Supercutaneous Plating for the Treatment of Traumatic Injuries of the Appendicular Skeleton in Dogs

Abstract

Objectives The purpose of this study was to report the clinical outcomes of traumatic appendicular bone injuries treated with supercutaneous plating.

Methods We conducted a retrospective case series of medical records following fracture fixation using locking implants with a supercutaneous plating technique. Inclusion criteria comprised a complete clinical and radiographical follow-up until implant removal. Patient history and signalment as well as fracture configuration were recorded.

Results Five appendicular long bone fractures (3 radii, 2 tibiae) were included in the study and they were all treated using conical coupling locking plates. The patient mean age was 2.3 years (range: 0.3–5.8 years) and the mean body weight 16.5 kg (range: 3–27 kg).

One major (implant failure) and minor complications (delayed bone union and iatrogenic recurvatum deformity) were detected. The removal of the plates was quick and did not require general anaesthesia. All five fractures treated healed and patients were sound at final follow-up. Neither discomfort nor pain were noticed during the postoperative patient management.

Clinical Significance The advantages related to the minimally invasive approach and implant removal could make the supercutaneous plating (SCP) an alternative to the traditional external skeletal fixation.

Further clinical investigations are required before definitive treatment recommendations using this technique can be made. In consideration of some of the complications detected, the use of fluoroscopy is recommended to support the surgeon at the beginning of their SCP learning curve.

Keywords

supercutaneous plating - locking plate - minimally invasive osteosynthesis - appendicular fracture - dog

Author Contribution

Both authors contributed to conception of study, study design, acquisition of data and data analysis and interpretation. They also drafted, revised and approved the submitted manuscript.

• References

• 1 Marcellin-Little DJ. Exernal skeletal fixation. In: Slatter D. , ed. Textbook of Small Animal Surgery. 3rd ed. Philadelphia, Pennsylvania: Saunders; 2002: 1818-1843
• 2 Kraus KH, Toombs JP, Ness MG. Complications. In: External fixation in Small Animal Practice. 1st ed. Oxford, UK: Blackwell; 2003: 88-99
• 3 Palmer RH. External fixators and minimally invasive osteosynthesis in small animal veterinary medicine. Vet Clin North Am Small Anim Pract 2012; 42 (05) 913-934 , v–vi
• 4 Ramotowski W, Granowski R. Zespol. An original method of stable osteosynthesis. Clin Orthop Relat Res 1991; (272) 67-75
• 5 Cronier P, Pietu G, Dujardin C, Bigorre N, Ducellier F, Gerard R. The concept of locking plates. Orthop Traumatol Surg Res 2010; 965: 517-536
• 6 Kerkhoffs GM, Kuipers MM, Marti RK, Van der Werken C. External fixation with standard AO-plates: technique, indications, and results in 31 cases. J Orthop Trauma 2003; 17 (01) 61-64
• 7 Kloen P. Supercutaneous plating: use of a locking compression plate as an external fixator. J Orthop Trauma 2009; 23 (01) 72-75
• 8 Woon CY, Wong MK, Howe TS. LCP external fixation--external application of an internal fixator: two cases and a review of the literature. J Orthop Surg Res 2010; 5: 19
• 9 Tulner SAF, Strackee SD, Kloen P. Metaphyseal locking compression plate as an external fixator for the distal tibia. Int Orthop 2012; 36 (09) 1923-1927
• 10 He X, Zhang J, Li M, Yu Y, Zhu L. Treatment of segmental tibial fractures with supercutaneous plating. Orthopedics 2014; 37 (08) e712-e716
• 11 Qiu XS, Yuan H, Zheng X, Wang JF, Xiong J, Chen YX. Locking plate as a definitive external fixator for treating tibial fractures with compromised soft tissue envelop. Arch Orthop Trauma Surg 2014; 134 (03) 383-388
• 12 Klos Z, Ratajska-Michalczak K, Sterna J. , et al. Zespol stabilizer in the treatment of open fractures of the zeugopodium in dogs and a goat. In Kossowsky R. , Kossovsky, eds. Advances in Materials Science and Implant Orthopaedic Surgery. 1st ed. New York, New York: Springer; 1995: 73-81
• 13 Nicetto T, Longo F. Supracutaneous plating using a locking plate for the treatment of a tibial fracture in a cat. Can Vet J 2017; 58 (06) 585-590
• 14 Mizuno K, Mineo K, Tachibana T, Sumi M, Matsubara T, Hirohata K. The osteogenetic potential of fracture haematoma. Subperiosteal and intramuscular transplantation of the haematoma. J Bone Joint Surg Br 1990; 72 (05) 822-829
• 15 Pozzi A, Hudson CC, Gauthier CM, Lewis DD. Retrospective comparison of minimally invasive plate osteosynthesis and open reduction and internal fixation of radius-ulna fractures in dogs. Vet Surg 2013; 42 (01) 19-27
• 16 Palmer RH. Biological osteosynthesis. Vet Clin North Am Small Anim Pract 1999; 29 (05) 1171-1185 , vii
• 17 Petazzoni M, Urizzi A, Verdonck B, Jaeger G. Fixin internal fixator: concept and technique. Vet Comp Orthop Traumatol 2010; 23 (04) 250-253
• 18 Nicetto T, Petazzoni M, Urizzi A, Isola M. Experiences using the Fixin locking plate system for the stabilization of appendicular fractures in dogs: a clinical and radiographic retrospective assessment. Vet Comp Orthop Traumatol 2013; 26 (01) 61-68
• 19 Perry KL, Bruce M. Impact of fixation method on postoperative complication rates following surgical stabilization of diaphyseal tibial fractures in cats. Vet Comp Orthop Traumatol 2015; 28 (02) 109-115
• 20 Millard RP, Towle HA. Open fractures. In: Tobias KM, Johnston SP. , eds. Veterinary Surgery Small Animal. External Fixation in Small Animal Practice. 1st ed. St Louis, Pennsylvania: Elsevier; 2012: 572-575
• 21 Rotne R, Bertollo N, Walsh W, Dhand NK, Voss K, Johnson KA. Influence of plate-bone contact on cyclically loaded conically coupled locking plate failure. Injury 2014; 45 (03) 515-521
• 22 Denny HR, Butterworth SJ. A Guide to Canine and Feline Orthopaedic Surgery. 4th ed. Oxford: Blackwell Science Ltd; 2006: 130-131
• 23 Beever LJ, Giles K, Meeson RL. Postoperative complications associated with external skeletal fixators in dogs. Vet Comp Orthop Traumatol 2018; 31 (02) 137-143
• 24 Stoffel K, Dieter U, Stachowiak G, Gächter A, Kuster MS. Biomechanical testing of the LCP--how can stability in locked internal fixators be controlled?. Injury 2003; 34 (Suppl. 02) B11-B19
• 25 Tonino AJ, Davidson CL, Klopper PJ, Linclau LA. Protection from stress in bone and its effects. Experiments with stainless steel and plastic plates in dogs. J Bone Joint Surg Br 1976; 58 (01) 107-113
• 26 Ang BFH, Chen JY, Yew AKS. , et al. Externalised locking compression plate as an alternative to the unilateral external fixator: a biomechanical comparative study of axial and torsional stiffness. Bone Joint Res 2017; 6 (04) 216-223