Surgical repair of dual hindlimb fractures using orthogonal titanium veterinary cuttable plates and t-plate in a pediatric canine

Introduction

Fractures in young dogs, particularly those resulting from trauma, present unique challenges in veterinary orthopedics due to the anatomical and physiological characteristics of their developing skeletal systems (Reddy et al., 2016) [6] . Among these, the femur and tibia being primary weight-bearing bones are commonly affected. Effective management is essential to ensure proper healing and restore functional mobility (Sai Bhavani et al., 2024) [7] . Open reduction and internal fixation (ORIF) using bone plates is a widely employed surgical approach that involves direct visualization of the fracture site, anatomical realignment of bone fragments, and stabilization using appropriate implants. This technique offers rigid fixation, allowing early weight-bearing; however, its invasive nature may impact biological healing (Sarrau et al., 2007) [8] . ORIF is especially suited for fractures requiring accurate reconstruction, such as transverse, oblique (short or long), segmental, minimally comminuted (with butterfly fragments), and intra-articular fractures (Castaldo et al., 2021) [1] . This report describes the successful surgical management of a 2-month-old female indie puppy diagnosed with comminuted diaphyseal fracture of the right femur and proximal transverse fracture of tibia following a vehicular accident. Due to the complexity of the fractures and the age of the patient, ORIF using orthogonal titanium Veterinary Cuttable Plate (VCP) and a titanium T-plate was selected. The objective was to achieve stable fixation, promote biological healing, and restore limb function. This case emphasizes the effectiveness of orthogonal double plating in managing complex pediatric fractures and highlights the importance of individualized surgical planning for young animals.

Case History and Clinical Observations

A 2-month-old female indie puppy weighing 2.3 kg was presented with a history of a vehicular accident that had occurred one day prior. The primary complaint was the inability to bear weight on right hind limb. Clinical examination revealed significant swelling of the right hind limb, along with bony crepitus and marked pain on palpation. The limb was completely nonweight-bearing, and abnormal medial rotation at the level of the stifle joint was noted (Figure 1). Additionally, a complete transverse fracture of the right tibia at the proximal metaphyseal region was observed, along with medial rotation of the stifle joint and patellar displacement from the trochlear groove (Figure 2). Given the complexity and the deformity, surgical management with ORIF was chosen. An orthogonal titanium VCP was used for the femoral fracture repair, and a titanium T-plate was applied to repair the tibial fracture.

Procedure Pre-operative Preparation

Pre-operative blood work showed mildly elevated total leukocyte count with other values within normal limits. The puppy was premedicated intramuscularly with butorphanol (0.2 mg/kg), glycopyrrolate (0.01 mg/kg), and midazolam (0.2 mg/kg). Intravenous isotonic crystalloid fluid was administered perioperatively, along with intramuscular ceftriaxone (20 mg/kg) as antibiotic prophylaxis and tramadol (2 mg/kg) for analgesia. The surgical site was clipped and prepared aseptically using 7% povidone-iodine scrub followed by 5% povidone-iodine solution. Anesthesia was induced with intravenous propofol (2 mg/kg) and maintained with isoflurane in oxygen.

Surgical Technique

After aseptic draping, a skin incision was made along the cranio-lateral aspect of the right thigh, extending from the greater trochanter to the distal femoral condyle. Blunt dissection was carried out through the subcutaneous tissues. The fascia lata was incised along the cranial border of the biceps femoris muscle, followed by retraction of the biceps femoris muscle caudally, while the vastus lateralis was retracted cranially to expose the femoral diaphysis. Reduction of bone fragments was achieved using pointed reduction forceps to minimize periosteal trauma. The butterfly fragment at the distal femoral fracture site was stabilized using a 1.5 mm titanium lag screw (8 mm in length). Once the main fragments were aligned, stabilization was accomplished using two 2.0 mm titanium Veterinary Cuttable Plates (VCPs): a 13-hole plate laterally and a 9-hole plate cranially (Figure 3,i). Both plates were fixed with 2.0 mm titanium cortical screws ranging from 8-12 mm in length (Figure 4). After the implants were secured in position, the fascia lata was closed using 3-0 polydioxanone (PDS) in a simple continuous pattern. Subcutaneous tissues were similarly apposed with PDS, and the skin was closed using 2-0 nylon in a simple interrupted pattern. The proximal tibial fracture was accessed through a standard medial approach. Following reduction with pointed forceps, a 2.0 mm titanium T-plate was secured using 2.0 mm titanium cortical screws (8-10 mm) to achieve stable fixation (Figure 3, II).

Post-operative Care

The puppy recovered uneventfully from anesthesia and was discharged the same day with instructions for strict cage rest for one week, followed by restricted activity for two additional weeks. Post-operative medications included: Syrup Cefpodoxime (10 mg/kg, once daily, orally) for 7 days, Syrup Meloxicam (0.2 mg/kg, once daily, orally) for 5 days as an antibiotic and analgesic support respectively along with daily antiseptic dressing of the surgical site for 10 days until skin suture removal.

Results and Discussion

The patient began partial weight-bearing on the operated limb within 24 hours of surgery, with noticeable reduction in limb swelling (Figure 5). Recovery progressed smoothly, and by 8 weeks post-surgery, the puppy demonstrated complete functional use of the limb with no significant signs of discomfort or lameness. Orthogonal plating is particularly advantageous in cases where delayed healing or insufficient post-operative immobilization is anticipated, as it enhances mechanical stability. Plates are typically applied on the tension side of the bone and can serve various functions including compression, neutralization, buttress, or bridging, depending on the fracture type and location (El Haj et al., 2013) [3] . Comminuted fractures, particularly in juvenile patients, are challenging due to the complexity of fragment alignment and associated soft tissue injury. Strategic planning of the surgical approach is crucial. Orthogonal plating offers increased resistance to mediolateral bending and greater load-bearing capacity under axial stress. However, it may necessitate additional screws in smaller bones, posing a logistical limitation (Gokarn et al., 2025) [4] . Double plating significantly improves both axial and rotational stability, making it an ideal choice for initial fracture repair and revision surgeries. Compared to single plating, dual plate constructs provide superior mechanical distribution of load across the fracture site, lowering the risk of implant failure and promoting consistent healing. This approach is especially beneficial for young, active animals, allowing earlier return to mobility. Nevertheless, the technique demands precision; improper dissection or plate positioning can lead to soft tissue damage and potentially delay bone healing (Craig et al., 2017; Meeson, 2017) [2,5] .

Conclusion

This case demonstrates the effectiveness of ORIF using orthogonal titanium VCP and T-plate in managing complex, comminuted fractures in young dogs. The surgical approach provided stable fixation, allowed early weight-bearing, and resulted in full functional recovery. The case underscores the importance of individualized treatment strategies and meticulous surgical execution in pediatric orthopedic patients to ensure optimal outcomes.

Acknowledgement

AcknowledgmentsThanks to the Managing Director and the team of Pet Life Care Animal Hospital by Sarvodaya Foundation, Faridabad, Haryana for providing support and facilities required for the surgical intervention and perioperative procedures.

References

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