Successful use of dual-plate fixation to treat a canine comminuted scapula fracture

Comminuted scapular body fractures are a relatively uncommon injury in dogs but cause substantial morbidity. The main segments of the fracture tend to tent up, leading to pain, reduced function and an increased potential for reinjury (Cook et al, 1997; DeCamp, 2015). There is no evidence-based clinical consensus on the optimum treatment of these complex fractures (Cook et al, 1997; DeCamp 2015). It is commonly accepted that conservative medical management is not recommended for comminuted fractures of the scapular body when significant displacement of fragments is present, because the lack of inherent stability and ongoing movement of the fragments can cause significant swelling and discomfort (Harari and Dunning, 1993; Cook et al, 1997; Bojrab et al, 2014; DeCamp, 2015). A longer recovery period and higher incidence of lameness may be seen in conservatively managed scapular body fractures, although case numbers are small (Harari and Dunning, 1993). A previous experimental research study of induced scapula fractures reported enhanced healing and earlier return to function when scapular body fractures were plated (Mbogwa et al, 1978). When comminution is present, bridging fixation with a bone plate allows realignment of the main fracture fragments. Without anatomic reconstruction due to the comminution, the implants must withstand the entire load of the patient during weight bearing. This can lead to implant failure through fatigue fracture or bending (Schwandt and Montavon, 2005; Morris et al, 2016; Sahu et al, 2017). In comminuted long bone fractures, it is common to add an intramedullary pin to resist the bending forces that often lead to plate failure (Hulse et al, 1997). In flat bones, it is not possible to add an intramedullary pin and this case report describes the addition of a second plate to treat a comminuted scapular body fracture.