Authors of section

Author

Cassio Ferrigno

Executive Editor

Amy Kapatkin

General Editor

Noel Moens

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Bridging plate

1. Principles

The intact fibula maintains the limb alignment. The plate function is to protect the fibula from loading forces and to stabilize the tibial fracture.

Note: All simple fractures may be reduced and stabilized with a compression plate. Anatomical reconstruction is not required because of the intact fibula and a bridging technique may be preferred.

bridging plate

2. Preparation and approach

For this procedure, one of the following two patient positions are used:

One of the following two approaches are used:

3. Surgical technique

Reduction

The fibula is helping the reduction and bone alignment. Care should be taken during surgery not to damage the fibula when manipulating the tibial fracture fragments.

bridging plate

Plate placement

The plate is contoured and placed on the medial side of the tibia, in bridging function.

Read more about plate preparation.

bridging plate

Plate application

The plate is applied by inserting at least three bicortical screws in each major segment. The plate should bridge at least 75% of the length of the tibia.

bridging plate

Locking plate

The use of a locking plate may be advantageous because it requires less contouring and provides superior fixation to the bone.

bridging plate

4. Case example 1

Radiographs of a 5-month-old Feline Domestic short hair who sustained a 42-A1 fracture of the distal diaphysis after falling down the stairs.

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Post-operative radiographs of a 42-A1 fracture (fibula intact) repaired with 2 cerclages and a bridging 2.0mm straight plate and 2.0mm screws.

Note: Ideally, no screws should penetrate the fibula, if possible.

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Recheck radiographs one-month post-op showing complete healing of the fracture.

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5. Case example 2

9-month-old female intact domestic short hair cat.

Indoor-outdoor cat, it came home lame on the right pelvic limb.

Pre-operative radiograph shows simple, complete long oblique fracture of the mid diaphysis of the right tibia with mild caudal, lateral, and proximal displacement.

Grade 1 open. The fibula is mildly bowed medially and caudally, but no cortical disruption is appreciated.

bridging plate

OBDNT approach was performed.

2 independent 1.5 mm screws in lag fashion were used for repair, together with a 14 hole 2.0mm LCP in neutralization.

A screw was lagged in position 8 through the plate; a locking screw was applied in position 1 and cortex screws in positions 3,5,13,14.

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Post-operative radiograph. There is good apposition and alignment of the previously described fracture fragments. The mild caudal bowing of the fibula appears decreased.

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Cat returned at suture removal doing well. Follow-up phone call reported that the cat went back to normal activity with no lameness.

6. Case example 3

Unknown age, but less than 8-month-old, female intact domestic shorthair.

Unknown trauma. Came home non-weight bearing on the right pelvic limb.

The radiograph shows complete short oblique fracture of the distal tibial diaphysis with cranial, lateral, and proximal displacement.

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Post-operative radiograph.

Repaired open approach with an 8 hole 2.0 LCDCP in compression.

Note that screw # 6 was too long and caused a transverse fibula fracture. Care should be taken to avoid this technical mistake.

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7. Aftercare

Phase 1: 1-3 day after surgery

The aim is to reduce the edema, inflammation and pain and to protect the surgical wound. A compressive bandage or modified Robert Jones bandage can be used. Integrative medical therapies, anti-inflammatory medications (note in the cat that many are toxic; only use drugs labeled for cats) and analgesics are recommended. In most cases, 10-20 minutes of ice therapy is recommended every 8 hours, but maybe challenging in cats.

Phase 2: 4-10 days after surgery

The aim is to resolve the hematoma, edema and control pain, and prevent muscle contracture. Analgesic medications may still be needed. Anti-inflammatory medications used in the cat are not labeled for continued use after a few days and should be avoided. Rehabilitation and integrative medical therapies can be used.

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

10-14 days after surgery the sutures are removed.

Phase 3: 10 day-bone healing

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

Implant removal

More information about implant removal can be found here.