250 Surgical Treatment
(A) (B)Figure 29.5 Lateral (A) and cranio-caudal (B) radiographs of a completed triple tibial osteotomy (TTO). A small amount
of the flare of the pre-contoured locking TPLO plate was removed. The plate is secured with two standard screws and
one locking screw above and below the ostectomy. Note that the tibial plateau angle has been reduced and the tibial
tuberosity advanced. A very small crack is evident extending distal from the hole at the distal end of the tibial tuberosity
osteotomy. A tension band was not considered necessary. The bone bridge caudal to the wedge is also cracked, but this
did not impact the reduction of the ostectomy. The removed bone wedge has been cut into 2-mm pieces and packed into
the defect behind the tibial tuberosity fragment.
In these cases, a cloverleaf-shaped TTO plate of
appropriate size or different TPLO plate (e.g.,
the SOPTMTPLO plate; Orthomed NA, Vero
Beach, FL, USA) can be contoured and applied
to stabilize the osteotomy (Figure 29.5).
Complications
During surgery it is possible that the bone
bridges may crack or fracture. If the base of the
tibial tuberosity fragment cracks, a tension band
wire is placed. If it fractures completely, a K-
wire is used to maintain reduction and a tension
band wire (or, in large dogs, two tension band
wires) is placed. If there is concurrent medial
patella luxation (MPL), the tuberosity fragment
can easily be lateralized. The base will usually
fracture with this re-positioning, and the place-
ment of one or two K-wires and a tension band
is indicated (Figure 29.6).
The caudal bone bridge also may crack dur-
ing reduction. This may cause the proximal
fragment to be more difficult to reduce, but
the situation is usually easily managed and the
plate can be applied.
If the patient is too active, it is possible that
the tibial tuberosity fragment may fracture. If