Introduction
Some fractures are so severe they
require the expertise of a specialist in bone surgery. We have a
specialist in bone surgery that will come to our hospital and perform
the repair. This has several advantages, not the least of which it
costs less than if we refer the repair to a surgical specialist at
his hospital. These pictures show the repair of Dakota, a Labrador
who fractured his tibia (shinbone) by playing.
Type of
Fracture
This fracture is called a spiral
fracture due to the winding nature of the crack. The fracture is much
more severe than is apparent on this x-ray. What is not apparent on
the x-ray are the numerous bone fragments that were found
surgically.
Surgery
The following area contains
graphic pictures of an actual surgical procedure performed at the
hospital. It may not be suitable for some children (and some adults
also!). Click here
if you would like to bypass the surgery pictures and view post
operative x-rays.
Our
surgeon needs to utilize specialized equipment if he is to put
this bone back together so that Dakota can return to normal
function. In this picture he is using magnifying glasses and
special lighting. In addition, he has orthopedic instruments
and equipment without which he would never be able to repair
such a severe fracture.
Bone infections can be
serious so significant time is spent in sterile preparation.
When Dakota has been anesthetized,
and adequately prepared, an incision is made on the inside of
his leg. This area has minimal muscle over it and gives good
exposure to the fracture site.
After careful dissection and control of hemorrhage the
main fracture segments are isolated.The surgeon
uses special wires called cerclage wires to begin the process of holding
the fracture segments in place. It is a tedious process that takes up
a significant amount of the surgery.
The wire is tightened down with a special
instrument that gives just the right amount of tension. Too
little tension and the wire is useless, too much and the bone
fractures even more.
At this point 2 cerclage wires have been applied to the
fractures at the top, with new ones being applied to the fractures at
the bottom.
Eventually 6 cerclage wires are applied to align the
bone fragments. Even though these wires are strong the bone will not stay
in place and heal with just these wires. A bone plate is needed for most
of the stability.
After the bone plate is measured and bent to the specific
shape of this tibia, holes are drilled into the bone with a special air
powered drill. They have to be drilled to the proper depth and angle or
the bone will fracture more or the plate will fail.
Drilling the holes is the first step in the
application of the plate. The depth of the holes is measured,
and specific screws are used. Some screws compress the plate to
the bone, others hold the plate in place.
Two hours from the start of the surgery the
plate has finally been applied. We will not remove it unless
there is a post operative complication.
The muscle is sutured to preserve its
function and to cover the plate. These sutures will slowly
dissolve over several months.
The skin sutures will stay in for 2 weeks.
at this point in the surgery Dakota is given an antibiotic
injection along with a pain injection. after one nights rest in
the hospital he will go home. He will need to be confined for
one month for healing to progress.
Before Dakota is fully awake
from anesthesia an x-ray is taken to assess the surgery. The
bend to the plate can be seen, along with the cerclage wires
and the different lengths of the various screws. The fractured
fibula (arrow) will heal by itself.
Once our surgeon is satisfied that everything is
in order Dakota is given a pain
injectionand awakened from anesthesia. He
will spend the night with us so that he can rest and so we can
monitor his recovery. He will need to rest at home for several months
before the healing is complete. We will not take the plate out unless
complications arise.
One month after the surgery we took an x-ray
to make sure the plate is holding well and the bone is healing.
If you look carefully, the small bone in the leg, called the
fibula, is healed (arrow). Compare it to the x-ray above where
you can see the fractured fibula.
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