Indirect reduction is achieved by distracting and aligning the major bone segments using bone clamps or other distraction techniques.
Validation of alignment and rotation
Once the bone length has been restored, it is necessary to check for correct alignment and rotation.
Rotational alignment can be judged by palpation or by direct visualization of the relation between the tarsus and the stifle.
Flexing and extending the tarsus and stifle will help to check the alignment of the repair.
Note: Position of the dog in dorsal recumbency permits a better three-dimensional view of the tibia, thus it helps in the verification of alignment.
A large plate must be selected because it must be able to withstand all the weight bearing forces because the bone will not be sharing the load. A lengthening plate (a plate without holes in the central part) can be used.
Note: A bridging plate used alone is acceptable in young dogs, when bone healing is fast, and in lightweight patients only.
The plate is contoured and placed on the medial side of the tibia, in bridging function.
The plate is applied by inserting at least three bicortical screws in each major segment. The plate should bridge at least 75% of the length of the tibia.
A locking plate can be used instead of a traditional bone plate. Using a combination of non-locking and locking screws or locking screws alone can provide adequate fixation. If a combination of screws is used, the plate must be anatomically contoured and the non-locking screws should be placed and tightened first because they will compress the plate to the bone.
4. Case example
Patient with a 42-B1 fracture.
Intraoperative image showing the creation of the epiperiosteal tunnel.
Intraoperative image showing the MIPO approach and plate placement.
The fracture was repaired with a locking compression plate as a bridging plate.
Postoperative radiograph at 60 days.
Phase 1: 1-3 day after surgery
The aim is to reduce the edema, inflammation and pain. A Robert Jones or modified Robert Jones bandage can be used to decrease the edema and protect the surgical wound. Integrative medical therapies, anti-inflammatory medications and analgesics are recommended. In most cases, 10-20 minutes of ice therapy is recommended every 8 hours.
Phase 2: 4-10 days after surgery
The 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.
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.
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.