196 PA RT T W O
TIBIAL FRACTURES
CHAPTER 74 Proximal Tibial Physeal Fractures
and Tibial Tuberosity Fractures
INDICATIONS
Candidates include animals with Salter I and Salter II fractures
of the proximal tibial physes.
OBJECTIVES
• To achieve anatomic reduction of the proximal tibial physis
and fracture stabilization
ANATOMIC CONSIDERATIONS
The medial aspect of the proximal tibia is covered only with
skin, subcutaneous tissue, and crural fascia and can easily be
palpated and approached. The saphenous artery vein and nerve
lies caudal to the medial surface of the proximal tibia.
EQUIPMENT
• Surgical pack, Senn retractors, Hohmann retractors, Gelpi
retractors, periosteal elevator, pointed reduction forceps,
Kirschner wires or small Steinmann pins for large dogs,
orthopedic wire, wire tightener, pin chuck or high-speed wire
driver, wire cutter or pin cutter
PREPARATION AND POSITIONING
Prepare the rear limb circumferentially from the hip to below
the hock. Position the animal in dorsal recumbency for greater
flexibility. Drape the limb out from a hanging position to allow
maximal manipulation during surgery. A cancellous bone graft
is unnecessary.
PROCEDURE
Approach: Incise the skin, subcutaneous tissue, and crural
fascia craniomedially from the distal femur to the proximal
diaphysis of the tibia to expose the fracture. Retract the skin
laterally to expose the lateral tibial epiphysis. Elevate the fascia
and muscle to expose both medial and lateral surfaces of the
fracture (Plate 74A).1
Reduction: Reduce the proximal physeal fracture by
extending the stifle and gently levering the epiphysis into
position. Maintain reduction using a pointed reduction forceps
(Plate 74B). Reduce the avulsed tibial tuberosity by extending
the limb and putting pressure on the tuberosity. Maintain
reduction with a pointed reduction forceps (see Plate 74B).
Stabilization of a Proximal Tibial Physeal Fracture:
Drive a Kirschner wire from the lateral surface of the tibial
• SURGICAL PROCEDURES FOR FRACTURES
epiphysis across the physis, into the tibial metaphysis, and
through the medial cortex. Drive a second wire from the medial
tibial epiphysis across the physis, into the metaphysis, and
through the lateral cortex. Bend the wires to prevent migration
and aid removal (Plate 74C).2
Stabilization of an Avulsion of the Tibial Tuberosity:
Drive two Kirschner wires into the tuberosity and across the
physis to lodge in the proximal tibia. Check the repair to see if
stabilization is sufficient to prevent avulsion of the fracture. If
not, place a tension band wire by drilling a transverse hole in
the tibial crest and passing a figure-eight wire through the hole
and around the Kirschner wires. Tighten the wire (Plate 74D).
Most repairs require a tension band wire.1
CAUTIONS
It is important to avoid damaging the physeal cartilage during
reduction and to avoid penetrating the articular cartilage with
the Kirschner wires.
POSTOPERATIVE EVALUATION
Radiographs should be evaluated for reduction and implant
placement.
POSTOPERATIVE CARE
The animal should be confined, with activity limited to leash
walking. Radiographs should be evaluated in 3 to 4 weeks. The
tension band wire should be removed at 3 weeks to allow
physeal function. Additional implant removal may be required
if soft tissue irritation occurs.
EXPECTED OUTCOME
Rapid bone healing is usually seen, but premature closure of
the physis will probably occur. Premature closure of the
tibial tuberosity physis in a very young animal may affect stifle
conformation.
References
1. Piermattei D, Flo GL: Brinker, Piermattei, and Flo’s Handbook of
Small Animal Orthopedics and Fracture Repair, 3rd ed. Philadelphia,
WB Saunders, 1997.
2. Johnson AL, Hulse DA: Management of specific fractures: Tibia and
fibular physeal fractures. In Fossum TW (ed): Small Animal Surgery,
2nd ed. St. Louis, Mosby, 2002.
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P L AT E 7 4

Patellar
ligament

A
Cranial tibial
muscle or