Nelson

Nelson was a 1 year, 9 month-old crossbreed who presented with a complex fracture of the right tibia (or shin bone). Traditionally such fractures would be managed with a plate and screws through a large wound spanning the length of the bone. A lot of time may have been spent trying to accurately fix each fragment. The combination of a large wound, long surgical time and large implants predisposes to infection and can result in problems with bone healing. An alternative strategy is to use an external skeletal fixator so that the fragment is stabilised with pins placed through the skin with a frame on the outside of the leg. This can be very effective but the frame can be difficult to manage postoperatively. Recent advances in bone plate technology have allowed human orthopaedic surgeons to pioneer what has become known as Minimally Invasive Plate Osteosynthesis, or MIPO. This strategy involves tunneling a plate across a fracture via small skin incisions at each end of the bone. It is a means of avoiding the morbidity and management difficulties associated with external skeletal fixation and also avoids the long surgery time and big wounds associated with traditional plate fixation. We have access to the same advances in bone plate technology (Synthes Locking Compression Plate, LCP) at Anderson Sturgess and Andy has successfully transferred this technique to some of our canine patients, including designing dedicated instrumentation.

MIPO technique in a dog

The results have been excellent, with a quick return to weight-bearing and early fracture healing. The fractures are typically healed at the first x-ray follow-up, 6 weeks after surgery. The rapid bone healing can be attributed to the avoidance of an open wound, and hence surgical trauma to the blood supply at the fracture site. 

Complex tibial fracture managed with MIPO (3.5 LCP):

Preoperative, immediate postoperative & 6 week follow-up x-rays

Nelson, day after MIPO surgery