A 4-month-old crossbreed presented to us at West Midlands Referrals with an unstable proximal tibial “dome” fracture ten days after the injury. Unfortunately, an initial attempt to stabilise this with a splint dressing had not worked and had in fact caused some dressing sores.
This was fixed with a 2.7mm locking plate with 4 screws, placed in a minimally invasive (MIPO) fashion. The plate was slid under the skin, with holes just big enough to allow screw placement. The advantage of this technique is the preservation of soft tissue attachments and blood supply, and minimal risk of damage to adjacent growth plates. The disadvantage is it is less easy to see if things are lined up straight!!
So, intra-operative radiography is very useful to help check alignment before closure and moving the patient out of the theatre.
23rd September 2020
