|Plate and rod|
|Diaphyseal fractures with non reconstructible fragments|
In the presence of non-reducible fragments or when devitalization of the fragments is likely during reduction, indirect reduction and a plate and rod stabilization technique are indicated.
|Diaphyseal fractures with reconstructible or non reconstructible fragments|
All B and C type fractures, especially the non-reconstructible types, are amenable for internal fixation with an interlocking nail (ILN). The ILN can be used with an open approach but is an excellent minimally invasive device, since it can be placed through small incisions without disturbing the fracture site.
The ILN provides good relative stability to the fractured bone. They are highly effective in counteracting bending forces because of their large diameter and intramedullary location. Unlike intramedullary pins, they effectively counteract axial compression and torsion because of their interlocking mechanisms.
|Diaphyseal fractures with non reconstructible fragments in young small patients|
32-B3, 32-C3 and usually 32-B2 fractures are not reducible fractures; therefore, biological fracture repairs are recommended.
A plate with a bridging function can under certain conditions be used alone for internal fixation of these fractures. If a bone plate is used alone, it must be able to withstand all the weight bearing forces during healing, as the bone will not initially be sharing the load.
A bridging plate used alone is acceptable in light weight, young dogs in which bone healing is fast.
For larger patients, stronger fixation such as plate and rod or an interlocking nail should be used. Double plating could be considered as an alternative. (see 32-B3 fractures).
|Comminuted diaphyseal fractures with non reducible fragments in small patients|
An external skeletal fixator with an intramedullary pin tie-in configuration is an alternative to bone plating in small dogs.
|Basic surgical experience, no specialized skills|
|Some specialized surgical experience|
|Highly experienced and skilled surgeon|
|Basic equipment only|
|Simple surgical and imaging resources|
|Full specialized surgical and imaging resources|