Tibial Fracture Management With Minimally Invasive Plate Osteosynthesis (MIPO) In Dogs

ABSTRACT Title : TIBIAL FRACTURE MANAGEMENT WITH MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) IN DOGS Name of the Student : BHAJAN CHANDRA DAS Degree of the Student : Ph. D. ( Veterinary Surgery and Radiology) Name of the Chairman : Dr. S. Thilagar, Ph. D. Controller of Examinations TANUVAS, Madhavaram, Chennai-51 University : Tamilnadu Veterinary and Animal Sciences University Chennai-51 Year : 2010Title : TIBIAL FRACTURE MANAGEMENT WITH MINIMALLY INVASIVE PLATE OSTEOSYNTHESIS (MIPO) IN DOGS Name of the Student : BHAJAN CHANDRA DAS Degree of the Student : Ph. D. ( Veterinary Surgery and Radiology) Name of the Chairman : Dr. S. Thilagar, Ph. D. Controller of Examinations TANUVAS, Madhavaram, Chennai-51 University : Tamilnadu Veterinary and Animal Sciences University Chennai-51 Year : 2010 The study was carried out on clinical cases referred to the Small Animal Orthopaedic Outpatient Unit, Madras Veterinary College Teaching Hospital, Chennai. Eighteen dogs of different breeds, sex, age and body weight with diaphyseal tibial fractures were selected and randomly divided into three groups. In Group I, six dogs were treated with conventional dynamic compression plating technique, in Group II, six dogs were treated with minimally invasive plate osteosynthesis (MIPO) without C-arm guidance and in Group III, six dogs were treated with minimally invasive plate osteosynthesis (MIPO) under C-arm guidance. Among the 1038 long bone fracture cases, tibia and fibula accounted for a total of 318 cases (30.6%). The highest incidence was recorded in Non-descript breed 101 cases (42.0%). Incidence was more in males 145 cases (61.0%) whereas in females it was 94 cases (39.0%). Most of the tibial fractures recorded in less than six months aged. In group I, conventional dynamic compression plating technique was carried out under open reduction through medial approach for transverse and short oblique fractures. In Group II and III, a 2 to 4 cm long skin incision over the proximal and distal fragment of the bone was made and a precontoured DCP was inserted epiperiosteally and the plate was fixed to the bone by one or two screws through the proximal skin incision. Then the fracture fragments were reduced by manipulation followed by fixing the distal plate holes by screws which was found to be technically suited for plate fixation. The parameters studied during the pre and post operative period were clinical evaluation, radiographic and ultrasonographic assessment, lameness grade, functional outcome and serum biochemical analysis. In Group I, the functional outcome was graded as excellent in three cases (50.0%) and good in two cases (33.3%) and fair in one case (16.7%). In Group II, the functional outcome was graded as excellent in four cases (66.7%) and fair in two cases (33.3%). In Group III, the functional outcome was graded as excellent in five cases (83.3%) and good in one case (16.7%). Radiographic evaluation of Group I, II and III cases indicated either primary or secondary healing and was related to stability at the fracture site. Ultrasonographic evaluation indicated earlier fracture healing in some cases compared to radiodiagnosis. Plate bending was observed in two cases in Group I and implant failure in one case in Group II. No postoperative complication was observed in Group III. Serum biochemical evaluation revealed increased alkaline phosphatase in immediate postoperative day as compared to preoperative day and gradually declined from 7th postoperative day to 60th postoperative day in all three groups. Serum level of calcium and phosphorus significantly increased at 60th postoperative day compared to preoperative day in Group II and Group III. In this study, conventional dynamic compression plating technique provided adequate apposition and early weight bearing with primary clinical union of bone. MIPO procedure was technically demanding and adequate reduction and alignment of fracture ends depended on factors like type of fractures and duration of fractures and required skill. Intra-operative evaluation of reduction and alignment of fracture fragments and proper positioning of contoured plate to the bone was technically easier to perform under C-arm guidance as compared to Group II and hence, MIPO with Carm guidance procedure is safe and effective for diaphyseal tibial fractures with less complications in dogs.