Authors of section

Author

Alan Ruggles

Executive Editor

Jörg Auer

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Plate fixation

1. Principles

Anatomic considerations

Because tibial crest fractures are of the avulsion type the tension band principle is used to counteract the distraction forces of the quadriceps apparatus on the fracture fragment.

The tibial crest has a twisted configuration in two planes and is of narrow width. Therefore it is possible to split the fragment with excessive screw placement especially in a linear plane.

plate fixation

Plate contour

Because of the configuration of the proximal tibia, the plate must be torqued along its long axis to maintain contact with the proximal tibia.

plate fixation

2. Preparation and approach

This procedure is performed with the patient placed in lateral recumbency, through the approach to the tibial crest.

approach to tibial crest

3. Reduction

Minimal soft-tissue dissection is required and fracture reduction is aided by extension of the hind limb. Reduction is maintained with the help of a bone reduction forceps or by your assistant.

plate fixation

4. Plate fixation

Plate selection and preparation

Typically a DCP or LC-DCP is used for this repair. Usually a 6-10 hole plate is adequate. In case an LCP is selected it has to be understood that only selected locking head screws can be used because these screws have to be inserted perpendicularly to the plate hole orientation in that spot.
An aluminum template is used to determine the contour of the plate. Care must be taken to adequately identify both the bending and torqueing required of the plate to properly fit the tibial crest.

plate fixation

Plate application

The plate is applied to the bone and a 4.5 mm cortex screw in lag fashion is placed in the second hole of the plate to compress the fracture and maintain reduction.
Additional cortex screws in lag fashion may be placed in hole #3 or #4 if appropriate for the fracture configuration.

plate fixation

5. Reduction and Fixation

Holes 1 and 4-8 are filled with bicortical 4.5 mm cortex screws.
The plate acts as a tension band to counteract the distracting forces on the tibial crest by the quadriceps apparatus and allows the horse to fix the femorotibial joint and bear weight.

Note: in the proximal aspect of the fixation it is an accepted exception to leave one screw hole empty to prevent splitting of the fragment along the screw holes.

plate fixation

Postoperative lateromedial view of a tibial crest fracture repaired with a 8-hole DCP and a concurrent Salter-Harris type II fracture repaired with a 5-hole LCP.

plate fixation

6. Closure

A closed suction drain is often used because of the likelihood of seroma formation in this location. The subcutaneous tissue and skin are closed routinely. A sterile dressing and a stent bandage are applied to the surgical incision.

7. Aftercare

Adult animals are kept under stall rest for 12 weeks with hand walking in weeks 9-12 followed by turn out after 12 weeks in a small paddock for 4 weeks prior to resuming normal activity.
In foals, a shorter period of stall rest for 3 -4 weeks is recommended.
Radiographic evaluation is recommended at 8 and 16 weeks postoperatively prior to changes in activity.
Plate removal is not necessary.

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