Ch 63 - Fractures of the Tibia and Fibula Flashcards

1
Q

What major muscles attach to the tibia and what is their function?

A
  • Quadriceps femoris (stifle extension)
  • Biceps femoris (stifle flexor)
  • Caudal part of sartorius (stifle flexor)
  • Cranial tibial muscle (tarsal flexor)
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2
Q

List the 4 epiphyses of the tibia

A
  • Proximal epiphysis
  • Tuberosity epiphysis
  • Distal epilphysis
  • Medial malleolar epiphysis
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3
Q

What is an apophysis?

A

A traction epiphysis such as the tibial tuberosity

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4
Q

How much of the longitudinal length of the tibia is from the proximal and distal epiphyses respectively?

A
  • Proximal 40%
  • Distal 60%
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5
Q

At what age does the tuberosity epiphysis fuse with the proximal epiphysis?
At what age does the tuberosity physis normally close?

A
  • Fuses to proximal epiphysis 5-9m in large dogs
  • Physis closes over 12m in large dogs
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6
Q

At what age does the medial malleolar epiphysis fuse to the distal epiphysis?

A

Very early, approx 4-5m in large breeds.

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7
Q

What part of the tibial plateau is articular?

A

The caudal 1/2

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8
Q

What muscles attach to the tibial tuberosity?

A
  • Quadriceps femoral
  • Parts of biceps femoris and sartorius
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9
Q

What are the main vessels which supply blood to the tibia and fibula?

A

Tibia
- Cranial tibial artery

Fibula
- Cranial tibial artery (head)
- Peroneal artery (fibula)

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10
Q

What vessels and nerves surround the tibia

A
  • Medial saphenous artery and vein and saphenous nerve obliquely cross the medial tibia
  • Tibial and popliteal artery along lateral and caudal aspect
  • Peroneal and cutaneous nerves along lateral and caudal aspects
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11
Q

What can result in a tibial tuberosity avulsion?

A

Contraction of the quadriceps while the stifle is flexed and the foot is firmly on the ground

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12
Q

What is Osgood Schlatter disease?

A

Considered to be a form of osteochondrosis but has been suggested that it should be classified as a minimally displace tibial tuberosity fracture

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13
Q

What leg position can aid in reduction of a tibial tuberosity fracture? What are the repair options?

A

Hip flexed and stifle extended
Repair options:
- 2 K-wires in a caudoproximal direction (very young small dogs with minimal displacement)
- Pin and tension band (preferred)
- Reattachment of patella tendon to bone tunnel if not enough bone to reattach

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14
Q

What are the repair options for a proximal physeal fracture?

A

Pinning!
- At least 2 cross pins
- Third pin through tuberosity recommened for better stability

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15
Q

What are the repair options for proximal metaphyseal fractures?

A
  • IM pin, cross pins, plate, lag screws
  • If fibular head had detacted from tibia, should be reattached with screws
  • If comminuted, plate must be placed on side of comminution to act as buttress plate
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16
Q

What is the ideal pin insertion point for normograde tibial IM pinning?
What is the recommended size?

A
  • Approx 1/3 - 1/2 distance from cranial tibial tuberosity to medial condyle of tibia
  • 50% width of isthmus (smaller that usually recommended as needs to bend with s-shaped bone)
  • 30-40% if using with a plate
17
Q

What unique consideration needs to be realised when placing cerclage around the distal tibia?

A

The tibia and fibula are closely associated from mid-diaphysis distally usually requiring the cerclage wire to be placed around both bones

18
Q

What is the reported rate of non-union in tibial fracture repairs?

A

4.1%

19
Q

What are the repair options for distial tibial physeal fractures?

A
  • Cross-pinning from medial and lateral malleoli
  • IM pinning or single transarticular pin (talus to tibial medullary cavity) with rigid external coaptation. Less desirable, ONLY if not enough bone for cross pinning
20
Q

What are the repair options of malleolar fractures?

A
  • Pins alone
  • Pin and tension band
  • Screw
21
Q

List the main forms of congenital/developmental tibial deformities and the breeds most commonly associated with them

A
  • Pes Varus - Dachshunds
  • Pes Valgus - Shelties, Large breeds
  • Significant increase in TPA - Westies