PMC9092591_01
The tibial and fibula fracture: (a,b) on presentation; (c,d) immediately after initial
surgical stabilisation with a modified type 2 external skeletal fixator; (e,f) 16 weeks
postoperatively; and (g,h) 20 weeks postoperatively
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Pelvic limb radiographs confirmed left tibial and metatarsal fractures as previously described and a mid-diaphyseal fibular fracture (Figure 1a,b; Figure 2a,b). The tibial fracture was stabilised with a modified bilateral uniplanar (modified type 2) ESF (Figure 1c,d; Figure 3a,c,e,g,i). Radiographs revealed delayed union of the tibial fracture (Figure 1e,f), functional malunions of metatarsals II-IV and an atrophic non-union of metatarsal V. Twenty weeks postoperatively, repeat radiographs of the tibia confirmed non-union of the tibia; thus, revision surgery was performed (Figure 1g,h).
The metatarsal fractures: (a,b) on presentation; (c,d) immediately after initial
surgical stabilisation with a modified type 2 freeform external skeletal fixator (ESF);
(e,f) 6 weeks postoperatively; (g,h) 16 weeks postoperatively, after removal of the
metatarsal ESF; and (i,j) 30 weeks postoperatively
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Pelvic limb radiographs confirmed left tibial and metatarsal fractures as previously described and a mid-diaphyseal fibular fracture (Figure 1a,b; Figure 2a,b). The metatarsal fractures were stabilised with a modified type 2 freeform ESF (Figure 2c,d; Figure 3b,d,f,h,j). After the cat was anaesthetised with the same protocol as previously described, the metatarsal ESF was removed (Figure 2g,h) and two loose pins from the tibial ESF were removed. Radiographs revealed radiographic union of the tibial fracture; the radiographic appearance of the pes was unchanged from the previous description (Figure 6c,d; Figure 2i,j).
The tibial and pes wounds: (a,b) immediately after surgical stabilisation, wound
debridement and lavage with sterile saline. The metatarsal fracture was stabilised with
a freeform external skeletal fixator where putty was used instead of connecting bars.
(c,d) After 7 days of conventional dressings (consisting of wet-to-dry dressings, which
were switched to hydrocolloid gel and polyurethane foam as soon as all devitalised
tissue was removed); (e,f) after 10 days of conventional dressing, prior to application
of negative pressure wound therapy (NPWT); (g,h) after 6 days of NPWT; and (i,j) after 8
days of NPWT, cessation of NPWT
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The tibial fracture was stabilised with a modified bilateral uniplanar (modified type 2) ESF (Figure 1c,d; Figure 3a,c,e,g,i). The metatarsal fractures were stabilised with a modified type 2 freeform ESF (Figure 2c,d; Figure 3b,d,f,h,j). After 10 days of wound management, both wounds had a small amount of healthy granulation tissue circumferentially in the periphery of the wound, but there was minimal evidence of wound contracture or epithelialisation and large areas of tibial and metatarsal bone remained exposed (Figure 3e,f). At cessation of NPWT, the tibial wound was completely covered by healthy granulation tissue (35 x 15 mm; Figure 3i). Healthy granulation tissue was present throughout the pes wound (55 x 30 mm), although a small portion of metatarsals III and V remained exposed (2 x 8 mm and 3 x 16 mm, respectively; Figure 3j).
Negative pressure wound therapy in situ at day 10 postoperatively. The black
polyurethane foam was applied over the cranial and caudal aspect of the limb to cover
both wounds. The external skeletal fixator bars and pins were padded (the lateral bar
with a white dressing). From the pes to the level of the proximal tibia was sealed with
adhesive polyurethane film, the leading edge of this polyurethane film was green, the
majority was the visible colourless film applied over the limb
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The dressing was replaced at 48-84 h intervals (Figure 4), totalling 8 days of NPWT.
Complete take of the free meshed skin graft applied to the pes wound, 10 days post-skin
graft procedure, 6 weeks post-injury
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The graft donor site wound and the tibial wound were fully healed and there was 100% graft take (Figure 5).
The tibial fracture: (a,b) immediately after revision surgery with internal fixation
(20 weeks post-initial surgery) and (c,d) 10 weeks post-revision surgery, 30 weeks post-
initial surgery. The radiographically apparent patella luxation was not clinically
appreciable in the conscious cat
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Following transverse ostectomies of the tibial and fibular fracture margins to reopen the medullary canals and allow a transverse surface for compression, the graft was applied to the fracture site and the tibia was stabilised with a medially positioned 2.7 mm locking compression plate (LCP; Synthes) placed in load (Figure 6a,b). Radiographs revealed radiographic union of the tibial fracture; the radiographic appearance of the pes was unchanged from the previous description (Figure 6c,d; Figure 2i,j).