The plate is contoured and 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 length of the plate should allow placement of at least three or four screws in each major fragment and at least two screws in the middle segment.
Precontouring of the plate to radiographs of the sound contralateral limb can help to facilitate implant selection, to reduce operating time, and to ensure that the S-shaped curve of the tibia is reproduced thus avoiding valgus deformities.
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 inserted in a neutral mode.
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 that cortical screws are used.
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.