Percutaneous tibial physeal fracture repair in small animals: technique and 17 cases

Abstract

Percutaneous tibial physeal fracture repair can be considered as a technique to treat tibial physeal fractures. The "spiking" technique was successfully applied in six dogs. A larger, prospective case series is indicated to provide additional clinical information.

Feline Distal Tibial Physeal Fracture Repair Using a Modified Cross-Pin Technique with Four Pins

“…In a previous report of three cats with distal tibial physeal fractures treated with a percutaneous cross-pin technique, ⅓ cats developed bandage related sores and also required pin removal due to protrusion through the skin. 10 Although minimally invasive osteosynthesis techniques (e.g. fluoroscopic-assisted percutaneous pinning) were not used in this report, the authors feel the technique could be adapted to allow this, particularly in minimally displaced fractures.…”

“…5 Cross-pinning has been traditionally described but with only very few cases reported within the peer-reviewed literature, often with limited detail. 9,10 External coaptation, most often with lateral splints, is generally advised by most authors when describing this technique to enhance rotational stability. 3,7,8,19 Brioschi and colleagues , 20 in a similar study, report that 2/6 cats that underwent external coaptation following Kirschner wire fixation of distal radius and ulna physeal fractures developed some degree of skin sores.…”

“…3,4,6,7 Fluoroscopy-guided percutaneous pinning has also been described with clinical success. [8][9][10] Regardless of repair and fixation method, rigid external coaptation to prevent repair failure has most commonly been advised, typically for 2 to 4 weeks postoperatively. 3,[7][8][9] In this report, we describe the use of a modified cross-pin technique for management of Salter-Harris type I and II fractures of the distal tibial physis in cats.…”

Use of Epiphysiodesis as Treatment for a Proximal Physeal Tibial Fracture in a Dog

“…Kirschner wires with or without tension band are mostly used, 7,8 reduction and fixation being performed either by open technique or percutaneously. 12,13 Proximal tibial epiphysiodesis has been described as a therapy for growing dogs with cranial cruciate ligament deficient stifles. It aims at closing the cranial part of the proximal tibial physis with a cancellous screw.…”

Questioning the status quo

“…To begin with, you can read how developments in diagnostic imaging and computer modelling provide new tools to investigate joint motion and to develop better methods of treating joint disease (1,2). Of course, imaging is also critical in clinical practice for the development and planning of minimally invasive surgery, as well as in reshaping our classification of certain fractures, such as those of the proximal tibia (3)(4)(5). Furthermore there are studies that ask questions about the stabilization of tibial osteotomy, correction of medial patellar luxation, and rehabilitation of dogs following limb amputation (6)(7)(8).…”