Compression plate fixation

The goal of 23-A2 fracture treatment is anatomical reduction of the radius and ulna (if needed). This can be achieved by compression plating with a straight plate applied to the medial or cranial aspect of the radius. Compression plating is the treatment of choice for these fractures in toy breed dogs.

In some cases, a T-plate repair may be appropriate (see the corresponding treatment “T-plate fixation”).

The fracture can be anatomically reduced with load sharing, which allows early limb use without external coaptation.

The patient can be in sternal, or lateral, or dorsal recumbency.

The preferred surgical approach for a 23-A2 fracture involves a cranial or craniomedial skin incision to expose the distal radius. If the associated ulnar fracture needs to be repaired, a separate, more lateral tissue dissection will be needed to expose the distal ulna. The length of the incision will be dictated by the length of the plate(s) selected for the repair.

The goal is to achieve anatomical reduction of the radius and, when indicated, ulna.

The distal fragment is manipulated with pointed reduction forceps to achieve reduction.

Alternatively, the plate can be fixed in the distal fragment first and then used to achieve reduction on the proximal fragment.

In this case, the plate should be contoured before application.

A straight locking or nonlocking plate of an appropriate size is selected. The plate can be applied to the medial or cranial surface. When both ulnar and radial fractures are to be repaired, it is more typical to apply the plate cranially.

For the purpose of illustration, a medial plate will be shown.

Ideally, three screws should be used in the distal fragment and three screws in the proximal fragment.

A plate of appropriate size is contoured to fit the shape of the distal radius.

The contoured plate is applied to the medial surface of the radius and secured with plate-holding forceps.

The anatomical reduction is carefully checked. If required, the alignment is corrected and the plate holding forceps are repositioned.

Usually, the plate is fixed on the distal fragment first.

The first screw is inserted in compression mode after drilling with a neutral or load guide through the plate on one side of the fracture line. The screw is not fully tightened.

The compression screws should be near the fracture line but should not enter it.

After drilling with the load guide, a second screw is inserted in compression mode on the other side of the fracture.

The screws are tightened alternatingly, generating interfragmentary compression across the fracture line.

The most distal and most proximal screws are inserted in neutral mode.

If locking screws are to be used in some locations, they need to be inserted after compression has been achieved with cortical bone screws.

All remaining screws are inserted in neutral mode. The plate is secured with at least three bicortical screws in each major fragment. It is not necessary to fill all the available plate holes.

Sometimes, it is not possible to insert three screws in the distal fragment, but a minimum of two screws is required.

The aim is to reduce edema, inflammation, and pain.

Following appropriate internal fixation, there should be no absolute need for external coaptation for a 23-A2 fracture. If bandaging is used to decrease edema and protect the surgical wound, it should be removed after 24–48 hours to reduce the risk of complications.

Integrative medical therapies, anti-inflammatory medications, and analgesics are recommended.

10–20 minutes of ice therapy is recommended every 8 hours in most cases.

The patient can immediately bear weight, but with strict control of activities.

The aim is to resolve hematoma and edema, control pain, and prevent muscle contracture. Anti-inflammatory and analgesic medications may still be needed.

Rehabilitation and integrative medical therapies can be used.

A careful evaluation is recommended if the patient is not starting to use the limb within a few days after surgery.

The sutures are removed 10–14 days after surgery.

Immature patients should be radiographed every 4 weeks. A radiographic assessment is performed every 4–6 weeks until bone healing is confirmed, more frequent assessment may be necessary for skeletally immature patients.