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Growth Plate Fractures

Growth Plate Fractures of the Tibia Bone

Avulsion fracture the tibial tuberosity occurs in young animal , usually between 4-8 months of age. The tibial tuberosity serves as the insertion point of the quadriceps muscles through the patellar ligament, and avulsion result from contaction of the muscle while stifle is flexed and the foot firmly on the ground, Such mechanism could easily occur during jumping or running and perhaps in a fall.

Surgery: Open reduction and internal fixation technique.

  • A longitudinal incision is made just medial to the patella, the patellar ligament, and the tibial tuberosity.
  • The blood clot and fibrin clot is removed from the original location of the tuberosity. Fracture is reduced and anchored in place with three Kirschner wires.

 

AfterCare:

  • Exercise should be restricted for 6-8 weeks until fracture have healed
  • In animal has a considerable amount of growth potential remaining, the fixation should be removed as early as possible to avoid premature fusion of the tuberosity to the shaft of tibia(shin bone)
  • Pin fixation need not be removed unless it loosens and migrates.
  • Radiographs (x-rays) should be taken about 2 months after surgery to evaluate healing of the fracture

Physeal fractures  usually Salter type 1 or type 11 injuries occur in young animal.  After skeletal maturity, fractures in this region are slightly more distal. The entire epiphysis and tibial tuberosity are usallu involved, and the tendency is for dislocation in a caudolateral direction in relation to the tibial shalft

Surgery: Open reduction and internal fixation technique.

A longitudinal skin inciosion is made on the craniomedial surface of the proximal tibia and  stifle. After open reduction, transfixed by multiple Kirschner wires. The medial and lateral pins are started near the periphery of the tibial plateau, where they do not interfere with the femoral condyles.These pins pushed to penetrate the opposite cortex for the best stability.

AfterCare:

  • Exercise should be restricted for 6-8 weeks until fracture have healed.
  • In animal has a considerable amount of growth potential remaining, the fixation should be removed as early as possible to help avoid interference with the growth plate.
  • Pin fixation need not be removed unless it loosens and migrates.
  • Radiographs (x-rays) should be taken about 2 months after surgery to evaluate healing of the fracture.

Mid-shift tibial fracture repaired:

  • The entire limb is shaved
  • An incision is made on the inner side of the tibia
  • The fracture is reduced and stabilized with one of the following
      1. Bone Plate and Screws
      2. Bone Plate and Pin Combination
      3. Intra-medullary Pins
      4. External skeletal fixator
      5. Combination of above

       

      Make a skin incision on the cranial aspect of the crus for the medial approach to the tibia. This approach will simplify closure and prevent the skin being closed directly over the plate.Wound breakdown over the distal tibia is a problem if this is not done. Intraoperative contouring of the bone plate, prior to application to the bone, is necessary due to the sigmoid shape of the tibia in a mediolateral and craniocaudal plane.

      • The use of aluminium bending templates greatly simplifies contouring and they are auseful (and inexpensive) investment;
      • When viewed from a medial aspect, the plate is applied to the line of ‘best fit’ and typically requires placement along the caudal edge of the proximal third;
      • Bending of the plate can be done with either a bending press, bending pliers or bending irons;
      • Slight twisting of the plate is usually necessary if the plate is applied to the full length of the tibia, to account for the 10-15o of tibial torsion. Whether twisting of the plate is necessary will be apparent from using a plate template and needs to be done with bending irons.

      AfterCare:

      • Ideally the animal would be allowed early, limited active use of the limb to promote healing
      • This requires totally stable internal fixation, good owner compliance with confinement and exercise restrictions, and a patient that will not overstress the repair because of hyperactivity.
      • Exercise should be severely restricted for 6weeks, with a gradual return to unrestricted activity 3-4 weeks after clinical union.
      • Radiographs should be taken at 6 or 8 weeks to confirm clinical union before any increase in exercise is allowed.

      Distal tibial fracture;

      This fracture is observed primarily in the immature animal as a physeal fracture of  Salter type 1 or type 11.

      Reduction and fixation vary with the individual case. In some patient s, reduction may be accomplished closed by a combination of traction, countertraction,  and manipulation.

      An open reduction may be mandatory for satisfactory reduction in most case: the approach is usually made on the medial side. Because the distal tibial has no muscular covering, the bone is virtually subcutaneous.

      Surgery: Open reduction and internal fixation technique.

      • After reduction, the insertion of two small, diagonally placed pins starting at the medial and Lateral malleoli is often the only practical methods of fixation because of the shortness of the fragment.
      • Supplemental fixation using a short lateral splint is applied.
      • Additional Rotational stability can also be achieved by a tension wire placed between the protruding pins on one or both side.

      AfterCare:

      • Activity is restricted during the healing period.
      • The external fixation can be removed when adequate primary callus has formed ( in about 3 weeks)
      • The transfixation pins are usually removed after clinical union has been reached.

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