Authors of section

Author

Cassio Ferrigno

Executive Editor

Amy Kapatkin

General Editor

Noel Moens

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Bridging plate

1. Principles

Fracture types:

A) Comminuted, unreduced fracture
B) Comminuted fracture aligned biologically
C) Fracture aligned and biologically stabilized

plate and rod

2. Preparation and approach

For this procedure, one of the following two patient positions are used:

One of the following two approaches are used:

3. Surgical technique

Reduction

Indirect reduction is achieved by distracting and aligning the major bone segments using bone clamps or other distraction techniques.

bridging plate

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.

plate and rod

Plate selection

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.

bridging plate

Plate placement

The plate is contoured and placed on the medial side of the tibia, in bridging function.

Read more about plate preparation.

bridging plate

Plate application

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.

bridging plate

Final fixation

42 B1

Locking plate

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.

bridging plate

Final fixation

bridging plate

4. Case example

~3 year old Pitt Bull Terrier with a 42-B3 fracture. Found by Animal Control with a non weight bearing lameness of the right pelvic limb. There was soft tissue swelling at the right midshaft of the tibia/fibula and mild instability at the fracture site. The injury was determined to be 2-3 weeks old at time of presentation.

bridging plate

The fracture was repaired with a 11 hole 3.5mm LCDCP plate in bridging fashion contoured using the contralateral radiograph. MIO approach was used proximal and distally.

bridging plate

No follow up because it was a shelter animal. The feedback was that the patient did well.

5. Aftercare

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.

Implant removal

More information about implant removal can be found here.