Objectives The aim of this study was to describe a screw fixation method of the tibial tuberosity after transposition during surgical treatment of patellar luxation and to report complications and outcome of the procedure.
Materials and Methods Medical records (2010–2016) of dogs treated for patellar luxation with tibial tuberosity transposition stabilization using a cortical bone screw placed adjacent to the tuberosity were retrospectively reviewed. Radiographs acquired immediately after surgery were evaluated for fissures. Proximal tibial dimensions and tibial tuberosity segments were measured. Intraoperative and postoperative complications were recorded.
Results One-hundred and six dogs and 131 stifle surgeries were included. Implant complications associated with the screw occurred in 2/106 dogs (1.9%). Two dogs developed tibial tuberosity fracture and proximal displacement within 1 week of surgery and required stabilization with pin and tension band. Patellar reluxation rate following surgery was 6.9% (9/131 procedures). Presence of a fissure on postoperative radiographs increased the odds of tibial tuberosity fracture development (p < 0.001), while greater tibial tuberosity size (p = 0.023) and larger distal cortical attachment (p = 0.018) decreased the odds of fissure formation.
Clinical significance Tibial tuberosity transposition can be achieved with a cortical screw placed lateral or medial to the tibial tuberosity.
Avulsion fracture of the tibial tuberosity is an infrequent injury in adolescents and an extremely rare occurrence in adults. We describe the case of an 86-year-old gentleman presenting after a fall, sustaining injury to the left knee. Radiographs of the left knee showed avulsion fracture of the tibial tuberosity. The purpose of this study was to present a rare case of tibial tuberosity avulsion fracture in an adult, the treatment performed, and the challenges faced. The case is discussed with the review of the literature.
SummaryObjective: To retrospectively identify factors that predispose to tibial tuberosity (TT) fracture after tibial tuberosity advancement (TTA) in dogs.Methods: The medical records and radio-graphs of a group of control dogs (n = 212) that had TTA surgery (n = 241 procedures) and did not sustain a fracture between 2008 and 2013, and those of 12 dogs that did sustain a fracture (n = 13 procedures) between 2008 and 2013 at two veterinary teaching hospitals were evaluated to determine the effect of signalment, body weight and surgical inaccuracies on TT fracture. Multivariable logistic regression was performed with the occurrence of TT fracture as the outcome variable of interest.Results: Signalment and body weight were not found to be associated with TT fracture. Of the surgical inaccuracies, osteotomy shape (p = 0.003), plate position (p = 0.009), and cage position (p = 0.039) were factors significantly associated with TT fracture.Clinical significance: This study provides data to support the hypothesis that poor plate position, poor cage position, and narrow distal osteotomy width are associated with TT fracture after TTA. We conclude that it is of paramount importance to pay careful attention to surgical technique in order to reduce this risk.
A total of 696 tibial plateau leveling osteotomy (TPLO) procedures were performed over a 30-month period following TPLO training. The overall complication rate was 18.8%.
Complications were classified as perioperative (1%), short-term (9.3%), and long-term (8.5%). Examples of complications encountered during the study were hemorrhage, swelling at the incision site, premature staple removal by the dog, tibial tuberosity fracture, patella tendon swelling, and implant complications. Based on the rate of complications observed, clinical outcomes of TPLO procedures within 30 months of TPLO training were considered good.
Tibial tuberosity advancement (TTA) is used to treat cranial cruciate ligament rupture of the stifle joint in dogs. Tibial tuberosity fracture/fissure is a complication of TTA that may have a favorable prognosis. The aim of this study was to detect how tibial tuberosity fracture/fissure through the Maquet hole worsens the progression of osteoarthritis (OA) in the stifle joint of dogs treated with porous TTA. Seventeen cases were included in the study, divided into two groups. The first group (n = 10) included subjects that had tibial tuberosity fracture/fissure through the Maquet, and the second group included subjects that had no complications (n = 7). Both groups showed significant progression compared to OA at 3 months after surgery. We observed that at T0, the control group showed a higher level of OA. For this reason, we normalized the OA scores, evaluating the percentage difference from T0 and T1. We verified that there were no statistically significant differences between the two groups. The results confirm that OA progression in subjects undergoing TTA was not significantly influenced by fracture/fissure of the tibial tuberosity through the Maquet hole. Therefore, fracture fissure through the Maquet hole should be considered as a common minor complication during TTA.
Tibial Tuberosity Transposition Stabilization Using a Cortical Screw Placed Adjacent to the Tuberosity in Dogs with Patellar Luxation
