Comparing internal versus external fixation for diaphyseal tibial and fibular fractures in skeletally immature dogs

PICO Question In skeletally immature dogs with simple non-displaced diaphyseal tibial and fibular fractures does internal fixation compared with external fixation result in less postoperative complications and improved fracture healing?   Clinical bottom line Category of research Treatment. Number and type of study designs reviewed There were no publications that answered the PICO question. Strength of evidence None. Outcomes reported Both external skeletal fixation and internal fixation are reported as techniques for diaphyseal tibial and fibular fracture management in companion animals, though no study has been reported to compare these techniques directly, or to report fracture healing and postoperative complications in skeletally immature dogs with non-displaced diaphyseal tibial fractures. Conclusion Given the absence of evidence answering the PICO, choice and recommendation on treatment for non-displaced diaphyseal tibial and fibular fractures in skeletally immature dogs should be decided on personal experience and stabilisation methods available to the veterinarian such as external fixation or internal fixation. Both surgical techniques have been reported in skeletally mature and immature dogs with diaphyseal tibial fractures, but not specifically in skeletally immature patients with non-displaced diaphyseal tibial and fibular fractures. They are both applicable methods of fixation for tibial fractures in companion animals, though there is lacking evidence for which has more favourable outcomes for non-displaced diaphyseal tibial and fibular fractures in skeletally immature dogs as no studies have directly compared these stabilisation techniques.   How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.