Short-term complications of internal versus external fixation of closed diaphyseal tibial fractures in 95 skeletally immature dogs

Objective To determine the influence of fixation method (internal vs. external) on short-term postoperative complications of closed diaphyseal tibial fractures in skeletally immature dogs. Study design Retrospective observational multicenter study. Animal population Skeletally immature dogs stabilized with internal fixation (IF) via plate osteosynthesis (n = 59) and external skeletal fixation (ESF) (n = 36). Methods Medical records from skeletally immature dogs with closed tibial diaphyseal fractures were reviewed. Data collected included signalment, fracture morphology, etiology, fixation technique, surgeon status, complications, time to discharge and time to final discharge. Results The total complication rate for IF was lower at 20.3% (p < .001, CI: 11.0-32.8) compared to ESF at 55.6% (CI: 38.1-72.1). A total of 95% of complications were considered major for external fixation versus 75% for internal fixation. Multivariable analysis revealed decreased odds of a postoperative short-term complication when a closed tibial diaphyseal fracture was stabilized with IF compared to ESF (p = .004, OR: 0.2, CI: 0.09-0.63). The median time to final discharge for ESF was 4 weeks (range: 2-13) and for IF was 6 weeks (range: 4-32) (p = .01). Conclusion ESF had a higher rate of short-term complications than IF, primarily due to pin-tract morbidity. The complication rate was 35.3% higher for ESF than for IF. Clinical significance Surgeons should consider the use of IF over ESF for skeletally immature dogs to reduce the risk of major complications.