1.26–3.07), sustained trauma before six years of age (OR=1.85, 95%CI 1.3–2.6), outdoor access at six years of age (OR=1.67, 95%CI 0.96–2.9), and overweight/obese status at six years of age (OR=1.62, 95%CI 1.13–2.33). Case cats scored significantly lower than control cats for the FMPI (p=0.003) and the VetMetrica domain of comfort (p=0.002), but not vitality (p=0.009) or emotional wellbeing (p=0.018). Total pain (p<0.0001), crepitus (p=0.002) and thickening (p=0.003) scores were higher in case cats. Accelerometry differentiated cases from controls with a 90.9% accuracy. Risk factor analysis demonstrated that obesity, outdoor access, and a history of trauma predispose cats to developing DJD, whereas neutering appears to decrease that risk. Changes in joint health as detected by orthopaedic examination and accelerometry reflected owner-reported mobility changes, differentiating cats with early DJD-related signs from healthy cats, whilst the VetMetrica comfort domain score indicated an impaired quality of life of cats with early DJD compared to healthy cats. Being able to recognise signs of mobility impairment earlier would allow interventions aimed at slowing DJD progression, thereby improving feline health and welfare. These findings have identified that orthopaedic examination, FMPI and accelerometry are effective in identifying early DJD-related mobility changes in cats.
... The mechanisms by which secondary DJD may have developed in the cats of this study can be explained by relevant literature to date. Skeletal fractures/dislocations involve direct trauma to the bones or joints and were reported in 60% and 68.9% of cats that were alive on arrival following RTAs 65 or falls from height, 66 respectively. Cat and dog bites can cause not only penetrating STT and fractures, 67 but also secondary DJD by instigating bacterial arthritis as resulting wounds contain a plethora of aerobic and anaerobic bacteria. ...
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Objectives: The aim of this case-control study was to identify early-life risk factors associated with the occurrence of owner-reported mobility changes in 6-year-old cats by examining prospective data from a longitudinal cohort study of pet cats, the Bristol Cats study. Methods: Data on potential risk factors were obtained from seven sequential questionnaires completed between the ages of 2-4 months and 5 years. Mobility-related questions from the study questionnaire distributed at the age of 6 years were used to calculate each cat's mobility score. Cats with mobility scores of ⩾2 and 0 were allocated to the case and control groups, respectively, and the cat's status was the outcome variable. Results: Of the 799 cats included for analysis, 238 (29.8%) had owner-reported mobility changes. Binomial logistic regression using backwards elimination identified four risk factors for owner-reported mobility changes at 6 years of age: entire neuter status at 6 months of age (odds ratio [OR] 1.97; 95% confidence interval [CI] 1.26-3.07), sustained trauma before 6 years of age (OR 1.85; 95% CI 1.30-2.60), outdoor access at 6 years of age (OR 1.67; 95% CI 0.96-2.90) and overweight/obese status at 6 years of age (OR 1.62; 95% CI 1.13-2.33). Conclusions and relevance: Risk factor analysis demonstrated that obesity, outdoor access and a history of trauma may predispose cats to developing owner-reported mobility changes associated with degenerative joint disease, whereas neutering before 6 months of age appears to decrease that risk.
Article
Kedilerde gözlenen travmalar ve bu travmalara bağlı oluşabilecek patolojik durumların hayvan travma triaj skoru (ATT) ve modifiye Glasgow koma skoru skalaları (MGCS) kullanılarak, önceden anlaşılması ve bunlara yönelik hazırlık aşaması, hastanın prognozu ve objektif değerlendirilme sonuçlarının ortaya konulması amaçlanmıştır. Çalışma materyalini Veteriner Fakültesi Cerrahi Anabilim Dalı Kliniği’ne 2020-2021 yılları arasında 10 aylık periyotta travma nedeniyle getirilen çeşitli yaş, ırk ve cinsiyetteki 30 kedi oluşturdu. Olguların yaş ortalamaları 6 ay ile 2 yıl arasındadır. İskelet sistemi ve nörolojik sistemleri değerlendirilerek MGCS ve ATT skorlarına bakıldı. Klinik, radyolojik, ultrasonografik muayeneleri ve kan gaz analizleri yapıldı. Skorlama sistemi bulgularına göre 30 kedinin; 6 tanesi yeşil kod (% 20) 14 tanesi sarı kod (% 46.6), 10 tanesi kırmızı kod (% 33.3) ile triaj renk kodlaması yapılmıştır. Otuz kedinin ATT puan dağılımı; % 3,3’ ünün 0 puana, %6,6’sının 1 puana, %23,3’ünün 2 puana, %33,3’ünün 3 puana, %6,6’sının 4 puana, %13,3’ünün 5 puana, %3,3’ünün 6 puana, %6,6’sının 8 puana ve %3,3’ünün 12 puana sahip olduğu gözlemlenmiştir. Kedilerde lezyonların dağılımı; 20 olguda yüksekten düşme, 4 olguda trafik kazası, 3 olguda ısırılmaya bağlı olduğu belirlenirken, 3 olguda neden bilinmemektedir. Kedilerde problemlerin dağılımı ise; 3 tibia , 6 femur, 2 humerus, 2 phalanx, 2 hernia diyaphramatica, 5 sacroiliac luksasyonu, 1 calcaneus luksasyonu, 2 antebrachium, 2 vertebra hasarı, 1 multiple coxae kırığı, 1 metatarsus kırığı, 2 yumuşak doku zedelenmesi ve 2 olguda yara oluşumu şeklinde belirlenmiştir. Sonuç olarak modifiye Glasgow koma skalası ve hayvan travma triaj skorlaması hekime prognoz yönünden yararlı olacağı ve hastayı daha objektif değerlendirmeyi sağladığı belirlenmiştir.
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Objective: To review the current literature pertaining to the pathophysiology, diagnosis, and treatment of injuries sustained from high-rise syndrome in cats and dogs. Etiology: High-rise syndrome is defined as a fall from a height of 2 or more stories that results in a constellation of injuries, including thoracic, abdominal, orthopedic, and orofacial trauma. Animals often fall after slipping from windowsills, engaging in mating behavior, or chasing prey. Cats suffer less severe injuries than dogs due to their "righting reflex" and smaller body mass. Affected animals are younger, and the frequency of falls is higher in warmer months. Diagnosis: Physical examination coupled with radiographs, ultrasound, and computed tomography can diagnose a myriad of injuries that include pneumothorax, pleural or abdominal effusion, orthopedic fractures, and orofacial injuries. Bloodwork may identify anemia, thrombocytopenia, or increases in hepatic, renal, or pancreatic values consistent with trauma to these organs. Serial venous or arterial blood gas can help determine the severity of respiratory compromise and influence resuscitative efforts. Traditional coagulation tests and thromboelastography can assess trauma-induced coagulopathy and guide transfusion therapy. Therapy: Animals presenting in shock require hemodynamic stabilization. Initial resuscitation may incorporate crystalloids, colloids, blood products, and analgesics. Thoracic injuries may require oxygen, thoracocentesis, chest tube placement, and mechanical ventilation. Fractures and wounds are decontaminated and splinted/bandaged, with definitive fixation pursued after stabilization. Abdominal injuries are managed medically unless there is severe ongoing bleeding, sepsis, or injury to the urinary tract. Prognosis: In feline high-rise syndrome, the prognosis is generally excellent following treatment, with survival exceeding 90%. Canine literature is sparse. The largest retrospective study reported a >90% survival to discharge and a greater need for surgical stabilization in this species. There are no prognostic factors identified that are associated with survival for either species.
Article
Objectives The purpose of this study was to prospectively evaluate the prognostic utility of the Animal Trauma Triage Score (ATTS) and Modified Glasgow Coma Scale (MGCS) in cats with high-rise syndrome. Methods ATTS and MGCS were obtained upon arrival from 25 client-owned cats presented for high-rise syndrome. Cases were followed during hospitalisation and several variables, including outcome, were recorded. Results The mortality rate in this cohort of cats with high-rise syndrome was 16%. Univariate statistical analysis showed that lactate ( P = 0.022), creatinine ( P = 0.01), body weight ( P = 0.036) and ATTS ( P = 0.02) were higher and MGCS ( P = 0.011) lower among non-survivors. Multivariable statistical analysis showed that ATTS was the only factor significantly associated with mortality (odds ratio 2.41, 95% confidence interval [CI] 1.02–5.71; P = 0.046). A receiver operating characteristics curve showed that ATTS was an excellent predictor of mortality (area under the curve 0.917, 95% CI 0.8–1.0; P = 0.009). An ATTS cut-off of 6.0 had a 75% sensitivity and 90% specificity for non-survival and a cut-off of 10 had a 25% sensitivity and 100% specificity for non-survival. Conclusions and relevance ATTS is predictive of severity and outcome in cats with high-rise syndrome and can help facilitate decision-making by owners and veterinarians.
Article
Objective: To compare the diagnostic utility of traditional diagnostic tests (ie, radiographs and focused assessment using sonography for trauma [FAST] scans) to whole-body computed tomography (WBCT) for characterizing injuries in polytrauma patients. A secondary objective was to compare costs of traditional diagnostic tests to WBCT. Design: Prospective, observational study. Setting: Private, level 1 veterinary trauma center. Animals: Convenience sample of 21 client-owned cats and dogs presenting with polytrauma. Interventions: Abdominal and thoracic FAST were performed by the primary clinician, if indicated. Radiographs were performed on areas concerning for trauma at the primary clinician's discretion. A WBCT was performed on each patient within 24 h of presentation and was blindly interpreted by a board-certified radiologist. Patients were only placed under anesthesia if further procedures were planned. IV contrast administration was employed at the discretion of the primary clinician and radiologist. Measurements and main results: Twenty-one patients (14 dogs and 7 cats) were enrolled. Sources of trauma included blunt force (80%), penetrating wounds (10%), and unknown sources (10%). Twelve injuries were missed on traditional diagnostics tests. Injuries missed on traditional diagnostic workup included pneumothorax, pneumomediastinum, pulmonary contusions, pleural effusion, traumatic bulla, peritoneal effusion, and an appendicular skeleton fracture. A distal metacarpal fracture was missed on WBCT. Traditional diagnostic tests misdiagnosed a diaphragmatic hernia and a ruptured urinary bladder, whereas WBCT was able to rule out these injuries. There were no adverse outcomes associated with missed injuries. The median cost of traditional diagnostic tests was significantly less than the cost of WBCT (P < 0.001). Conclusions: Although cost is higher, WBCT is a single test that can provide more comprehensive information and may help decrease the risk of missed injuries compared to traditional diagnostic tests. WBCT may be considered as a first-line diagnostic in severely traumatized patients.
Chapter
A physical oral examination followed by maxillofa‐cial and dental radiography is the main basis of diagnosis and decision making. The results of the oral and dental assessment determine the treatment plan. A general examination with palpation, delicate movement of the jaw, and inspection of the oral cavity may be accepted, but to get the full range of information, sedation or anesthesia is necessary. Pain occurs upon palpation and manipulation of the jaws. Additional signalments include hemorrhage or bruising of the palatal mucosa. If temporomandibular joint (TMJ) fractures occur without damage of the TMJ capsule or creation of a malocclusion, they can be managed by limiting mobility of the jaws or through adequate pain management. TMJ ankylosis, palatal defects, endodontic problems, and many other conditions that require accurate advanced imaging necessitate good preparation, occasional staging of treatment, and ‐ often ‐ referral to a specialist.
Chapter
Feline medicine is increasingly popular and cat‐friendly or exclusively feline clinics are becoming more and more common. Three major problems affect most feline dental patients: periodontal diseases, caudal stomatitis, and tooth resorption. Many feline oral conditions have an ethology or treatment that is either very complex or unknown. Quite often, therefore, cats are treated via selective or total extraction of affected teeth. The correct instrumentation will respect the fragile feline structures and the small space in oral cavity. The guidelines on cat‐friendly clinics include many instructions specifically for dentistry, showing its importance in feline medicine. Juvenile gingivitis occurs in young cats around the time of permanent teeth eruption and is associated with circumferential marginal and free gingiva inflammation. Juvenile periodontitis may be seen as a rapidly progressive condition in young cats, with predilection in Siamese and Maine coon breeds, and experience also in British shorthairs.
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The records of 207 cats with high-rise syndrome over a period of I I years were reviewed. Cats fell from the height of the 2nd to the 8th floor and their mean age was 1.2 years. Shock was diagnosed in 17% of the cats, pneumothorax in 4% and pulmonary contusion in 7%. Limb fractures were seen in 50%, spinal fractures or luxations in 10% and split hard palates in 3% of the cats. A total of 93% of the cats survived. It was found that as the height from which the cats fell increased, the number of total and orthopaedic injuries also increased.
Article
Sixty-six children who fell distances up to 96 feet were studied to determine the frequency and patterns of injuries sustained. Upper extremity, skull, and femoral fractures were most common; there was only one pelvic fracture and one os calcis fracture. Two of the children died, and 64 children returned to normal activities.
Article
High-rise syndrome was diagnosed in 132 cats over a 5-month period. The mean age of the cats was 2.7 years. Ninety percent of the cats had some form of thoracic trauma. Of these, 68% had pulmonary contusions and 63% had pneumothorax. Abnormal respiratory patterns were evident clinically in 55%. Other common clinical findings included facial trauma (57%), limb fractures (39%), shock (24%), traumatic luxations (18%), hard palate fractures (17%), hypothermia (17%), and dental fractures (17%). Emergency (life-sustaining) treatment, primarily because of thoracic trauma and shock, was required in 37% of the cats. Nonemergency treatment was required in an additional 30%. The remaining 30% were observed, but did not require treatment. Ninety percent of the treated cats survived.
Article
A review of 200 patients who fell from various heights is reported. The age incidence was greatest in the first three decades, the first decade being greatest. The higher the fall, the greater the mortality. Statistically, the 0-10 year and over 50 years age groups had the same mortality rate. The condition of the patient on ad-mission influenced survival. Patients who entered the hospital comatose or in shock had a greater mortality rate. Multiple injuries of long bones or visceral injuries alone did not affect survival, but these injuries associated with either pelvic or skull fractures increased mortality. Patients with vertebral fractures had minimal clinical symptoms and the association of vertebral and os calcis fractures was not frequent in these vertical deceleration injuries. Clinical management of patients with multiple injuries is discussed.
Article
We evaluated 81 dogs with high-rise syndrome. Dogs fell from 1 to 6 stories, and of 52 dogs for which the fall was witnessed, 39 had (75%) jumped. Dogs sustained a triad of injuries to the face, thorax, and extremities, similar to injuries seen in cats with high-rise syndrome, but with differences in degree and distribution. Height fallen and landing surface affected initial status and type and severity of injury. Cause of fall influenced distribution of extremity injury. Dogs falling < 3 stories had a high prevalence of extremity fractures. Higher falls resulted in more spinal injuries. We recommend initial treatment for shock and thoracic trauma followed by orthopedic and neurologic evaluation. Visceral trauma should be considered if response to emergency treatment is poor. All but 1 of the dogs survived.
Die polytraumatisierte Katze
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Barth, R., 1990. Die polytraumatisierte Katze. Kleintierpraxix 35, 321e330.
High-rise syndrome: retrospective study on 413 cats
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Dupre, G., Allenou, A., Bouvy, B., 1995. High-rise syndrome: retrospective study on 413 cats. Veterinary Surgery 24, 294.
Feline high-rise syndrome in the greater metropolitan area of Copenhagen. A four-year retrospective study
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Flagstad, A., Arnbjerg, J., Jensen, S.E., 1998. Feline high-rise syndrome in the greater metropolitan area of Copenhagen. A four-year retrospective study. The European Journal of Companion Animal Practice 9, 165e171. Gordon, L.E., Thacher, C., Kapatkin, A., 1993. Highrise syndrome in dogs: 81 cases (1985e1991). Journal of the American Veterinary Medical Association 202, 118e125.