Wednesday 24th Apr, 2019
Proximal tibial fractures are common and account for around 10% of dog fractures with over 50% of them occurring in dogs less than 1 year old.
This curved fracture however was not of the growth plate as would usually be seen, but of the proximal tibial metaphysis.
What do you think is the best way of managing such a fracture without damaging the growth plate and allowing future bone growth?
We repaired the fracture using a T-shaped, 2.0mm LCP notched T-plate, which has been affectionately named a ‘Mickey Mouse’ plate. Using this plate allowed us to fit both ‘ear’ screws and one other onto the tiny portion of metaphyseal bone, whilst avoiding the growth plate itself.
The ‘locking’ plate was also good since it did not require to grip into the bone, instead acting like a little ‘internal fixator’: where the screws gripped the plate and held the small, soft bone fragments in place until healing occurred.
When it's so close to the 'growth plate' (which is 'weaker') why would it fracture here?
Most likely this fracture occurs due to twisting forces, such as a varus or valgus force applied to the tibia during the fall.
Similar to kids that get trampoline injuries it is also likely that for a short time only, dogs’ metaphyseal bone is weaker than the growth plate itself.
Can you think of any potential future complications that could occur?
Stone’s bone healed well and as can be seen in the image below, the tibia also continued to grow.
What is also visible however is that there is mild curvature of the tibia, likely due to the injury or repair. This was not clinically significant in Stone, who has recovered really well, but all the same this highlights the importance of advising of this potential complication, and using implants which minimise damage to the growth plate and allow normal bone development to continue.