ABSTRACT
If surgery is to be attempted, an approach can be made craniomedially over the stifle joint, displacing the patella medially (168b). Reconstruction of the articular surface by placing a 1.5 mm lag screw is the first consideration. A 3 mm intramedullary pin can then be placed normograde from the base of the tibial crest through the medullary cavity of the proximal fragments to that of the distal tibia. Some of the smaller fragments are irreducible; therefore, the limb will need considerable support (heavy full limb bandage) for several weeks following surgery. Good pre-and postoperative analgesia is essential. In the immediate perioperative period both opioids (e.g. buprenorphine) and NSAIDs (e.g. meloxicam or carprofen) are indicated. Continued NSAID therapy should be given for at least 7-14 days, or longer if necessary. Exercise should be severely restricted (by cage resting) for 4-6 weeks and then slowly returned to normal over the following six weeks. Follow-up radiographs 6-8 weeks after the surgery are recommended to assess healing. d Implant removal may need to be considered in the longer term, although in most cases the pins and screws are left in place. Unless the articular surface is perfectly congruous, which is difficult to achieve, there is an increased risk of degenerative joint changes occurring in the left stifle following this type of injury.
