How to deal with this cat's broken hip (X-rays included)

One of my cats (female, at least 9 years old) has apparently been hit by a car earlier today. I took her to a vet which took 2 X-rays. For context, I found that cat about 9 years ago. She had a broken leg, which the vets fixed - I think with a metal plate and screws of some sort. I can't remember if they took it out at some point. Since the surgery the cat has been jumping and running with no signs of pain or discomfort. I messaged a few veterinary orthopedic surgeons with the X-rays. They gave me the following advice (translated by me): Vet 1: There is an acetabular fracture and a sacroiliac separation. It may be required to operate only on the acetabular fracture, or it may be needed to fixate the sacroiliac separation. Vet 2: One of the traumas is on the cup of the hip joint (the "acetabulum", right?). Even if we can fix it, the risk of developing coxarthrosis ("hip osteoarthritis", right?) after some time, which will be painful and will require further surgery, is high. He suggested we remove that joint - resection of femoral head. After the joint is removed, it will be replaced with a "fake" joint that the cat already has on the other side with the previously-broken leg. The other fracture the hip is separated from the spine, but it doesn't bear weight there, so it might be treated conservatively (without surgery). The second vet suggested a price that's roughly 35% less than the first vet. Can anyone comment on the advice? The cat has been lying down for about 12 hours and doesn't exhibit signs of pain (normal breathing and no sounds). How urgently should I take her for an surgery? Vet 2 said the earliest would be in 2 days, while Vet 1 still hasn't contacted me with more information. I'm giving her gabapentin and meloxicam to treat the pain (prescribed). She ate very little, but drank a normal amount of water a few hours ago. She tried to go to her toilet, which is near her, but it hurt her. I held her, but she didn't go in the toilet. I'll monitor whether she urinates and defecates normally.  

Hello - and my heart goes put to your cat; what dramatic radiographs.  I am no orthopaedic specialist and in any case it's considered terrible form to read another vets radiographs, because they have met the patient and know more context than me; acting as a 'second opinion' despite having less information is somewhat inappropriate.  More to follow.

However, this question is about treatment culture, which changes from vets to vets.  I have worked in places where most clients were unemployed; where, for financial reasons and lack of expertise, acetabular fractures were always treated by removing the hip (and frequently, the whole leg).  I have also worked at practises where the approach was always to treat every animal to the highest possible standards;  where the surgeons have prided themselves on their orthopaedic skill and precision, and will try to preserve function to the best of their ability.  Now:  surgeon one might call surgeon two excessive, expensive and money-grabbing; surgeon two might call surgeon one, lazy, unskilled or 'make do and mend.'  But both levels of treatment have their place.... in most cases.   Sadly I have seen cases where highly skilled  surgeons have tried ambitious, clever repairs which have failed, and the client wishes thry had gone straight for removing the hip.  I have also seen cases where the repair would simply have been done much better, had the more highly trained surgeon had chance to operate.  Where does that leave us?  (More to follow)

Vet 1 sounds to be in a hurry.  They havent given very much information; they havent got back to you.   Vet two seems to have put a lot of thought into their answer, which therefore sounds less convincing - but then, it's a difficult case.  The reality is, that this is a difficult case with lots of potential problems; it needs to be managed medically at least as well as surgically.  Neither seems to have talked about your cats ability to urinate, which would be my first concern; one can fix a pelvis beautifully, but if the bladder or urine tube is damaged, the long term prognosis may be poor.  So I think that the first priority, in telling this, may lie with your GP.

Vet 1 sounds to be in a hurry.  They havent given very much information; they havent got back to you.   Vet two seems to have put a lot of thought into their answer, which therefore sounds less convincing - but then, it's a difficult case.  The reality is, that this is a difficult case with lots of potential problems; it needs to be managed medically at least as well as surgically.  Neither seems to have talked about your cats ability to urinate, which would be my first concern; one can fix a pelvis beautifully, but if the bladder or urine tube is damaged, the long term prognosis may be poor.  So I think that the first priority, in telling this, may lie with your GP.

Ok thats lots of waffle: please read this one 1.  Do the vets still have concerns about your cats' ability to urinate?  (This may need to take priority and comes before repairs - hopefully they are watching the situation carefully.  At worst, it may be that the case might not progress further.    2.  It's worth observing that the way a vet presents themselves is very rarely connected to the value of what they are saying.  This makes it hard.  However a great question for your vet, who knows everyone concerned would be, what would you do if this were your cat? - as there is a cats' 'person', as well as a cats skeleton, to look after here. I apologise for all my thinking out loud and hope that something there helps.

Thank you so much for the thoughtful replies, Liz. The cat went to the toilet again, this time urinating. I had to pick her up and put her back in her bed. The urine-soaked litter was a bit darker than usual and it smelled a bit stronger than usual. It wasn't red, pink or brown, though, just a bit darker. Maybe because she didn't have much water to drink. I don't think the vets asked me about this, as they possibly only care about the orthopedic side of the issue. ~~~~ I called a third vet who spend 11 minutes explaining the possible treatments suggested by the two other doctors. He said it's complicated and that both treatments were an OK course of action. He even guessed correctly which of the other two doctors suggested which treatment, after I told him their names (he asked me who I first spoke to in the end). He said that fixing the acetabular fracture would be more aggressive for the cat, but that it might start walking more quickly after the surgery. He said that it seems like the other leg that was broken had a excision of the femoral head (that I called resection before), and if it's true, it would be better to fixate the other fracture. He said that if the sacroiliac separation isn't fixed, it would also be better to fixate (not sure if that's the correct term in English) the acetabular fracture. But that's me paraphrasing him from a long conversation where the main point was that there are advantages and disadvantages to both treatments and that it's a complicated matter. ~~~~ > However a great question for your vet, who knows everyone concerned would be, what would you do if this were your cat? This advice is great - I never thought of phrasing the question like this. ~~~~ I'll go with vet 1 mainly because vet 3 leaned towards his treatment plan and because of financial reasons (I don't have to pay it all now, even though it's more expensive overall. I'll share what happens afterwards. ~~~~ I really appreciate everything you wrote here. Uncertainty is really confusing and worrying, especially for those without a background in the subject like me. You and vet 3 both helped alleviate a lot of these negative feelings in me.

Thankyou for this lovely reply and please do let us know how things go

My reply doesn't seem to appear on the site, although it said "duplicate reply" after trying again.

Thanks anyway, I guess I can't really post here reliable. Not sure why my previous comment about not being able to post made it through, but my original post didn't. Not sure if this one will work, either.