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.
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.
The plate is secured to the bone using bone clamps.
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.
Compression is applied with the same technique in the distal segment.
The remaining screws are now inserted in a neutral fashion.
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.
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 dog is not starting to use the limb within 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.