Abigail Turner, Michelle R. Joffe, Conor Davis, Sophie Baron, Gideon Meyerowitz-Katz, Andrew S. Levien
Background
Proximal tibial physeal fractures are common in young dogs, typically classified as Salter–Harris type 1 (SH-1) or type 2 (SH-2). These injuries can increase the tibial plateau angle (TPA), raising the risk of cranial cruciate ligament rupture. Surgical repair with Kirschner wires (K-wires), with or without a tibial tuberosity tension band, is the preferred treatment. However, limited studies have examined how surgical technique influences postoperative TPA changes.
Methods
This retrospective study reviewed medical records from 2017 to 2022 at a veterinary referral hospital. Dogs with SH-1 or SH-2 fractures treated surgically with K-wires, with or without a tension band, were included if radiographs were available preoperatively, postoperatively, and at follow-up (4–8 weeks). Four investigators measured TPA using standardized radiographic techniques. Statistical analyses assessed changes in TPA over time and compared outcomes between fixation methods.
Results
Thirty-two dogs met inclusion criteria (22 repaired with K-wires + tension band, 10 with K-wires only). The mean TPA decreased:
-Preoperative to first reevaluation: –5.89° (p < 0.001)
-Immediate postoperative to first reevaluation: –2.2° (p = 0.018)
No significant differences were observed between repairs with or without tension bands. Despite imperfect reductions, TPA trended toward normalization postoperatively. French Bulldogs were the most represented breed.
Limitations
As a retrospective study, limitations included incomplete records, small sample size (especially for second reevaluation), variability in surgeon experience, and limited representation of large and giant breeds. Radiographic challenges (e.g., implant interference) and lack of blinding introduced potential bias. Long-term outcomes beyond skeletal maturity were not assessed.
Conclusions
TPA decreased progressively following SH-1 and SH-2 fracture repair with K-wires, regardless of tension band use. Imperfect reduction did not necessarily increase risk of cruciate rupture, suggesting additional corrective surgery may be unnecessary if high TPA is observed immediately postoperatively. Future prospective studies with larger cohorts, longer follow-up, and inclusion of larger breeds are needed.
1–1.4: Example of TPA measurement of a 5-month-old French Bulldog from left to right (1.1 contralateral; 1.2 preoperative; 1.3
immediate postoperative; 1.4 first reevaluation). Line A is the functional tibial axis line, drawn between the midway point of the tibia
intercondylar eminences and the center of the talus. Line B is the medial tibial plateau line, drawn between the most cranial and most caudal
points on the tibial plateau. Line C is the reference line, drawn perpendicular to Line A where it intersects Line B. The TPA ismeasured as the angle
formed between Lines B and C. TPA, tibial plateau angle.
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