Page 343 - Canine Lameness

19.3 ­FractFres ofctrf ctofr ret o 315

injuries is imperative. The patient will typically exhibit non-weight-bearing lameness, with variable
amounts of swelling and crepitus around the fractured region. Examination of the area usually shows
severe pain upon manipulation. Diagnosis of these fractures can generally be accomplished with
orthogonal radiographs, although the diagnosis can be missed if only a single view is taken (Figure 19.4).
CT may be beneficial for complex fractures, to identify intra-articular components, bone fissures,
and additional fragments that may be missed with radiographs.

19.3.1 Patellar Fractures

Traumatic patellar fractures are rarely encountered in dogs. They are the result of severe, direct
trauma to the patella and can be diagnosed with standard radiography (Figure 19.3). Because of
the extreme tension by the quadriceps muscle, treatment is challenging. Surgical fixation and par-
tial patellectomy are potential treatment options. These fractures may also be associated with dis-
ruption of the patellar ligament and other soft tissue pathologies (e.g. cruciate and collateral
ligaments, and menisci), which need to be carefully investigated (either at the time of surgery or

(A) (C) (E) (G) STIFLE REGION

(B) (D) (F) (H)

Figure 19.4 Examples of physeal fractures in four patients. Patient I (A) severely displaced avulsion
fracture of the tibial tuberosity apophysis without disruption of the proximal tibial epiphysis. These
fractures generally require surgical reconstruction. Patient II (B) minimally displaced tibial tuberosity
avulsion fracture (MDTTAF). These patients are generally treated nonsurgically. Patient III (C–F) mildly
displaced fracture (C, D) of the proximal tibial apophysis and epiphysis. The small fragment (white arrow
image (C)) indicates that this is a Type II SH fracture. Note that the fracture is difficult to identify on the
craniocaudal view. The only abnormality is a (white arrow) slight widening of the lateral aspect of the
proximal tibial physis. Images (E, F) are of the normal leg and provided for comparison. Patient IV (G, H)
mildly displaced SH Type I fracture. Note the subtle (white arrows) widening of the medial and caudal
aspect of the proximal tibial physis.