Tibial Fractures

Jeffrey A. Seaman, DVM,* and Amelia M. Simpson, DVM, DACVS†

Tibial fractures are common in small animal practice. As with other appendicular fractures,
the patient’s age, fracture location, and fracture type must be considered thoroughly. While
methods for tibial fracture repair are similar to those used for appendicular fractures
elsewhere, there are some unique considerations, both anatomically and functionally, that
must be contemplated before repair. The following article will review the incidence of tibial
fractures, tibial fracture types, and options for tibial fracture management and treatment.
The use of external fixators, orthopedic bone plates, open reduction with internal fixation
(ORIF), and external coaptation will be discussed. An emphasis will be placed on the most
common types of tibial fractures, as well as those best suited for repair by general
practitioners of veterinary medicine. Three case based examples will follow the overview.
Clin Tech Small Anim Pract 19:151-167 © 2004 Elsevier Inc. All rights reserved.

KEYWORDS fractures, tibia, dog, cat

T ibial fractures are the third most common fracture type

(after femur and radius/ulna). They account for approx-
imately 20% of long bone fractures.1 Approximately 73% of
tures are uncommon.4 Involvement of the articular surface
requires meticulous reconstruction. Diaphyseal fractures of
the tibia are common.2 Fractures of the diaphysis may be
all tibial fractures are diaphyseal fractures.2 Distal tibial frac- incomplete or greenstick, spiral or oblique, transverse, seg-
tures occur less frequently, and account for approximately mental, and comminuted or complex.3 Distal tibial fractures
20% of all tibial fractures. Proximal fractures of the tibia are may be physeal (most commonly Salter-Harris types I and II),
least common (7%). Fibular fractures frequently accompany metaphyseal, lateral and medial malleolar, and epiphyseal. As
fractures of the tibia. with proximal epiphyseal and multi-fragmentary fractures,
There is significant variation in fracture location and type comminuted fractures with involvement of the articular sur-
for skeletally immature animals as compared with skeletally face in distal tibial fractures are uncommon and require me-
mature animals. Proximal tibial fractures are seen almost ex- ticulous reconstruction. Fibular fractures can be proximal,
clusively in skeletally immature animals, but are rare in older diaphyseal, or distal. Isolated fibular fractures are rare.
animals. Greenstick and segmental fractures are more com-
mon in younger animals whereas open, comminuted, and
malleolar fractures occur more frequently in adults.2,3 Fracture Management
and Treatment
Fracture Types A Robert Jones bandage is recommended as soon as possible
Tibial fractures are generally classified by location as proxi- after diagnosis of a tibial fracture to immobilize the fracture
mal, diaphyseal, and distal fractures. Proximal and distal tib- and protect the surrounding soft tissue structures from dam-
ial fractures may be epiphyseal, metaphyseal, and physeal. age.5 Open fractures should be decontaminated as thor-
Tibial fractures may be open or closed. Specific fracture types oughly as possible before bandaging.
within each anatomic segment are listed in increasing order External coaptation is an option for stable tibial frac-
of complexity. tures amenable to closed reduction in skeletally immature
Proximal tibial fractures include avulsion of the tibial tu- animals. Although this has also been suggested for similar
berosity, physeal (most commonly Salter-Harris types I and fractures in adult dogs and cats, rigid fixation via external
II) and metaphyseal. Epiphyseal and multifragmentary frac- fixator or internal fixation is preferable.6 Commonly used
devices for external coaptation are the long leg cylinder
cast, lateral splint, or modified Thomas splint (Fig. 1).
*Oradell Animal Hospital, Paramus, NJ. Stable coaptation requires immobilization of the joints
†University of Pennsylvania Veterinary Hospital, School of Veterinary Med- proximal (stifle) and distal (tarsus) to the fracture. This
icine, Philadelphia, PA.
Address reprint requests to Jeffrey A. Seaman, DVM, Oradell Animal Hospi-
may be difficult to achieve in proximal tibial fractures, or
tal, 580 Winters Avenue, Paramus, NJ 07652. E-mail: carnivalcman@ in short legged or muscular breeds. The coaptation device
hotmail.com should be crafted to maintain the stifle and tarsus in the

1096-2867/04/$-see front matter © 2004 Elsevier Inc. All rights reserved. 151
doi:10.1053/j.ctsap.2004.09.007
152 J.A. Seaman and A.M. Simpson

Figure 1 Illustration of a cylinder cast (inset) and modified Thomas splint that can be used to immobilize the hindlimb.

normal angle of flexion for the standing animal.4 Reduc- IA fixators should be applied to the medial surface of the
ible, stable diaphyseal fractures are suitable for external tibia. Type IB and II fixators are employed when the fracture
coaptation, as are reducible Salter-Harris type I and II site is more severely comminuted.8 Type IB fixators can be
fractures, provided the distal femur can be adequately utilized in proximal or distal fractures when there is short
immobilized by the coaptation device. Healing time for metaphyseal segment. Type III fixators are used when there is
diaphyseal fractures treated with external coaptation is extensive bone loss across the fracture site as they provide the
typically 3 to 5 weeks.3 Potential complications for exter- most stiffness and stability.5 Repair of tibial fractures using
nal coaptation of tibial fractures are similar to those seen circular ring fixators has also been described. For this
for fractures elsewhere. method, smaller Kirschner wires (K-wire) under tension re-
External skeletal fixators are particularly well suited for place the pins used in type I, II, and III fixators. Circular ring
tibial fractures, as the tibia is easily accessible on both sides, fixators are more commonly employed for limb lengthening
with minimal interference by adjacent musculature. They are or correction of angular deformity.9
applicable to virtually all types of tibial fractures. External Predrilling pilot holes for placement of threaded positive
skeletal fixators can be used alone or in combination with profile pins for external skeletal fixators is recommended,
other methods of internal fixation. One advantage of external as the use of a pilot hole increases the pull out strength of
skeletal fixators is that minimal disruption of the vasculature the pin. The pilot hole should be slightly smaller than the
occurs with application, thus permitting the greatest degree inner diameter of the positive profile pin.10 Porous, tita-
of biological osteosynthesis. External skeletal fixators also nium surfaced pins have been shown to increase pull out
facilitate management of adjacent soft tissue injury.7 strength as compared with smooth Steinmann pins.11
The type of external skeletal fixator chosen is dependent It has been documented that the greatest pull out
on the patient’s signalment and fracture characteristics (Fig. strength is demonstrated after one-way insertion of trans-
2). Type IA fixators are often used young animals, as well as fixation pins used in external skeletal fixators. One-way
for simple or segmental tibal fractures in older animals. Type insertion requires placing the pin in one forward motion,
Tibial fractures 153

Figure 2 Illustration of external fixator types IA, IB, IIA, III commonly used for tibial fracture repairs.
154 J.A. Seaman and A.M. Simpson

Figure 3 The correct location for placement of a Steinmann pin in the

tibia is one-half to one-third the distance from the cranial aspect of
the tibial tubercle to the medial condyle of the tibia. Alternatively,
the straight patellar tendon and the medial collateral ligament may
be used as landmarks. Figure 5 Left, A-P radiograph of a Salter I fracture of the distal tibia
in the same 1-year-old DSH from Figure 4.

rather than retracting a pin that has been placed into and
through the distal cortex.12
Open reduction, internal fixation (ORIF) may be em-
ployed for nonreducible fractures, unstable Salter-Harris I
and II fractures, Salter-Harris III and IV fractures, and open
fractures. ORIF techniques for tibial fractures include pins,
wires, screws, plates, or interlocking nails.13-16
Steinmann bone pins are often used in the repair of tibial
fractures. Intramedullary bone pins should be placed in nor-
mograde fashion, to minimize the potential for interference
with the synovial cavity, cranial cruciate ligament, patella,
patellar ligament, and femoral condyle.17 With the patient in
dorsal recumbency, and the stifle at a 90° angle, the pin is
inserted near the medial border of the tibial plateau, approx-
imately halfway between the cranial surface of the tibial tu-
bercle and the medial tibial condyle (Fig. 3). The pin is
passed medial to the patellar ligament and should be angled
Figure 4 Left, lateral radiograph of a Salter I fracture of the distal tibia slightly caudomedially.4,18 Although it has been demon-
in a 1-year-old DSH. strated that careful retrograde insertion using strict cranio-
Tibial fractures 155

Figure 7 Left, A-P stressed view radiograph of the 1-year-old Labra-

Figure 6 Left, A-P radiograph of a 1-year-old Labrador Retriever dor Retriever from Figure 6. In this case, the stressed view helps to
presenting for lameness. clearly define a Salter II fracture of the proximal tibia.
156 J.A. Seaman and A.M. Simpson

tifragmentary proximal physeal fractures a buttress plate may

be utilized.4
The tibial diaphysis is the most common location for a
fracture.2 Incomplete, or greenstick fractures are good candi-
dates for external coapatation. The same is true for simple
tibial fractures in which the fibula is intact (Fig. 10). ORIF
methods for repair of diaphyseal fractures include Steinmann
pin(s) with or without supplementary pin/wire/screw fixa-
tion, external skeletal fixators, orthopedic bone plating and,
in select cases, interlocking nails.4,13-16
Transverse tibial fractures may be repaired by Steinmann
pin alone in young animals, however, supplementary fixation
is usually necessary to provide rotational stability. As such,
external fixation or compression bone plating is preferred for
transverse fracture repair (Fig. 11).
Tibial wedge or multifragmentary fractures can be repaired
using bone plates, or external skeletal fixators. Intramedul-
lary pins with supplementary fixation (cerclage or lag screws)
can be used provided the fragments are reducible.4
Segmental tibial fractures can be repaired via external skel-
etal fixators or bone plates. If bone plates are used for the
repair, they should be applied to provide compression at

Figure 8 Cross pins may be used for proximal tibial fractures. They
should be placed in the proximal fragment, near the insertion of the
collateral ligaments, and directed into the opposite cortex of the
distal fragment.

medial direction may be acceptable, this technique is not

advised.19
The tibia normally has a slight S shaped curve. After
penetrating the proximal cortex, the pin should be manu-
ally advanced. Gentle advancing of the pin allows it to
bend slightly and to conform to the normal anatomic con-
formation of the tibia. The diameter of the intramedually
pin should not exceed 50% of the diameter of the medul-
lary canal to prevent forced straightening of this curve
resulting in a valgus deviation.4
Physeal fractures are typically Salter-Harris type I or II
fractures (Figs. 4-7). ORIF methods of repair typically utilize
multiple wires, or small gauge Steinmann pins. Pins are
placed medially and laterally (Fig. 8). They are directed
through the fragment diagonally into the opposite cortex. If
additional rotational stability is required, another pin may be
placed in the tibial tuberosity. Another method for repairing
tibial physeal fractures includes the use of an intramedullary
Steinmann pin and a smaller diagonal transfixation pin. In
this method, the Steinmann pin should be seated distally in
the tibia. The use of cancellous bone screws is an option in
patients close to skeletal maturity. Single screws may be di-
rected diagonally, or transversely if accompanied by an addi-
tional tranverse pin.4
Metaphyseal fractures may be repaired using the same
techniques and principles discussed above for physeal frac-
tures. In addition, orthopedic bone plates may be used. Bone Figure 9 Right, A-P radiograph of a diaphyseal fracture repair in a
plates on the tibia require careful contouring to prevent de- 14-month-old Boxer. Significant contouring is necessary at the dis-
formity of the limb distal to the plate (Fig. 9). Plates that tal aspect of the plate to prevent iatrogenic valgus deviation of the
apply compression at the fracture site are preferred. For mul- limb.
Tibial fractures 157

terrupted suture material. Closure of the deep crural fascia

and subcutaneous tissues is via continuous absorbable or
interrupted nonabsorbable suture material.20 The skin is rou-
tinely apposed.
Mid-shaft fibular fractures do not typically require repair.
Proximal and distal fractures of the fibula are only repaired
when they cause instability of the lateral collateral ligaments
of the stifle and tarsus respectively.18 The proximal fibula
may be stabilized by securing the fibular head to the tibia by
using a bone screw, Kirschner wires (K-wires), or Steinmann
pins. Occasionally in large breeds, the fibula may be repaired
with an intramedullary pin to provide additional stability.4
There are some additional considerations specific to the
repair of tibial fractures. The distal half of the tibia does not
have any muscles arising from it.21 While this makes appli-
cation of external skeletal fixators easier than elsewhere in the
body, it can make the use of orthopedic bone plates more
difficult. The use of bone plates in this region requires ensur-
ing adequate coverage of the plate by subcutaneous soft tis-
sue.18 Bone plating often requires greater vascular disruption,
which inhibits biological osteosynthesis.4 The use of percu-
taneous bone plates is believed to minimize vascular dis-
ruption. Experimental studies have successfully used this
technique for comminuted tibial fractures.22 Another con-
sideration for tibial fracture repair is that the S-shaped curve
of the tibia causes the lateral cortex to support a more signif-
icant component of forces acting on the tibia. Nonreducible
fragments in this area create a stress riser on a medially placed
orthopedic plate and subject the repair to a higher risk of
implant failure.4 This is an example where the use of an
external skeletal fixator, alone or in combination with a bone
plate, would be a better method for repair. The aforemen-
tioned notwithstanding, ultimately the selection of external
Figure 10 Left, A-P radiograph of a 2-month-old Beagle. This dog fixator versus bone plate is dependent on surgeon’s prefer-
was successfully splinted as the fibula was intact. ence as both methods, with a few exceptions, are often
equally acceptable.23
Postoperatively, the patient should be exercise restricted.
Controlled weight bearing should be allowed and daily range
each fracture site. Type I and II external skeletal fixators are of motion exercises for the stifle and hock help to minimize
also commonly used for this type of repair.4 stiffness. Healing times range from 3 to 20 weeks.3 The vari-
Medial and lateral malleolar repairs are often necessary as ation in healing time is multifactorial. Young animals heal
their ligamentous attachments are required to maintain sta- more rapidly than older animals. Repair methods also con-
bility of the tarsocrural, or hock, joint. Repair of these frac- tribute to healing times. Closed fractures treated with casts or
tures is typically achieved using a cancellous bone screw, splints heal in approximately 4 weeks. Pin/wire fixation re-
transfixation pins/wires, or a figure-of-eight tension band sults in healing in approximately 7 weeks in young animals
wire (Figs. 12 and 13).18 The medial malleolus is approached and 13 weeks in older animals. Healing times for external
via a curved incision on the medial surface of the tarsus that skeletal fixators and orthopedic plates are similar.23 Healing
originates at the distal fourth of the tibia and terminates at the times of 10 weeks in young animals to 19 weeks in older
tarsometatarsal joint. The subcutaneous and deep crural fas- animals are typical. In most cases, healing should be assessed
cia is incised along the same line to expose the bone. Closure with radiographs at approximately 4 weeks. Gradual in-
of the deep crural fascia and subcutaneous tissues is via con- creases in activity level are permitted when there is radio-
tinuous absorbable or interrupted nonabsorbable suture ma- graphic evidence of healing (callus formation, loss of fracture
terial. The skin is routinely apposed. The lateral malleolus is line). With the exception of cerclage and screws, implant
approached via a curved incision on the lateral surface of the removal is recommended after healing has occurred.4
tarsus, which originates near the lateral saphenous vein and
terminates at the tarsometatarsal joint. The subcutaneous and Case Examples
deep crural fascia is incised along the same line to expose the
underlying extensor retinaculum. The extensor retinaculum Case 1
is incised parallel to the dorsal aspect of the peroneus longus History
tendon, exposing the underlying lateral malleolus (Fig. 14). A 5 month, 17-lb, male Miniature Schnauzer was evalu-
The extensor retinaculum is closed using nonabsorbable in- ated for acute right hindlimb lameness of unknown origin.
158 J.A. Seaman and A.M. Simpson

Figure 11 Right, A-P and lateral radiograph of a transverse tibial fracture in a 1-year-old Border Collie. An orthopedic
bone plate provides the rotational stability necessary for healing. An external fixator also would have been appropriate
for this fracture and would also be expected to provide good rotational stability.

On physical examination the patient was partially weight femur distally. The splint was changed weekly for a
bearing on the affected limb. There was mild soft tissue 3-week period. The patient demonstrated a complete re-
swelling at the stifle and the patient was consistently pain- turn to normal function after splint removal.
ful in this region. For more significant avulsions, or in larger or more
Radiographic Diagnosis active patients, ORIF would be the preferred method for
Partial avulsion of the tibial tuberosity (Figs. 15 and 16). repair. The ideal ORIF method for tibial tuberosity avul-
sions is the pin and figure-of-eight tension band wire. This
Repair and Comments
method provides good biomechanical fixation, and also
Avulsion of the tibial tuberosity is an injury seen in imma-
does not require excessive disruption of the proximal os-
ture animals. A hereditary predisposition has been sug-
sification center.25 The stifle should be in full extension to
gested in certain breeds.24 With a complete avulsion, the
minimize tension from the quadriceps. Slow and consis-
distal aspect rotates cranially and the tuberosity is proxi-
mally displaced. For partial avulsions and in large breed tent tension fatigues these muscles and allows the tuber-
dogs, which often have irregular ossification, radiographic osity to be placed in the correct position. The tuberosity
comparison of the contralateral stifle may be helpful. can be temporarily held in place using reduction for-
Rarely, in small, sedentary animals with radiographic dis- ceps.4,18 Two pins are placed through the tuberosity, di-
placement less than 2 to 3 mm, external coaptation is an rected caudodistally. Orthopedic wire is passed around
option.4 In this patient, the displacement was within the the pins and through a small hole on the cranial surface of
acceptable range for external coaptation. The patient was the tibia, distal to the tuberosity, in a figure-of-eight fash-
not excessively active, and the owner was able to assure ion (Fig. 17). In animals with significant growth potential,
complete compliance in minimizing any physical activity the implant should be removed as soon as possible to help
for a 3-week period. A lateral fiberglass splint was applied prevent premature cessation of the endochondral ossifica-
which effectively immobilized the limb from the mid- tion process.4
Tibial fractures 159

Figure 12 Left, A-P and lateral radiograph of a 3-year-old

Dalmatian with pins and tension band repair of a medial
malleolar fracture.

Figure 13 Right, A-P and lateral radiograph of a

2-year-old Ferret with a pin and tension band
repair of a medial malleolar fracture.
160 J.A. Seaman and A.M. Simpson

Figure 16 Left, lateral stifle radiograph of the same 5-month-old

Miniature Schnauzer from Figure 15. Comparison of the contralat-
eral limb is helpful. Particularly in cases of a partial avulsion.

Figure 14 Deep dissection of the approach to the lateral malleolus.

The lateral extensor retinaculum is transected and reflected to visu-
alize the lateral malleolus.

Figure 17 Illustration of the tension band repair for an avulsion of the

tibial tuberosity. Pins are directed through the avulsed fragment,
Figure 15 Right, lateral stifle radiograph of a 5-month-old Miniature caudo-distally into the tibia. Orthopedic wire is passed around the
Schnauzer with an avulsion of the tibial tuberosity. The tuberosity is pins, in a figure-of-eight fashion, through a hole made in the cranial
displaced cranially and proximally. tibia.
Tibial fractures 161

Figure 18 Right, lateral radiograph of a spiral tibial fracture in a

2-year-old Daschund.

Case 2
History
A 2-year, 19-lb male castrated Daschund was evaluated for
acute right hindlimb lameness subsequent to a fall. On phys-
ical examination the patient was minimally weight bearing on
the right hind leg and had moderate swelling in the mid-tibial
region. There was palpable crepitus.
Radiographic Diagnosis
Mid-diaphyseal oblique, long spiral, tibial fracture. Mid-shaft
fibula fracture (Figs. 18 and 19).

Figure 20 Right, A-P and lateral radiographs of a 1-year-old Labrador

Retriever after surgical repair of an oblique fracture. In a young,
athletic dog, 2 Steinmann pins would not be expected to provide
adequate rotation stability at the fracture site. In this patient, the use
of 5 cerclage wires provides the necessary rotational stability.

Repair and Comments

A Robert Jones bandage was placed overnight. Surgery was
performed the following day.
In oblique fractures, the fracture line is greater than 2 times
the diameter of the bone. Young animals readily form calluses
at the fracture site, which provides rotational stability. Thus,
in some cases their oblique fractures may be secured by an
intramedullary Steinmann pin alone. Combining supple-
mentary fixation with an intramedullary Steinmann pin pro-
vides greater rotational stability. Supplementary fixation is
most commonly in the form of at least 2 cerclage wires or, in
larger dogs, at least 2 screws (Fig. 20). If screws are used, they
must be directed so that their path is not obstructed by the
intramedullary pin. Type IA, IIA, and IIB external skeletal
fixators as well as orthopedic bone plates may also be applied
to oblique tibial fractures. Six to 8 cortices of bone must be
penetrated by the bone plate screws. In this case, external
coaptation was a less desirable option given the patient’s age,
Figure 19 Right, A-P radiograph of a spiral tibial fracture in a 2-year- and short-legged anatomy, which would have made immo-
old Daschund. bilization of the stifle difficult. For this particular patient,
162 J.A. Seaman and A.M. Simpson

ORIF was selected. This selection took into account that the
tortuous anatomy of the tibia in this breed would require
painstaking contouring of an orthopedic plate. While exter-
nal fixation would have been a suitable option, it also would
have required additional postoperative care for the patient
and taken longer to heal.
The standard approach to the shaft of the tibia involves a
medial incision originating at the medial tibial condyle, and
terminating at the medial malleolus (Fig. 21). The incision
should gently curve to the cranial tibial surface at midshaft
before gradually returning medially to terminate at the me-
dial malleolus. The subcutaneous tissues are incised in simi-
lar fashion. Care should be taken whenever possible to pre-
serve the saphenous vessels and nerves as they course over
the cranial tibial surface, from medial to lateral, approxi-
mately one-third to one-half the way down the length of the
tibia. The medial surface of the tibia can be visualized by
incising the overlying crural fascia. The tibia can be further
exposed by incising the fascia of the cranial tibial muscle and
the deep digital flexor muscle. The lateral aspect of the tibia
can be exposed by incising the cranial border of the crural
fascia from the tibial tuberosity to the distal, tendinous aspect
of the cranial tibial muscle. Caudolateral retraction of the
cranial tibial and long digital extensor muscles exposes the
lateral cortex. Care must be taken not to damage the cranial
tibial artery as it travels between the tibia and fibula.20
Figure 21 Illustration of surgical approach to the tibial shaft.
Open reduction was achieved and stabilized through the
use of 2 cerclage wires (Fig. 22A,B). In this case, because of
the exaggerated anatomic conformation of the patients’ tibia,

Figure 22 Right, A-P and lateral radiographs of the

2-year-old Daschund from case 2. The postoperative
films show anatomic reduction at the fracture site. The
exaggerated tibial curvature in this patient precluded
the use of a Steinmann pin.
Tibial fractures 163

Figure 23 Right, A-P and lateral radiographs of the

2-year-old Daschund from case 2. The films taken
6-weeks postoperatively show anatomic bony cal-
lus formation at the fracture site.

intramedullary Steinmann pins were not placed. Younger the distal fragment is often quite short, the possibility for
patients have faster healing times. They also form bony cal- bone plating is limited. Options for repair include pin/wire
luses more rapidly that help to stabilize the fracture. fixation, or external skeletal fixators. Transfixation, or cross,
Closure of the deep crural fascia and subcutaneous tissues pins are commonly employed and may be placed diagonally
may be via continuous absorbable or interrupted nonabsorb- starting at the medial and lateral malleoli (Fig. 26). Alterna-
able suture material. The skin is routinely apposed using tively, a Steinmann pin can be driven normograde into the
nonabsorbable suture material in an interrupted pattern or distal fragment. The use of a light splint is advised for addi-
stainless steel staples. tional rotational support after either of these methods for 2 to
The patient was placed in a light lateral splint postopera- 4 weeks postoperatively. If external skeletal fixators are ap-
tively. Radiographs taken 6-weeks postoperatively indicate plied, they may need to be modified to permit adequate pin
bony callus formation and absence of the original tibial frac- insertion in the distal fragment. These modifications can
ture line (Fig. 23A,B). combine different aspects of each type of fixator. In some
cases T-shaped bone plates can permit incorporation of an
Case 3 adequate number of distal cortices for repair.4
History In this patient, options for repair were limited by the com-
A 6-year, 75-lb spayed female Golden Retriever was evalu- minuted nature of the fracture to an external fixator or an
ated for acute right hindlimb lameness subsequent to motor orthopedic bone plate. The type of external fixator used de-
vehicle trauma. On physical examination the patient was pends on how much bone is available distally for transfix-
nonweight bearing on the right hind leg and had extensive ation pins. The use of a multi-plane fixator (eg, type III), or
swelling in the distal tibial region. There was palpable crep- hybridization of different external fixator types would likely
itus and instability at the distal tibia. be necessary. In this patient, there was adequate bone distal
to the fracture site to permit application of an orthopedic
Radiographic Diagnosis
bone plate. In addition, the owner expressed concern over
Proximal comminuted fracture of the distal tibial metaphysis.
home management of the patient.
Distal fibula fracture (Figs. 24 and 25).
Open reduction was achieved and stabilized through the use
Repair and Comments of cerclage wires and a bone plate (Figs. 27 and 28). The patient
The limb was splinted overnight. Surgery was performed the was placed in a light lateral splint postoperatively. The fibula
following day. fracture was proximal enough that the lateral collateral ligament
Distal tibial fractures are usually Salter types I or II in was not affected. Radiographs taken 5 weeks postoperatively
young animals and metaphyseal in older animals.18 Because indicate bony callus formation (Figs. 29 and 30).
164 J.A. Seaman and A.M. Simpson

Figure 24 Right, lateral radiograph of a 6-year-old Golden Retriever Figure 25 Right, A-P radiograph of a 6-year-old Golden Retriever
with a proximal, comminuted fracture of the distal tibial metaphysis with a proximal, comminuted fracture of the distal tibial metaphysis
secondary to trauma. secondary to trauma.
Tibial fractures 165

Figure 26 Illustration of the use of transfixation pins in a distal tibial

fracture. Cross pins are placed in the distal fragment and directed
proximally into the opposite cortex.

Figure 27 Right, lateral radiograph of the 6-year-old Golden Re-

triever from case 3 with a proximal, comminuted fracture of the
distal tibial metaphysis secondary to trauma. The postoperative film
shows repair via an orthopedic bone plate. Comminutions at the
fracture site were reduced using cerclage wire.
166 J.A. Seaman and A.M. Simpson

Figure 29 Right, lateral radiograph of the 6-year-old Golden Re-

triever from case 3 with a proximal, comminuted fracture of the
distal tibial metaphysis secondary to trauma. This radiograph was
taken 5-weeks postoperatively. There is evidence of bony healing.

Figure 28 Right, A-P radiograph of the postoperative films for the

6-year-old Golden Retriever from case 3.
Tibial fractures 167

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