Authors of section

Author

Bruno Peirone

Executive Editor

Amy Kapatkin

General Editor

Noel Moens

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Compression plate

1. Indications

32-C2 (segmental fractures) with reconstructible transverse or short oblique segments are generally repaired with a compression plate.. The goal is to achieve anatomic reduction and rigid stabilization that usually leads to direct bone healing.

If comminution exists at one or both of the fracture lines, indirect reduction techniques and bridging osteosynthesis should be used.

compression plate

2. Patient positioning and approach

This procedure is performed with the patient in lateral recumbency, and through the open approach to the shaft.

open approach to the femoral shaft

3. Surgical technique

Plate selection

The length of the plate should allow placement of at least 3-4 screws in each major fragment and, if possible, at least two screws in the middle segment.

Read more about plate preparation.

32 C2

Reduction

The plate is contoured, secured to the proximal and distal fragment with two bone holding forceps. The central fragment is lifted up and anatomically reduced with the help of a pointed reduction forceps, a Hohmann retractor or other instruments.

An intramedullary pin may be used to help in reduction and alignment of the bone.

compression plate

Preliminary fixation

The plate is secured to the bone using bone clamps.

compression plate

Plate application

The central segment is fixed to the plate with two cortex screws inserted in a neutral mode.

compression plate

Compression is applied on the proximal side by inserting a screw in compression mode in the hole closest to the proximal fracture line. If necessary, additional compression can be applied by inserting a second compression screw in the same segment.

compression plate

Compression is applied with the same technique in the distal segment.

compression plate

The remaining screws are now inserted in a neutral fashion.

compression plate

Fixation with a locking compression plate

When a locking compression plate is used, the previous steps are the same. A push-and-pull device can be used in both proximal and distal segments in order to achieve temporary stabilization.
The central segment is fixed to the plate with two cortex screws inserted in a neutral mode. Compression is applied on the proximal side by inserting a screw in compression mode in the hole closest to the proximal fracture line. Compression is applied with the same technique in the distal segment.
Once compression is achieved across the fracture lines, the fixation can be completed by inserting one to two locking screws in the proximal and distal segment.

Note: The plate must be anatomically contoured in the area where cortical screws are used.

compression plate

4. Aftercare

Phase 1: 1-3 day after surgery

Aim is to reduce the edema, inflammation and pain.
Integrative medical therapies, anti-inflammatory and analgesics.

Phase 2: 4-10 days after surgery

Aim is to resolve the hematoma, edema and control pain, and prevent muscle contracture.
Anti-inflammatory and analgesic medications may still be needed. Rehabilitation and integrative medical therapies can be used.

Special attention should be given to patients less than 1 year of age with a femoral fracture. Rehabilitation is strongly recommended to help prevent quadriceps muscle contracture.

If the cat is not starting to use the limb within fa few days after surgery, a careful evaluation is recommended.

10-14 days after surgery the sutures are removed.

Radiographic assessment is performed every 4-8 weeks until bone healing is confirmed.

~3-4 months after follow up radiographs surgery check bone healing.