Indie (a 2 year old female Boxer) was out for a walk and jumped onto a slope. She landed awkwardly, cried out and was suddenly unable to bear weight on the leg. She was taken to the Rosemary Lodge Veterinary Hospital where a fracture was suspected. She was given strong pain relief, radiographs were taken and the leg was placed in a support bandage. The radiographs showed that there were fractures of the right tibia and fibula, with a butterfly fragment at the mid shaft tibia, and a spiral fissure extending towards the hock. Indie was subsequently referred to Jon Shippam at Bath Vet Referrals.
Fractures that are very close to, or even involving joints are more demanding to treat. If the joint is involved then accurate reconstruction is essential to avoid severe osteoarthritis and joint pain. If a fracture or fissure extends very close to a joint it creates difficulties placing implants to achieve sufficient stability for the fracture to heal. In this case a CT was performed to check the exact location of the fissures to help with surgical planning.
After assessing the CT images it was decided that standard plating procedures would carry a significant risk of the fissure propagating, but that a double plating technique using a single locking screw at the lower end of each plate would minimise this risk whilst achieve the minimum requirement for stable fixation. Locking screws have threaded heads that ‘lock’ into the plate. The CT showed that a fissure extended to within 10 mm of the joint surface, but confirmed that it would be safe to place two locking screws at 90 degrees to each other and avoid the fissure and the joint surface.
Two locking compression plates (LCP’s) were applied to the right tibia, one on the cranial aspect of the bone, and one on the medial aspect of the bone. Post operative radiographs showed that the tibia was suitably aligned and that the most distal screw had successfully avoided the joint surface and the fissure.
Indie was cage rested for 6 weeks, with regular short toilet walks outside. Follow up radiographs were taken after 6 weeks which showed good progression of bone healing. Exercise was cautiously increased and at at the final recheck 11 weeks after surgery the owner was not seeing any signs of lameness and was able to build up to normal exercise.