Opinions please - distal femoral growth plate #

RE: Opinions please - distal femoral growth plate #

Glenn Hodgson — Tue, 21 Jul 2015 10:40:18 GMT

Did this morning, went well.

Tried without bone clamps but proffered the security of positioning they offered prior to placing k-wires.

thanks again

Glenn

RE: Opinions please - distal femoral growth plate #

Glenn Hodgson — Tue, 21 Jul 2015 08:38:43 GMT

Thanks for all of the pointers folks! Really appreciated.

RE: Opinions please - distal femoral growth plate #

Malcolm Ness — Mon, 20 Jul 2015 18:01:04 GMT

3mm isn't very much and these fractures tend to deform caudally, in the same plane as the stifle joint moves. Consequently, and if the fracture feels fairly stable, consideration can be given to conservative management. By that I mean medical pain control and absolutely no splints, casts or other dressings. Frequent clinical monitoring (check the leg still looks straight and feels stable and document some increase in toe-touching to weight-bearing). Rpt rads after a week to make sure that the fracture hasn't moved further.

If conservatism fails or is inappropriate or if the owner wants a quicker fix, then surgery is indicated.

Skin incision cranial midline over patella and down just past tibial tuberosity. Medial and lateral parapatellar incisions into stifle joint. Identify fracture (not always as easy as the rads will lead you to believe) Avoid unnecessary dissection and don't faff about. Reduce the fracture by manipulating the tibia against the femoral shaft - the small distal femoral epiphyseal fragment is attached to the tibis by 2 cruciates and 2 collateral ligaments so you have full control.Maintain reduction by digital pressure and manipulation. The tip given above about a small hole and pointed reduction forceps is a good one provided you are very careful as the bone is soft and easily damaged. Use 2 K wires about 1.0 or 1.2mm diameter. Start on medial and one lateral at the edge of the articular surface (but very, very close to it). Both wires are started rather more caudally than you might think and directed proximally to cross the physics and exit the femoral metaphysis/diaphysis on the opposite side. The K wire should just exit the bone with .5 - 1mm pin protruding. Once both wire are placed, check that the patella runs smoothly through the full range of stifle motion before cutting the wires flush with the bone (they will be intra-articular and must not protrude as they will catch in the joint) Don't attempt to bend over the ends as you will likely tear the K wire through the soft bone.

Tack the joint capsule - don't be overzealous about closing the joint as the resulting tightness will be enough to cause continuing joint stiffness and lameness. Close the fascia and then the skin.

Post op rads and check X rays after a month.

Avoid bandages and encourage the dog to start using the limb asap.

Significant chance that the K wires will move once the fracture has healed and need to be removed but that is a 2 minute job. The pup should be weight-bearing within a day or two and the fracture will be effectively healed within a month or so.

Prognosis for a return to lifelong athletic activity is excellent.

RE: Opinions please - distal femoral growth plate #

Tim Charlesworth — Mon, 20 Jul 2015 15:21:56 GMT

[quote user="Utlendigur"]

I'd go for k-wires. One tip I found useful was to drill a small hole or dent in the cranial surface of the distal femur. Place the stifle in extension which usually reduces the fracture nicely, then use a pair of pointed reduction forceps with one end in the hole and the other in the joint, to hold everything in place while placing the pins.

[/quote]

+ 1 to the above. The distal physis has a nice "W" shape to it so it interdigitates well. Although he may not have much more growing to do, I wouldn't plate the physis but would use 2 k-wires as above. There is a tendency to over-reduce these so be careful you don't accidentally open up the caudal fracture gap.

PS if an orthopod replies then go with whatever they say!

Tim

RE: Opinions please - distal femoral growth plate #

Utlendigur — Mon, 20 Jul 2015 14:13:50 GMT

RE: Opinions please - distal femoral growth plate #

grumpyoldman — Mon, 20 Jul 2015 12:37:36 GMT

Maybe better to use the k-band wires to position it and eliminate the 3mm error and then use a 2:1 screws contoured bone plate to stabilise/fix, then take the wires out .