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370 Fractures of the Tibia and Fibula

• Radiographs may not reflect maximal spinal
displacement. Neurologic evaluation is often
VetBooks.ir • Radiographs have moderate sensitivity for
more helpful than radiographic evaluation
for prognosis.
spinal fractures and subluxations and low
negative predictive values for canal narrowing
or fragments within canal.
Technician Tips
When admitting a patient with spinal injury,
A B provide safe transport of patient on rigid board
or vacuum-activated surgical positioning system
FRACTURES OF THE SPINE/LUXATIONS OF THE SPINE Radiograph of a canine cervical spine. A,
Lateral view showing an oblique C4 vertebral body fracture through caudal endplate (arrow) with ventral from car into the clinic and prevent owners
displacement. Intervertebral disc space at C4-C5 is collapsed (arrowhead). B, Transverse CT view (dorsal at from carrying patient by themselves.
bottom of the image) of the C4 vertebra showing a laminar fragment compressing the spinal cord (arrow). This
lesion could not be detected with cervical radiographs. Client Education
Care for paralyzed patients is laborious. It can
Drug Interactions PROGNOSIS & OUTCOME take months until improvement is observed,
Do not give steroidal and NSAID medications and return to function cannot be guaranteed.
simultaneously, and avoid NSAIDs until animal • Patients with pain sensation: good prognosis Depending on severity of injury, euthanasia
is well hydrated and shock is resolved. for functional recovery may be a reasonable option.
• Patients with loss of pain sensation: fair to
Possible Complications guarded prognosis SUGGESTED READING
• Respiratory arrest due to cervical fractures • Severed spinal cord or areflexia: grave prognosis Weh M, et al: Vertebral fractures, luxations, and
• Hemorrhage • Perioperative mortality for surgical stabiliza- subluxations. In Johnston SA, et al, editors:
• Neurologic deterioration tion of cervical vertebral fractures is up to Veterinary surgery: small animal, ed 2, St. Louis,
• Myelomalacia 36%. Nonsurgical treatment often provides 2018, Elsevier, pp 529-548.
• Infection, including urinary tract infection reasonable outcome. AUTHOR: Susanne K. Lauer, Dr.med.vet., DACVS,
• Implant failure DECVS, DACVSMR
PEARLS & CONSIDERATIONS EDITOR: Kathleen Linn, DVM, MS, DACVS
Recommended Monitoring
• Serial neurologic evaluations Comments
• Respiratory monitoring with cervical fractures • Up to 20% of patients with traumatic spinal
and trauma patients fractures have a second fracture.

Fractures of the Tibia and Fibula Client Education
Sheet

BASIC INFORMATION PHYSICAL EXAM FINDINGS Initial Database
• Pain, swelling, and crepitus at the fracture site • Craniocaudal and lateral radiographs, includ-
Definition • Stifle effusion with proximal physeal or ing the stifle and hock
Fractures of the tibia and fibula account for 20% tuberosity avulsion fractures • Stress radiography if a nondisplaced malleolar
of long-bone fractures and include avulsion of • Tarsocrural (hock) instability with malleolar fracture is suspected
the tibial tuberosity, separation of the proximal fractures • CBC, serum biochemistry panel, and uri-
or distal tibial physis, tibial shaft fractures, and nalysis to assess anesthetic risk; see American
fractures of the medial or lateral malleolus. Etiology and Pathophysiology Society of Anesthesiologists classification
• Because of sparse soft-tissue coverage, tibial (p. 1196).
Epidemiology fractures are often open.
SPECIES, AGE, SEX • Most fibular fractures occur with tibial Advanced or Confirmatory Testing
Tuberosity avulsions and physeal fractures occur fractures and are not repaired unless stability • Radiographs of the contralateral leg to
in immature animals. of the stifle or hock is compromised. differentiate traumatic physeal separation
from a normal open physis (growth plate)
RISK FACTORS DIAGNOSIS in immature patients
• Direct trauma • Bone biopsy for suspected pathologic fracture
• Muscle contraction causing avulsion fractures Diagnostic Overview
• Torsional athletic injuries History and physical examination can identify TREATMENT
• Bone tumors or metabolic bone disease most fractures. Radiographs are used to confirm
• Complication of cranial cruciate ligament repair the diagnosis and determine the best method Treatment Overview
(tibial plateau leveling osteotomy [TPLO] or for repair. Tibial fractures require stabilization for optimal
tibial tuberosity advancement [TTA]) healing. The method of repair should maintain
Differential Diagnosis normal limb length and joint alignment without
Clinical Presentation • Osteochondrosis of the tibial tuberosity compromising future bone growth, and must
HISTORY, CHIEF COMPLAINT • Primary or metastatic bone neoplasia take into account the nature of the fracture,
Acute lameness • Stifle or hock luxation patient size, and activity level.
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