The plate is contoured and 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.
The length of the plate should allow placement of at least three screws in each major fragment and at least two screws in the middle segment.
Care should be taken to check the availability of long plates within the selected plating system before surgery.
Precontouring of the plate to radiographs of the sound contralateral limb can help facilitate implant selection, to reduce operating time.
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. If necessary, additional compression can be applied by inserting a second compression screw in the same segment.
Pitfall: Compression plates must be prestressed to produce a 1-2 mm gap between the plate and the bone at the fracture sites. Over bending of the plate at the fracture lines ensures even compression across the fracture lines.
Compression is applied with the same technique in the distal segment.
The remaining screws are inserted in a neutral mode.
Fixation with a locking compression plate
When a locking compression plate is used, the previous steps are the same. Temporary stabilization is achieved using K-wires through the locking drill guide in each of the fragments.
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 that cortical screws are used.
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.
More information about implant removal can be found here.