Authors of section

Author

Tomas Guerrero

Executive Editor

Amy Kapatkin

General Editor

Noel Moens

Open all credits

Combined treatment options

1. Principles

B3 fractures are fixed with a combination of the methods used to treat A1, B1, B2 and Salter-Harris type I fractures.

In this type of fracture, the femoral neck fracture (B1, B2, Salter-Harris type I) is treated first, followed by reconstruction of the greater trochanter.

2. Patient positioning and approach

This procedure is performed with the patient in lateral recumbency.

One of the following approaches are used:

lateral recumbency position

3. Surgical technique

Combined treatment options

For a detailed description of the surgical techniques please see:

  • "Tension band" fixation method for A1 fractures.
  • "Parallel K-wires or Lag screw and K-wires" fixation method for B1 and B2 fractures.
combined treatment options

  • "Parallel K-wires" fixation method for Salter-Harris type I fracture in immature animals and "Lag screw and K-wire" fixation for B2 fractures (neck fractures or more mature animals with minimal growth potential remaining).

31 B3

4. Case example B3

8-month-old Australian shepherd with a B3 fracture from being hit by a car.

definition

The capital physeal fracture was repaired using parallel K-wires, and the trochanteric fracture using a tension band.

combined treatment options

Postoperative radiographs at one month showing stable fixation but self-limiting resorption of the femoral neck.

combined treatment options

5. Aftercare

Activity restriction is indicated until evidence of bone union is detected on radiographic examinations.

Implants may cause discomfort of the adjacent soft tissue. If this occurs, implants are removed after radiographic evidence of bone healing is complete. In case of infection, implants must be removed after complete bone healing.

Phase 1: 1-3 day after surgery

Aim is to reduce the edema, inflammation, and pain.

Integrative medical therapies, anti-inflammatory and analgesic medications.

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 a 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 complete bone healing is confirmed.

Implant removal

If there is no implant failure or infection, there is no need for implant removal.