Reducible C3 fractures should be anatomically reduced with lag screws and cerclage wires to reconstruct the bone column. K-Wires may be used to provide temporary or additional fragment stabilization.
A plate is used in a neutralization fashion and a lag screw is positioned into the femoral neck and head.
In some situations, it is beneficial to re-attach the femoral head and neck to the proximal fragment before securing the bone plate. This can be done by using an independent screw in lag fashion into the neck. The placement of the plate will have to be slightly modified to not interfere with the screw head.
Note: If anatomical reconstruction cannot be accomplished, the fracture will be indirectly reduced and stabilized with a bridging plate.
The plate is positioned as proximal as possible to have access to more bone stock for plate fixation.
Following contouring, the plate is applied to the lateral surface of the reconstructed bone.
The plate position and contouring to the bone is checked thoroughly and adjusted, if required.
An antirotational K-wire or screw is inserted in the femoral neck and head.
The plate is fixed in a neutralization fashion.
The first screw is inserted in lag fashion in the second or third plate hole engaging the femoral neck and head.
A second screw is inserted on the distal part of the bone.
Additional screws may be inserted through the plate holes where needed.
Validation of fixation
Postoperative orthogonal radiographs are taken to assess fixation.
Fixation with a locking plate
If a locking plate is used, only 2-3 locking bicortical screws per main fragment are needed. A lag screw is positioned into the femoral neck and head. One advantage of using a locking plate is that precise contouring is not necessary.
Note: If a combination of cortex and locking screws is used, the plate must be anatomically contoured at the sites of cortex screw insertion. The cortex screws must be inserted and tightened before any locking screws are placed.
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.
If there is no implant failure or infection, there is no need for implant removal.