Tibial Fractures

              Key Points

              Because the tibia bone is just beneath the skin on the inner side of the limb, there is increased risk for a sharp bony fragment to penetratrate throught the skin; this can be prevented by supporting the limb with a splint before the surgery is performed

              Tibial fractures are usually repaired using a plate and screws, but other forms of repair are also possible

              These type of fractures do not respond well to casting

               

              Anatomy

              The tibia bone is the shin bone

              The top of the tibia bone forms the knee joint with the femur bone

              The bottom of the tibia bone forms the ankle or hock joint with the bones of the paw

               

              Considerations

              Tibial fractures in young dogs heal very quickly

              Young dogs have open growth plates, which are the soft regions of the bone (at the ends) which are susceptible to fracture

               

              Surgery

              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

                Plate and screws

                Pins

                Wires

                External skeletal fixator

                Combination of above

                A bone graft from the top of the pelvis or bone bank may be used to stimulate healing of complicated tibial fractures (multiple pieces)

                The radiographs below show a transverse fracture of the tibia bone

                In the radiographs below, a long plate and screws were used to repair the fracture.

                In the photo below, the plate and screws have been secured to the bone to reduce the fracture.  The band of red tissue crossing over the plate is the saphenous nerve, artery and medial saphenous vein.

                Aftercare

                The limb may be bandaged for about 5 days

                Watch incision for signs of infection

                Limit activity until the fractures have healed which is about 2 months

                No jumping, running, rough play

                Pet should be kept indoors other than short leash walks for elimination purposes

                Activity can return to normal once we have determined that the fractures have healed (based on radiographs)

                Prevent licking of the incision

                Licking the surgical site

                  can open the incision

                  can introduce infection

                  does not help to heal the wound

                  Licking can be deterred by

                    placing an Elizabethan collar on your pets neck

                    applying a combination of bitter apple solution and liquid heet (2:1) around the incision

                    applying liquid bandage (facilitator) onto the incision

                    Radiographs (x-rays) should be taken about 2 months after surgery to evaluate healing of the fracture

                     

                    Potential complications

                    Anesthetic death

                    Infection

                    Breakage of the implants if exercise has not been restricted during the healing phase

                    Cancer of the bone induced by the implants is a very rare, but potential complication; therefore we recommend removal of plates and screws

                     

                    Timing of removal of plates and screws

                    Mature animals = 1 year after surgery

                    Immature animals = same amount of time after surgery as the age of animal (example 4 month old dog can have implants removed in 4 months)

                    Reasons to remove implants

                      cold sensitivity – lameness when dog is outdoors in winter

                      infection

                      implants can induce a bone cancer – very unusual, but occasionally will occur

                      osteoporosis due to bone relying on plate for strength

                      the surgeon will make recommendations on the need to remove implants in your pet


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