Screw fixation

Anatomic reconstruction of the joint surface is essential.

Interfragmentary compression is achieved with a lag screw for anatomical reduction of the articular fracture.

This procedure is performed with the patient placed in either of the two positions:

• Lateral recumbency
• Dorsal recumbency

One of the following approaches is utilized:

• Lateral parapatellar approach
• Percutaneous approach

The fracture is reduced, and preliminary stabilization achieved with pointed reduction forceps. Anatomic reduction is essential in all cases.

The lag screw is inserted perpendicular to the fracture plane.

Note: If the screw insertion point is intra-articular, care must be taken to ensure the head is completely countersunk below the articular surface to avoid trauma to the joint surfaces and pain for the patient.

The screw may be placed in lateral to medial direction.

The screw may also be placed in medial to lateral direction.

The starting point is variable depending on the fracture configuration. The screw should be directed caudolaterally to maximize purchase of the fracture fragment.

Note: Care should be taken not to penetrate the articular surface with the screw. The screw head should be countersunk to avoid soft tissue irritation and maximize contact between the screw head and the bone.

Note: If the screw is not placed perpendicular to the fracture plane, this will result in loss of anatomic reduction of the articular surface.

Additional stabilization can be achieved by:

• A K-wire
• An additional lag screw in larger fragments

Postoperative radiographs should be taken to assess the repair.

Activity restriction and controlled walking is indicated until evidence of bone healing is detected by radiographic examinations.

The aim is to reduce the edema, inflammation and pain using anti-inflammatory and analgesic medications.

Passive range of motion of the hip and stifle joint can be initiated to promote mobility and joint health.

The aim is to resolve the hematoma, edema and control pain, and prevent muscle contracture.

Anti-inflammatory and analgesic medications are still 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, as they are at risk for developing quadriceps contracture. Early controlled activity and passive range of motion is strongly recommended to help prevent this complication.

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

Rehabilitation therapy is continued.

10-14 days after surgery the sutures are removed.

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

Implants may be removed if there is irritation or infection present, however if they are not causing problems for the patient, there is no need for implant removal.