Tibial Tuberosity Avulsion Fractures
Bless my clients! Sometimes, I get emails asking me, “Laurie, XYZ happened to my friends dog, and the vet recommended surgery, but I thought I should ask you to see if that really was the best option.” Sometimes it isn’t and sometimes it is! One such recent case was that of a 4-month-old large breed puppy that developed a sudden onset tibial tuberosity avulsion fracture (TTAF) while playing with other dogs. She sent me an x-ray, and I had to say, “I agree with the veterinary recommendation.”
I have only seen a handful of these cases. Three in total, come to mind. One was a young Borzoi with a non-displaced TTAF. The second opinion vet in that case advised no surgery, just rest. That dog did well. I’ve seen two that were adverse events after surgery. One ended up with a displaced tibial tuberosity and was very much compromised. The other with a presumed allergic reaction to the pin that ended up with a dissolved tibial tuberosity and compromed common peroneal nerve.
So, when I saw the following paper cross my desk, I was inspired to piece it together for this blog.
Miller ZA, Cabrera SY, Mason D, Kass PH. Good clinical outcomes achieved in young dogs with tibial tuberosity avulsion fracture repairs when implants were left in situ past skeletal maturity. J Am Vet Med Assoc. 2022 Sep 28;260(15):1941-1946.
Here's the abstract:
To evaluate outcomes of tibial tuberosity avulsion fractures (TTAF) in dogs with implants left in situ past skeletal maturity and to compare clinical outcomes with published outcomes in dogs whose implants were removed 4 to 6 weeks postoperatively.
ANIMALS: 47 client-owned dogs.
In this retrospective study, 47 dogs had surgery to correct a TTAF before 10 months of age and had the implants left in situ past skeletal maturity. Of these, 42 were followed for a median of 36 months postoperatively. Short- and long-term complications were recorded and compared with historically published data in which the implants were removed within 6 weeks of surgery.
14% (6/42) of our population experienced minor long-term complications (stiffness and lameness), 6% (3/47) experienced major short-term complications (repair failure), and 14% (6/24) experienced major long-term complications (implant removal). There was no difference in long-term outcomes when compared with results of historical reports in which implants were removed 4 to 6 weeks postoperatively. Client satisfaction was high, with 93% (38/41) grading outcomes as excellent and 95% (39/41) stating they would have surgery performed again in retrospect.
Immature dogs with surgically repaired TTAFs have favorable long-term outcomes when the implants were left in situ past skeletal maturity. Dogs with TTAF repairs may not need implant removal unless it becomes clinically necessary. Avoiding a second procedure will decrease patient morbidity, recovery time, and cost.
Well, despite a complication rate of 34%, I think that when confronted with an x-ray like the one above, surgery is still the best option.
I’m looking forward to seeing the pup (from the x-ray above) in the upcoming week or so! Fingers crossed, it ends up being one of the 66% fully successful!
Until next time… Cheers!