When it rains, it pours! Two more plate-rod fractures featuring IMPeek
Sticking with the theme here, it was indeed raining broken cats and dogs the last few weeks, with many poor creatures either hit by cars or run over by their own owners. We were fortunate enough to be able to assist in these magnificent animals' recoveries using a variety of surgical techniques.
Cat on the Town
Our first case was a lovely little Siamese cat who escaped from his usual confines at home and went on an overnight bender. When he eventually staggered home however, he was nursing a rather bruised and battered left humerus. He was seen at the emergency clinic and referred for surgical repair of a grade 1 open, transverse, non reconstructable fracture of the mid humeral diaphysis. Neurological exam pre-op was normal and no other co-morbidities were appreciated.
A medial approach to the left humerus was performed. To facilitate accurate plate placement distally, the supracondylar foramen was rongeured off and the median nerve and brachial artery released from its confines.
A look, but do not touch approach was utilized for the fracture site as much as possible, thus ensuring the fracture hematoma was left intact. Sequentially larger metallic IM pins were then inserted proximal retrograde, from the fracture through the greater tubercle, until a 4mm IMPeek rod could be inserted. The IMPeek rod was then driven from the greater tubercle into the distal fragment to help maintain fracture alignment and bone length. A 10 hole, 2.4 mm LCP was then contoured and applied to the medial cortex of the bone and affixed with 5 locking screws and 1 (most proximal) cortical screw. The IMPeek rod was engaged at all screw holes to create an interlocking construct. This cortical screw use was due to the plate being angled a little cranially at the most proximal aspect of the bone.
Post op radiographs showed good alignment of the bone, restoration of the long axis and good implant placement. The cat was discharged 24 hours later with intact neurological status and was toe touching on the limb. Recheck is scheduled in 2 weeks.
The Old Dog and a Blind Spot
In the second case in as many days, we saw a lovely 10 year old male neutered Mastiff X who had been sleeping quietly under the owner's truck trying to hide in the shade during an oppressively hot summer day. Unfortunately for everyone involved, the dog was not seen resting under the wheels and the inevitable happened when the owner tried to back the car up.
He was presented with a closed, mid diaphyseal, comminuted fracture of the left tibia.
A mini-medial approach to the tibia was made using proximal and distal skin incisions. The fracture hematoma was left in situ, preserving the biology of the area. The fracture was reduced by inserting sequentially larger IM pins proximal normograde via a mini medial stifle arthrotomy, until a 6mm IMPeek rod could be inserted into the medullary canal. Driving the IMPeek rod into the distal fragment helped to restore the limb length and alignment. A 14 hole, 3.5mm broad LCP was then contoured and affixed to the medial cortex using 6 locking and 1 cortical screw. The distal most mono-cortical screw on the medial malleolus had to be shortened and redirected to limit imposition on the tibiotalar joint.
The post op radiographs show restoration of the limb length and alignment, with good implant placement. The IMPeek rod could be recessed a little further or trimmed slightly in hind sight.
The healing progression will be posted here in the near future, so stay posted.