Proximal Physeal Fracture of the Tibia with Caudal Bascule of the Tibial Plateau Managed with Epiphysiodesis of the Proximal Tibia

A 3.5-month-old Boxer dog was presented for a nonweight bearing lameness. Radiographs showed a mild caudal bascule of the tibial plateau. Conservative management was first proposed. On day 7 clinical status had improved but caudal bascule of the tibial plateau had worsened. Fracture could fuse spontaneously with conservative management. Nevertheless, increased TPA might predispose the dog to a future cranial cruciate rupture. Surgical treatment was finally decided on day 12. Asymmetrical epiphysiodesis of the proximal tibia was decided to stabilize the fracture and to reduce spontaneously the TPA before the end of the growing phase. Two 2.7-mm cortical screws were placed under fluoroscopic guidance in the cranial portion of the tibia through the growth cartilage. Follow-up was made until the end of the growing phase of the dog and showed a final TPA of 8 degrees.

Diagnosis of proximal physeal fracture of the tibia is often delayed which induce several therapeutic options: conservative management, surgical stabilization, or a tibial plateau leveling procedure in case of chronic fracture. In the case presented here, stabilization of the physeal fracture was performed with cortical screws to achieve both the fracture fixation and the asymmetrical closure of the physis. Epiphysiodesis of the proximal tibia was initially described to manage cranial cruciate rupture in growing dogs. The growth capacity is primordial to obtain sufficient correction and avoid overcorrection.