Surgical management of supracondylar femoral fractures in dogs using supracondylar plates and plate-rod constructs

Introduction

The complex field of veterinary orthopaedics focuses on enhancing treatment protocols for common musculoskeletal injuries in companion animals. Supracondylar femoral fractures in dogs present a notable clinical challenge due to the anatomical intricacies and vital function of the distal femur. These fractures often the result of high energy trauma such as falls or vehicular accidents are particularly common in young, active dogs because of the vulnerability of their developing bones (Voss et al., 2009; Scott et al., 2007 and Harasen,

Materials and Methods

Pre-Operative Clinical Examination

At presentation, twelve canine patients with supracondylar femur fractures commonly showed pain on palpation, swelling, inability to bear weight, stifle joint instability, and visible deformity with functional impairment. Palpable crepitus was consistently noted and all fractures were closed. Despite these local signs, baseline physiological parameters such as pulse, respiration and body temperature were stable, and cardiovascular and respiratory assessments including mucous membrane color and capillary refill time were within normal limits.

Pre-Operative Radiographic Evaluation

Medio-lateral and cranio-caudal radiographic views provided critical information for managing supracondylar femur fractures. These orthogonal images confirmed the fracture, detailed its configuration, aided classification and facilitated selection of appropriately sized surgical implants (Fig. 1-12).

Planning of Surgery

Preoperative radiographic measurements of the affected femur, including bone length and transcortical diameter at various sites, were crucial for accurately determining the appropriate length of supracondylar plates and screws for fracture fixation.

Patient Preparation

To ensure patient safety before surgery, owners were advised to withhold food for 12 hours and water for 6 hours.

The affected limb was aseptically prepared by shaving and scrubbing with 7.5% povidone-iodine, followed by surgical spirit, covering from the dorsal midline to the tarsal joint.

The cephalic vein on the same side was prepared for intravenous access. During surgery, continuous intravenous infusion of normal saline at 5 ml/kg/hour was maintained to support hydration and circulation.

Anaesthesia

Preoperative drugs included intravenous ceftriaxone (20 mg/kg) and subcutaneous meloxicam (0.2 mg/kg). Premedication with atropine sulfate (0.02 mg/kg, SC) was given 30 minutes before anesthesia induction. Sedation was achieved using intramuscular xylazine (1 mg/kg) and butorphanol (0.2 mg/kg), followed by intravenous induction with diazepam (0.2 mg/kg) and ketamine hydrochloride (5 mg/kg). Anesthesia was maintained with propofol administered IV at 0.5 mg/kg. Endotracheal intubation was performed post-induction.

Positioning

The surgical approach targeted the cranio-lateral femur by positioning dogs in lateral recumbency with the fractured limb uppermost. The distal limb was wrapped in sterile gauze to maintain sterility during manipulation. Sterile draping was applied to expose the surgical site while isolating non-sterile areas.

Orthopaedic Instruments

The surgical management of supracondylar femur fractures utilized a standard orthopedic instrument set for fracture reduction and fixation. This included Gelpi and Hohmann retractors for soft tissue retraction, periosteal elevators, bone hooks for fragment handling, bone files, rongeurs, cutters for bone trimming, reduction and bone holding forceps, pin and K-wire cutters, and both hand and electric drills with drill bits. Plate benders were used for implant shaping. All instruments, including implants, were sterilized using a horizontal autoclave, while the electric bone drill underwent chemical sterilization before surgery, ensuring aseptic conditions throughout the procedure.

Implants

Implant (Fig. 13) details are summarized in Table 1. Plate length for Group I was selected using medio-lateral radiographs matched to bone size, with 2.7 mm plates for dogs ≤10 kg and 3.5 mm plates for those >10 kg. Screw length was calculated by measuring transcortical bone diameter at multiple sites using digital calipers, adding plate thickness to ensure secure bicortical fixation.

In Group II, combined fixation with a supracondylar plate and intramedullary pin was used. Plate and screw sizes followed the same weight-based criteria. The intramedullary pin occupied about 40% of the medullary canal diameter at the isthmus. Radiographic views guided accurate implant sizing and placement. Implant specifications are listed in Table 2. Surgical Approach to the Distal Femur Surgical access to distal femur fractures was achieved through a craniolateral parapatellar approach extending to the stifle joint. The procedure involved incising the tensor fascia lata, separating the biceps femoris and vastus lateralis muscles and performing stifle arthrotomy in most cases, except for fractures proximal to the joint capsule (Fig. 1415161718192021). The incision was extended proximally to expose part of the femoral diaphysis for plate placement. This combined approach aligns with techniques described by Piermattei et al. (2006) [20] and Madhu et al. (2014) [16] .

Fig 14:

Craniolateral approach extending to the stifle joint.

Closure of the incision

In case of femoral approach, the fascia lata was sutured with 2-0 polyglactin 910 in a simple continuous suture pattern. Subcuticular sutures were applied with 2-0 polyglactin 910(Fig. 20). Skin incision was closed with a row of cruciate mattress sutures of 2-0 polyamide (Fig. 21)

Post-Operative Care and Management

Postoperative radiographs were taken immediately after surgery for all groups. Surgical sites were managed with 5% povidone-iodine dressings, resulting in clean wounds. Limb immobilization was effectively achieved using a modified Robert-Jones bandage. Pain control was maintained with oral carprofen (2 mg/kg) and infection was prevented with prophylactic amoxicillin (15 mg/kg) in all cases.

Results

Clinical evaluation was carried out every alternate day to check for the presence of swelling, exudation and weight bearing in all the dogs. The appearance of suture line was also examined every alternate day until the sutures were removed. The post-operative day on which the day started bearing weight was recorded and graded for lameness (Fig. 22). After suture removal, the dogs were examined once in a week for the limb stability until fracture healing was considered satisfactory.

Postoperative Clinical Evaluation

Throughout the study, surgical wounds healed primarily by first intention, with no discharge observed in any group. Skin sutures were removed between 10 to 14 days postoperatively, allowing clean wounds to close with minimal complications. Systemic administration of broadspectrum antibiotics effectively supported infection prevention during the recovery period.

Lameness grading

A detailed summary of lameness assessments for all dogs across the three groups is shown in Table 3

Post-Operative Radiographic Observations

Immediate postoperative radiographs confirmed correct placement of the supracondylar femur plate with selftapping cortical screws and good alignment of fracture fragments in all dogs (Figs. 23-24). Immobilization was satisfactory in every case. Radiographs taken on the 30th postoperative day showed proper fragment alignment, reduced fracture gaps, and progressive callus formation with increasing radiodensity. By day 60, the fracture line had disappeared, callus was fully radiodense, and the corticomedullary canal was clearly defined in all dogs. Both groups demonstrated excellent radiographic healing without complications (Figs. 25-26).

Post-operative complication

In Groups I and II, all implants remained until plate removal, with full functional recovery by day 60 postsurgery. Muscle atrophy in two cases due to poor postoperative care was successfully treated with implant removal and physiotherapy. Post-removal radiographs confirmed complete fracture healing with no displacement, highlighting the pin-plate construct's effectiveness in providing stable fixation and promoting bone healing.

Discussion

Post-operative management in the present study demonstrated the efficacy of a multi-modal approach for orthopedic surgical wound healing. The consistent application of 5% povidone-iodine pads effectively maintained a clean surgical site in all canine subjects. This was complemented by immediate post-operative limb bandaging, specifically using a Modified Robert Jones bandage for ten days, a practice supported by established veterinary orthopedic recommendations (Tobias, 1995; De Camp, 2003; Johnson, 2013; Reddy, 2020; Pravalika, et al. 2023) [25,8,12,23,21] . Furthermore, a week-long course of amoxicillin proved satisfactory in preventing post-operative infections, aligning with the positive outcomes reported by Bose (2017) [4] and Kumar (2017) [14] . While this comprehensive approach consistently yielded well-healed surgical wounds without complications in all dogs, it was important to acknowledge contemporary perspectives. For instance, Yayla et al. (2022) [27] suggest that for certain procedures like plating, avoiding bandaging might facilitate earlier ambulation. Similarly, Mercillin and Freeman (2005) [18] advocate against post-joint surgery bandaging to promote early rehabilitation and mitigate negative effects of immobilization. Despite these contrasting viewpoints, the protocols employed in this study consistently led to satisfactory outcomes, indicating their suitability for the specific surgical contexts investigated. In the present study, our findings highlight that orthopedic stabilization of supracondylar fractures can be achieved using several techniques described by Aithal et al. (1999) [1] , Lidbetter and Glyde (2000) [15] , Harasen (2001) [11] , and Mahajan et al. (2007) [17] , including intramedullary pins, crossed K-wires, Rush pins, dynamic compression plates, plate-rod constructs, and hybrid external fixators. Consistent with Braden and Brinker (1973), we observed that plating specifically the use of caudally bowed supracondylar plates (Kumar, 2017; Reddy, 2020; Pravalika et al., 2023) [14,23,21] provided stable fixation and facilitated appropriate screw placement in the distal fragment, supporting reliable functional recovery.

For comminuted or multifragmentary fractures, our experience supports a shift towards minimally invasive techniques as promoted by Beale (2004), where use of the plate-rod construct, as advocated by Lidbetter and Glyde (2000) [15] , Harasen (2002) and Basha et al. (2023) [2] , preserved soft tissue attachments and promoted biological osteosynthesis. The plate-rod combination notably increased the implant's fatigue life and resistance to deformation, consistent with their biomechanical findings.

Conclusion

The plate-rod construct offered superior mechanical stability compared to plating alone due to its combination of a rigid fixation plate and an intramedullary rod. This synergistic load-sharing between the plate and rod effectively counters bending, torsional and compressive forces at the fracture site, thereby promoting osteosynthesis. This enhanced stability reduces micromotion, facilitates more direct bone healing and enabled a quicker functional recovery in dogs.

In comparison, although plating provided good stability, it lacks the additional intramedullary support and therefore was less effective at counteracting multiple forces simultaneously. Importantly, plates used in both plating and plate-rod techniques generally require removal after clinical union in growing dogs to prevent interference with bone growth. Therefore, the choice between these techniques should consider fracture characteristics, patient size, and the need to preserve physeal function, balancing mechanical demands with biological and clinical factors.

Acknowledgement

AcknowledgementsThe author gratefully acknowledges the College of Veterinary Science, Rajendranagar, PVNRTVU and Hyderabad for providing vital infrastructure and facilities essential to conduct this research. Appreciation is also extended to the dog owners for their cooperation in bringing their dogs for regular postoperative evaluations of supracondylar femur fracture cases.

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