16 week post op radiographic update in a complex tibial fracture repaired with plate and IMPeek rod

These are the radiographs obtained at the primary care veterinarian approximately 16 weeks post op repair of a comminuted left tibial fracture in an elderly large breed dog.

The image quality is suboptimal due to movement artifact and other digital radiographic gremlins, but what we do see is stable implants, a healed fibula, slow attempts at callus formation across the major fracture gap and progressive resorption of the cranial butterfly fragment. There is a radiolucent line around the IMPeek rod which is likely a digital radiographic artifact called the Uberschwinger effect. You can see all of these changes more prominently on the side-by-side comparison of the 16 (left) and 10 week (right) caudocranial images below. 

The veterinarian reports the dog remains persistently weight bearing, but an intermittent lameness is still present after long walks and after prolonged rest. The client is very pleased with the outcome so far.

Nevertheless, this fracture would ideally be healed with aggressive callus at this point. In hind sight, bone grafting of the fracture gap should have been performed. I have recommended that we repeat imaging in 6 weeks time again, and depending on those findings, likely surgically revise the fracture gap and instill some autogenous bone graft and shorten the IMPeek rod which is a little too proud within the stifle. 

Updates will be posted here in the future.