Advances in the Canine Cranial Cruciate Ligament, 2nd edition

Closing Cranial Wedge Ostectomy and Triple Tibial Osteotomy 247

the screws also converge slightly on the lat-
eral aspect. These features reduce the ability of
this plate to counter the forces working to open
the osteotomy, and catastrophic failure of screw
purchase can occur. For this reason, a T-style
or cloverleaf plate with a wider screw distri-
bution may provide greater stability. If a plate
designed for TPLO is used, it is essential to
add adjunct fixation. Options for adjunct fixa-
tion include a cranial tension band wire, small
plate or, with an angled osteotomy, a bone screw
lagged across the osteotomy (Figure 29.3).

Complications

The primary major complication specific to

CCWO is failure of fixation of the proximal

fragment. This risk is reduced if an appropri-

ately sized plate is selected and adjunct fixation

is well placed.

Outcome

Outcome has been reported for a number of

small case series, usually with some defining

(A) (B)

Figure 29.3 Lateral (A) and cranio-caudal (B) postoperative radiographs after a 41◦closing cranial wedge ostectomy
(CCWO). The cranial cortices were aligned and the osteotomy stabilized with a 3.5 cloverhead plate with three locking
screws in the proximal fragment applied medially (Veterinary Orthopaedic Implants, St Augustine, FL, USA). A 2.7-mm
‘L’ plate (DePuy SynthesVet, Paoli, PA, USA) has been applied cranially as a ‘tension band’ to counter the quadriceps
force that tends to open the osteotomy.