Comminuted mid-diaphyseal fracture in a 30kg dog using IMPeek

This is our fifth clinical case report focuses on a 10 month old, M 30kg Labrador X who escaped from the yard and was lost for several hours before being found by a good Samaritan. He was presented to the local ER and diagnosed with a grade 1 open, mid-diaphyseal, comminuted left femoral fracture. He was stabilized and transferred for surgery several days later. 

A lateral approach was made to the left femur. The open wound was debrided en bloc until healthy, clean tissue was observed. Bone fragments that had lost all soft tissue attachments were resected. The fracture hematoma was left in situ where possible. 

A 1/4" Steinmann pin inserted proximal retrograde until it exited the intertrochanteric fossa. The Steinmann pin was then removed and a 6mm diameter IMPeek Rod inserted from proximal normograde across the fracture defect and into the distal segment to re-establish bone length. 

A 14 hole Synthes LCP was then contoured to the lateral femur and affixed in a bridging fashion with 1 distal cortical screw and 3 distal bicortical locking screws. Proximally, 3 bicortical locking screws and a single monocortical locking screw were placed. Intentional attempts to drill through and engage the IMPeek rod was not performed, however 2 locking screws distally and proximally did happen to pass through and threaded into the IMPeek rod. 

A left, proximal humeral cancellous bone autograft was then obtained and packed into the fracture defect. The soft tissues were closed at both sites routinely and post operative radiographs obtained showed excellent limb alignment and implant positioning. 

The patient was walking on the limb with sling support the day after surgery and is scheduled to have sutures out in 2 weeks. I will post follow up radiographs here at 8 weeks.