Simultaneous fluoroscopic-guided tibial plateau leveling and fracture reduction for the concurrent treatment of chronic cranial cruciate ligament tear and comminuted diaphyseal fracture of the tibia and fibula in a dog

Petazzoni M, Buiatti M.
J Am Vet Med Assoc. 2019 Mar 1;254(5):613-618.

CASE DESCRIPTION A 12-year-old obese spayed female American Staffordshire Terrier was admitted for evaluation of acute non-weight-bearing lameness of the right pelvic limb attributed to motor vehicle-related trauma that occurred 2 hours previously. The owners reported a chronic, progressive weight-bearing lameness of the right pelvic limb secondary to a complete cranial cruciate ligament (CrCL) rupture that was diagnosed 6 months previously. They had declined surgery for CrCL repair because of the advanced age of the dog.

CLINICAL FINDINGS Physical examination revealed a 2-cm skin wound on the craniomedial aspect of the midtibial region. The dog had non-weight-bearing lameness of the right pelvic limb with associated muscle atrophy and signs of pain on palpation of the right tibia. Radiography was performed, and tibial and fibular fractures were diagnosed. The fractures were classified as second-degree open, severely comminuted, complex nonreconstructible diaphyseal fractures.

TREATMENT AND OUTCOME The tibial fracture and CrCL rupture were treated by closed reduction and simultaneous tibial plateau leveling by indirect fluoroscopic-guided alignment, plus stabilization with a monoplanar external fixator. The 2 main tibial fragments were manipulated via the frame clamps to restore limb length and alignment and tibial plateau slope. Both the tibial and fibular fractures healed within 16 weeks after surgery. At the 2-month recheck examination after implant removal, the dog was walking normally.

CLINICAL RELEVANCE Simultaneous treatment of tibial fracture and CrCL rupture with unilateral external fixation was successful in this dog and may be helpful in similar cases.