avulsion fractures of the tibial crest

Question
My 4-5 month old (appears to be mostly German Shepherd) puppy has an avulsion fracture of the tibial crest. The one vet who saw him recommended a bone screw. I am not too worried about the cost. I am worried about my young dog going through surgery & anesthesia, especially if there are other options. He bears a little weight on it. But carries it if he goes fast. It has been only one full day since his injury.

If he has the surgery what are the short/long-term ramifications? If I wait or avoid the surgery all together what problems is he facing? Thank you so much for your help - Brian

Answer
It sounds like your puppy has a Salter fracture at the tibial crest growth plate. This is not an uncommon area for fractures in puppies because the growth plate is a weak point on the bone until it closes at around 6-7 months.(Any growth plate is for that matter.) Another option besides surgery if the fracture is relatively non-displaced is to simply splint the leg and allow it to heal by immobilizing it. Fortunately, puppies bones heal very quickly. The whole thing should heal in about 4-6 weeks with proper immobilization. Placing an internal fixation screw is the ideal treatment option but obviously more invasive and costly. The risks of using the splint are potentially delayed healing or non-healing but in my experience this is a rare occurrence. As I am sure your vet explained, any injury to a growth plate area can cause cessation of growth but fortunately there are lots of other growth plates on the hind limb that are still open and working. The worst case scenario is that the pup ends up with a discrepancy in the length of his hind limbs but I have never seen this happen. I hope your vet has put him in at least a temporary splint at this point to prevent further displacement of the fracture until you make a decision about treatment and also placed him on some pain meds.
Dr. G.