Indian J. Anim. Hlth.

(2018), 57(1) : 113-116 Short Communication

SURGICAL MANAGEMENT OF OBLIQUE DIPHYSEAL

TIBIAL FRACTURE IN CANINE

D. GHOSH*, V. KUMAR, A. DEBNATH, V. LALZAWMLIANA

P. MUKHERJEE1, S. CHOWDHURY1 AND S. K. NANDI

Department of Surgery and Radiology

Faculty of Veterinary and Animal Sciences
West Bengal University of Animal and Fishery Sciences
Kolkata- 700 037, India

A cross breed medium size dog, aged nine months was presented in the clinic with a history of accident,
swelling on the lateral aspect of tibia. The radiological examination confirmed a complete oblique mid
shaft fracture of tibia. Hybrid internal fixation with intra medullary pinning combined with cerclage
wiring was used for fracture repair with standard surgical approach to bone under standard anaesthetic
protocol. The patient was successfully treated and recovered completely after 2 months.

Key words: Anaesthetics, Cerclage wiring, Fracture, Intramedullary pin

Fractures are one of the most common (Zaal and Hazewinkel, 1996). Tibia is
clinical presentations observed in dogs. covered by less musculature and soft
They are most commonly caused by
tissues, and being an important weight
accidental trauma. Tibial fractures occur
bearing bone, it is very prone for fracture
very frequently, and they account for
around 20% of all long bone fractures (Harasen, 2003). Tibial fractures are
(Unger et al., 1990; Seaman and Simpson, predisposed to open fractures due to the
2004). Tibial shaft fracture is most common smaller amount of soft tissue surrounding
accounting for nearly 73% of tibial fractures the tibial bone (Pope, 1998).
* Corresponding Author
1
Department of Veterinary Clinical Complex, West Bengal University of Animal and Fishery Sciences,
Kolkata- 700037
114 Indian Journal of Animal Health, June, 2018

A medium sized male cross breed dog, proximal tibia (Howard, 1991). The pin was
weighing 14 kg, aged 9 months was chosen in such a way that it fills
presented in clinic with a history of accident. approximately two third of the medullary
The physical examination of the patient cavity. A cerclage wiring of the edges of
revealed non-weight bearing lameness of the fractured bones was done with 20 gauge
left hind limb, swelling over the lateral stainless steel orthopadeic wire to support
aspect of tibia with crepitation on palpation. the immobilization and maintain the bone
Radiological examination confirmed in its alignment. The intramedullary pin was
complete, diphyseal oblique fracture of left so used that the distal tip of the pin anchored
tibia (Fig. 1). in the distal epiphysis of the tibia firmly and
the proximal part is cut bending the
The dog was planned for internal proximal edge medially. The surgical
immobilization with hybrid fixation wound was closed in a routine manner with
technique in combination with non-absorbable synthetic suture material.
intramedullary pinning and cerclage wiring. Post-operatively, the operated limb was
The animal was administered with
given external support with modified Robert
ceftrioxone @10 mg/Kg b.wt. b.i.d, i/m,
Jones’s bandage with antiseptic dressing of
temporary immobilization with Robert
the wound on 3rd, 5th and 7th day. The animal
Jhones bandage for 3 days before surgical
was administered with ceftrioxone
intervention. The animal was prepared for
(@10mg/Kg b.wt) and meloxicam (@
aseptic surgery by routine way in the medial
aspect of the fractured tibia and fibula. The 0.4mg/Kg b.wt) for 7 and 3 days
dog was administered with atropine sulphate respectively. Calcium and vitamin D
@ 0.02mg/Kg s/c, xylazine 1mg/Kg and supplement was also given for 1 month. The
butorphanol 0.2mg/Kg i/m, as client was advised to restrict the activity of
preanasethetics. General anaesthesia was the animal for first 2 weeks and later the
maintained with diazepam 1mg/Kg and dog was allowed leash walk. The radiograph
propofol 2mg/Kg intravenously. The taken immediately after surgery and
incision was made at the cranio-medial subsequently at a regular fortnight intervals
aspect of tibial bone of effected limb and were evaluated for fracture healing, pin
the fractured parts were exposed. Drilling position, any complication, time taken for
was done obliquely on the medial side of callus formation and time taken for
the proximal tibia until it reached the complete bone healing (Fig. 2 and Fig. 3).
medullary space. Normograde insertion of The sutures and intramedullary pin were
intramedullary pin of 3.5mm depending age removed after 14 and 42 days of surgery
of the dog and diameter of the tibia was respectively and the bone eventually healed
performed from the medial side of the after 2 months.
 Surgical management of tibial fracture in canine 115

Intramedullary pinning of the tibial fracture plates or screws are used as fixation devices
and the ancillary fixation that is necessary then the implants must be removed as early
depend on the fracture configuration. In this as possible in order not to affect the growth
present study intramedullary pin was plate. In case of intramedullary pinning,
chosen such that it fills approximately two the pin can be left in place unless loss of
third of the medullary canal (Boudrieau, function and pin loosening is present
1991). Intramedullary pin was placed in (Piermattei and Flo, 1997). The
such a way that it should not interfere with intramedullary pinning of long bone cannot
the normal joint function. Retrograde pin
neutralize the rotation force of bone as a
insertion from the fracture site must be
result there may be delayed and mal union.
avoided because if the pin exits within the
A full cerclage wiring was done to hold both
stifle joint can cause severe joint damage
fracture ends opposed to each other and to
(Pardo, 1994). Normograde insertion of an
restrict the rotational instability of fractured
intramedullary pin was performed from the
tibia. In some cases cerclage wires were
medial side of the proximal tibia to prevent
complications with the joints (Howard, thought to be the reason for failure to heal
1991). The radiograph taken immediately in some fractures (Withrow, 1978), and the
after the operation revealed good positioning mechanism was thought to damage the
and alignment of fracture ends. Subsequent blood supply. But extensive investigation
radiographs revealed initiation of callus of the blood supply to the callus has shown
formation on 15th days, resorption of primary that it is not affected by stable cerclage
callus on 30th day and complete remodeling (Wilson, 1991). Since the cerclage wiring
with evidence of diphyseal medullary cavity was stable enough such complications and
on 45th day at the fracture site. delayed healing was not observed here. But
we have removed the pin after clinical union
Since the animal presented was of growing in order to prevent further complication.
age, fixation provided by intramedullary The wiring was kept in situ without
pinning was opted to prevent premature perceptible complication for a period of 2
closure of the growth plate (Lipowitz et al., years of follow up time. Clinical union
1993), which can be a problem in other occurs after 8 weeks and the patient
method of fixation. In growing dogs if regained original locomotory function.

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116 Indian Journal of Animal Health, June, 2018

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Article received on 15.01.2018 and accepted for publication on 20.05.2018