Clinical Communication 453

Locking T-Plate Repair of Ilial Fractures in Cats

and Small Dogs
Andrew B. Scrimgeour1 Andrew Craig2 Philip G. Witte2

1 Rata Veterinary Surgery, Bristol, United Kingdom
2 Southwern Counties Veterinary Specialists,
Ringwood, United Kingdom
Vet Comp Orthop Traumatol 2017;30:453–460.
Address for correspondence Andrew B. Scrimgeour, BVSc, BPhil(Vet),
MANZCVS(Surgery), MVM(Surgery), Rata Veterinary Surgery,
9 Stanley Road, Bristol BS6 6NP, United Kingdom
(e-mail: andrew@ratavetsurgery.co.uk).

Abstract Objectives To assess screw loosening and pelvic narrowing following the use of
locking implants to stabilise ilial body fractures in cats and small dogs.
Methods Review of clinical records and post operative and follow up radiography of
12 cats and five small dogs to evaluate accuracy of fracture reduction, screw purchase
Keywords and subsequent screw loosening and reduction in pelvic diameter.
► fracture repair Results No screw loosening or reduction in pelvic diameter was observed at follow up.

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► locking plates Clinical Significance Locking T-plates may prevent complications reported following the
► ilium use of conventional implant systems for the repair of ilial fractures in cats and small dogs.

Introduction that have very thin cortices, which appears to be of particular

Fractures of the pelvis are a common sequel to trauma
accounting for 22 to 34% of all fractures.1,2 Fracture repair
is indicated to restore the weight bearing axis of the pelvis
(comprising the acetabula, ilial bodies and sacroiliac joints)
and in cases with pelvic canal narrowing which may result in
obstipation. Intractable pain or neural deficits potentially
associated with sciatic nerve impingement are also consid-
ered indications for surgery.3
Ilial body fractures disrupt the weight bearing axis and are
therefore considered indications for surgery in the majority of
cases. Lateral bone plating is the most common management
strategy for ilial body fractures, presumably since the approach
is considered the simplest and allows best visibility of the
fracture.4 Other described options include dorsal plating,
ventral plating with or without a lateral plate, interfragmen-
tary pinning and placement of lag screws, intramedullary
Steinmann pinning, compound fixation with pins, screws,
orthopaedic wire and polymethyl methacrylate and external
skeletal fixation.4–10 One concern with lateral plating of ilial
fractures is the frequency of screw loosening (25% in small
dogs and 60% in cats), and the secondary loss of fracture
reduction and pelvic canal narrowing.5 Loosening of non-
locking plate–screw constructs may be associated with bones
concern in the cranial ilial wing.11 The authors hypothesized
that use of locking plate technology might reduce the inci-
dence of screw loosening and pelvic canal narrowing. This
report describes a retrospective analysis of the surgical tech-
nique and outcomes of use of locking T-plates for repair of ilial
fractures in cats and small breed dogs.
Materials and Methods
Case Selection
Clinical records of two referral orthopaedic practices
between January 2011 and December 2014 were reviewed.
Inclusion criteria included cats or dogs with bodyweight less
than 10 kg, ilial fracture fixation using a locking T-plate (2.0-
or 2.4-mm PAX T-plate; Securos, Fiskdale, Massachusetts,
United States) and locking screws on both sides of the
fracture and follow-up by veterinary examination and radio-
graphy at least 4 weeks following surgery. Information
gathered from the medical records included signalment,
bodyweight, concomitant injuries and implants used to
repair the fracture. Complications were also recorded and
were classified as minor when they had been addressed
through non-surgical measures and major where surgical
intervention was required.

received Copyright © 2017 Schattauer DOI https://doi.org/

January 25, 2017 10.3415/VCOT-17-01-
accepted after revision 0015.
July 12, 2017 ISSN 0932-0814.
454 Locking Plates for Repair of Ilial Fractures Scrimgeour et al.
Surgical Procedure
Patients were positioned in lateral recumbency. A standard
lateral surgical approach was made to the ilium involving
‘roll-up’ of the gluteal muscles.12 Fracture reduction was
facilitated where necessary by the manipulation of frag-
ments through the application of bone holding forceps to
the greater trochanter or the ischiatic tuberosity. Where
possible, reduction of the fracture was maintained by the use
of self-centring bone forceps or pointed reduction forceps. A
2.0- or 2.4-mm locking T-plate (Securos) with the appro-
priate number of screw holes as determined by the surgeon
was approximately contoured and applied to the ilium, and
the appropriate length locking screws were placed through
the plate into the bone. The orientation of the cross section of
the T-plate, whether placed cranially or caudally, was accord-
ing to surgeon choice.
Where fracture stabilization using bone holding forceps
was not feasible, the plate was first applied to the caudal
fragment of the fracture, then temporary fracture fixation
was achieved through the use of a 1.0-mm Kirschner wire
(1.0-mm arthrodesis wire; Veterinary Instrumentation,
Sheffield, United Kingdom) placed through the appropriate
hole in the cranial portion of the plate. The remainder of
the screws were placed and the Kirschner wire was
removed.
After surgery, strict cage rest for a period of 4 weeks was
advised, followed by 4 weeks of restriction to a single room
with limited opportunity to jump. Follow-up radiographs
were advised 4 to 6 weeks after surgery depending on surgeon
preference.
Radiographic Interpretation
Preoperative radiographs were reviewed to assess fracture
configuration. Immediate postoperative radiographs were
used to evaluate fracture reduction (graded subjectively as
anatomic, near anatomic, good, fair or poor), plate orientation
(i.e., cross-section cranial or caudal), number of screws per
fracture fragment, screw purchase (defined as cranial and
caudal to the fracture line) and sacral index.13 Follow-up radio-
graphs were used to evaluate sacral index, fracture healing and
evidence of implant complications including screw loosening.
Results
Seventeen patients (12 cats and 5 dogs) satisfied the inclusion
criteria for this study. A further seven cases did not have
adequate radiographic follow-up to allow inclusion. Amongst
the cats, one was a Bengal, one a Maine Coon and one a domestic
longhair cat. The remaining nine cases were domestic shorthair
cats. Six cats were neutered males and six were neutered
females. The age range was 1 to 10 years (mean 2 years), and
bodyweight ranged from 2.8 to 5.7 kg (mean: 3.7 kg). Four of
the five dogs were female neutered Jack Russell Terriers and the
remaining dog was a male neutered Yorkshire Terrier. The age
range was 1 to 5 years (mean 3 years) and the mean body weight
was 4.0 kg with a range of 1.8 to 8.7 kg.
All the ilial fractures in this study were oblique, orientated
cranioventral to caudodorsal. Two fractures were mildly com-
Veterinary and Comparative Orthopaedics and Traumatology Vol. 30
minuted and the remainder were simple fractures. Ipsilateral
ischial and pubic fractures were present in 11/17 cases, and
contralateral sacroiliac luxation in 4 cases. Two cases had
concurrent sacral body fractures and an ipsilateral acetabular
fracture occurred in one case. Concurrent orthopaedic injuries
not including the pelvis were recorded in three cases (one
tarsal luxation, one ipsilateral hip luxation and one case with
multiple metatarsal fractures of the contralateral limb). These
cases are detailed in ►Appendix Table 1.
Mean time to surgery from injury was 3 days (range 1–15
days) and follow-up radiography ranged from 28 to 270 days
with a mean of 42 days.
The 2.4-mm locking T-plates were used in five cases
(three dogs and two cats). One was a five-hole plate, three
were six-hole plates and one was a seven-hole plate. The
T-section of the plate was caudally orientated in four cases
and cranially orientated in one case. In the remaining
12 cases, 2.0-mm locking T-plates were used, ranging in
size from four-hole plates to eight-hole plates, with a mean
of six holes. The T-section of the plate was orientated
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cranially in 2 cases and caudally in the other 10 cases.
Overall, 14 plates were placed with the T-section orientated
caudally and three with the T-section placed cranially.
Two to four screws (mean
three) were placed in the cranial
fracture segment, and two or three screws (mean
two) were
placed caudal to the ilial fracture line. Mean purchase cranial to
the fracture line was 17.1 mm (range: 8.5–28.0) with an
average per screw of 5.9 mm. Caudal to the ilial fracture,
screw purchase ranged from 9.3 to 27.8 mm, with an average
purchase per screw of 13.9 mm. No screw holes were left open
in 5 cases, one screw hole was unfilled in six cases and six cases
had two empty screw holes. There was no screw loosening
recorded in any case in this study.
Fracture reduction was rated as anatomic in five cases,
near anatomic in one case, good in 7 cases and fair in the
remaining four cases (►Fig. 1).
Concurrent injuries to the pelvis and other orthopaedic
injuries were treated as indicated. Two cases of sacroiliac
luxation were stabilized with transilial pins, and the remain-
ing two cases were stabilized with sacroiliac screws. In one
case, a sacral body fracture was stabilized with a six-hole
2-mm PAX reconstruction plate (Securos). The other sacral
body fracture was not stabilized as this patient had under-
gone a previous amputation of the contralateral limb at the
mid femur level. The method of stabilization selected was the
surgeon’s preference.
Of the concurrent non-pelvic orthopaedic injuries, a
pantarsal arthrodesis was performed for the tarsal luxation,
and an external fixator was used to repair the metatarsal
fractures. A femoral head and neck ostectomy was performed
on the luxated hip.
Eleven cases in this study had no change in sacral index
between surgery and follow-up radiography. The remaining
six cases had a change in sacral index between –2.2 and þ6.1%.
Four of the cases with sacral fracture or sacroiliac luxation had
no change in sacral index between surgery and follow-up
radiography. The remaining two cases had an increase in sacral
index of 4.2 and 6.1% (►Fig. 2; ►Appendix Table 2).
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 Locking Plates for Repair of Ilial Fractures Scrimgeour et al. 455

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Fig. 1 (A) Immediate postoperative ventrodorsal (VD) and (B) lateral radiographic projections of an accurately anatomically reduced fracture.
(C) Immediate postoperative VD and (D) lateral radiographs of satisfactorily aligned fracture. Both reveal satisfactory implant positioning. The
sacral index was calculated as a ratio of the width of the cranial border of the sacrum (top black line in both VD projections) to the width between
the medial cortices of the acetabular bones (bottom black line VD and lateral). The accurately anatomically reduced fracture (A,B) had a sacral
index of 0.93, and the satisfactorily reduced fracture (C,D) had a sacral index of 0.94. Screw purchase was measured as the amount of the screw
shaft that was within bone, per fragment (black lines).

No minor or major complications were recorded for any
case in this study, and all ilial fractures had achieved radio-
graphic union at follow-up radiography.
Discussion
The most commonly reported complication of repair of ilial
fractures with non-locking lateral bone plating is screw
loosening. Screw loosening was reported in 5/10 cases
repaired with a single laterally placed dynamic compression
plate, compared with 1/13 cases repaired with a single
locking plate and 0/11 cases where a double locking plate
construct was used.14 A case series using non-locking tibial
plateau levelling osteotomy plates to repair ilial supracoty-
loid fractures included one feline case.15 This case also
suffered screw loosening.
Screw loosening and loss of construct stability can allow
pelvic canal narrowing. It has been suggested that pelvic
narrowing of 45% or greater during postoperative healing of
the ilial fracture was associated with a high risk of recurrent
constipation.13 The mean change in sacral index of the 18
cases in this study was 0 (range: –2.2 to þ6.1%).
Non-locking bone plates rely on friction between the plate
and underlying bone to confer stability to a fracture repair. The
friction attained is a product of the coefficient of friction of the
implant and the compressive force on the bone of the screws
inserted through the plate.16 Placing screws with increased
torque will increase the friction applied to the plate and should

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456 Locking Plates for Repair of Ilial Fractures Scrimgeour et al.

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Fig. 2 (A) Follow-up ventrodorsal and (B) lateral radiographic projections of the accurately anatomically reduced fracture and a (C,D)
satisfactorily reduced fracture (bottom row) as in ►Fig. 1, both revealing no implant-related complications and clinical union of the fracture site.
The sacral index and screw purchase were calculated as described previously, and had not changed for either fracture.

lead to a more durable fixation. Studies in other species suggest
a screw insertion torque in excess of 3 Nm is required to
provide adequate friction between plate and bone to provide a
stable construct.16 To our knowledge, these data have not been
ascertained for lateral plate fixation of small animal ilial
fractures, but an experimental study found stripping of screws
inserted into the cranial ilial wing of dogs occurred frequently
at a torque of 1.8 Nm.11 This was a study using cadaveric bone,
which may not reflect the true resistance of ilial bone to screw
stripping in vivo, but it does suggest that a durable bone–
implant interface sufficient to allow uncomplicated fracture
healing may be difficult to achieve in the cranial ilial wing.
Premature implant loosening when a non-locking plate is
applied to stabilize an ilial fracture may therefore be inevitable
in some cases. A study of implant stability following triple
pelvic osteotomy surgery found that premature screw loosen-
ing occurred in 57% of cases.17 All of these screws could be
retightened adequately, suggesting screw loosening, rather
than pull-out, had occurred. When locking triple pelvic osteot-
omy plates and screws were used to secure the ilial osteotomy
during triple pelvic osteotomy surgery, no screw loosening
was observed.18 Low torque resistance may limit the genera-
tion of sufficient torque during screw placement to provide an
adequate degree of plate–bone friction, and ensure construct
durability throughout the period of fracture healing.
The mode of loading of the pelvis is cantilever bending
and the tension aspect of the ilium is the ventral aspect
during weight bearing. All fractures in our case series and in
previous studies were transverse fractures or oblique frac-
tures orientated in a cranioventral to caudodorsal direc-
tion.5,13 When ilial fracture fixation is performed with
lateral non-locking plating, load sharing between the frac-
ture fragments and implants in these fracture configurations
is limited to that provided by friction between fragments

Veterinary and Comparative Orthopaedics and Traumatology Vol. 30 No. 6/2017

 Locking Plates for Repair of Ilial Fractures
(and only in a situation of anatomical reduction and com-
pression). Thus, the implants are required to sustain the
majority of forces acting on the repair during healing of ilial
fractures, in contrast to fracture patterns where load sharing
between implants and fracture fragments is achieved.
Screws applied from lateral to medial across the ilium engage
bone which has thin cortices that are close together, short-
ening the working length of the screw. The latter factor was
highlighted by the finding in our study that screws placed in
the cranial segment had less screw purchase than those in
the caudal segment. These factors are considered important
in screw loosening following lateral plating of ilial fractures.
Loosening of screws may result in patient discomfort and
pelvic canal narrowing and is therefore to be avoided.5
Locking plates and screws do not rely on the screw–bone
interface or avoidance of toggling (the mechanism of screws
pivoting within the screw holes during loading) to maintain
stability and may therefore be beneficial in situations of poor
bone rigidity and short screw working lengths.
The results of this study suggest that the risks of premature
screw loosening and pelvic canal narrowing may be reduced
through the use of a locking plate construct in cats and small
breed dogs, in agreement with previous reports.14,19 The
stability of this type of construct relies on the screw–plate
interface (though the exact nature of this interface varies with
implant systems) and does not rely on the magnitude of
friction that can be generated at the plate–bone interface.
The absence of screw loosening in our study employing just
a single locking plate suggests that use of double locking
plates as was reported previously may not be critical to
satisfactory outcomes in the repair of ilial fractures in cats
and small breed dogs.14
The recommended minimum number of screws to be
placed either side of a fracture when repaired with non-
locking plates is three.19 Fractures of the ilium commonly
have a short juxtaarticular segment cranial to the hip, making
the placement of adequate numbers of screws in this segment
problematic. The use of T-plates for the repair of fractures of
the ilium has been reported previously as a solution to allow an
adequate number of screws to be placed caudal to the frac-
ture.20 An alternative that was previously suggested was to
perform an osteotomy of the greater trochanter exposing bone
dorsal to the acetabulum to allow placement of a plate
extending sufficiently caudally to allow the requisite number
of screws.20 The recommendation for the implants used in this
study is to place a minimum of two screws either side of the
fracture. The requirement for fewer screws in this limited area
reduces the emphasis on exposure such that greater trochan-
teric osteotomy, itself associated with the potential for com-
plications, is not considered necessary.
All fracture repairs in this study achieved union regard-
less of the accuracy of anatomical reconstruction at surgery.
These results indicate that accurate fracture apposition is
not essential for a good clinical outcome. This may be
because load sharing between bone and implants when a
lateral plate is used to repair an ilial fracture is minimal. The
pelvis has an extensive soft-tissue envelope and fracture
healing can be expected to be rapid, as evidenced by the fact
Scrimgeour et al. 457
that historically a proportion of pelvic fractures have been
successfully managed conservatively.21 The most serious
complication of pelvic narrowing is constipation leading to
obstipation and megacolon.13 Management of this condi-
tion may involve surgery and carry a poor prognosis.22,23
Our results suggest that, as the degree of pelvic canal
narrowing was not affected by the accuracy of reduction
of the fractured ilium, the intraoperative priority should be
to establish adequate pelvic diameter rather than anatomi-
cal reduction of the fracture.
In addition to the cases reported as a single study pre-
viously, the use of locking plates for the repair of pelvic
fractures has been described as part of a series of fracture
repairs with different implant systems.24–26 There were not
any recorded complications with these repairs, although
specific analysis on the fracture repairs was not provided.
There are major limitations to our case series as it was a
retrospective study without a control group or use of alter-
nate implant systems for fracture repair to allow comparison
with differing locking plate systems.
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Conclusion
Lateral plating of ilial fractures presents a mechanical chal-
lenge resulting from poor bone quality and difficulty achiev-
ing a load-sharing construct. This may lead to premature
screw loosening and associated pelvic narrowing if non-
locking implants are used. In our study, these complications
were not recognized when ilial fractures were stabilized
using single locking T-plates and screws.
Authors’ Contributions
All authors contributed to the study design, collection and
interpretation of data. AS was the primary author but AC
and PW contributed to the manuscript and were instru-
mental in revision and editing of the text.
Conflict of Interest
None declared.
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Appendix Table 1 Signalment and presenting injuries of cases

Case Species Age (y) Sex Breed Weight Injury Concurrent Time to
(kg) injuries surgery
(d)
1 Canine 2 FN JRT 8.7 Right oblique ilial Right ischial and 2
fracture pubic fractures
2 Canine 3 FN JRT 6.1 Right oblique ilial Right ischial and 1
fracture pubic fractures
3 Feline 2 MN DLH 5.7 Right oblique ilial Left sacroiliac 4
fracture luxation
4 Feline 2 MN DSH 3.4 Right oblique ilial S1 transverse 1
fracture, fracture
moderate (previous
comminution contralateral mid
femoral limb
amputation)
5 Feline 1 MN DSH 2.8 Right oblique ilial Left sacroiliac 3
fracture luxation
6 Canine 3 FN JRT 6.1 Right oblique ilial Left sacroiliac 2
fracture luxation, tarsal

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luxation
7 Feline 2 MN DSH 3.7 Right oblique ilial Right acetabular 3
fracture fracture,
transverse
8 Feline 1 FN Bengal 3.7 Right oblique ilial Right ischial and 4
fracture pubic fractures,
right fractured
metatarsals 1–4
9 Feline 4 FN DSH 4.1 Left oblique ilial Left Ischial and 1
fracture pubic fractures
10 Feline 5 FN DSH 4.1 Left oblique ilial Left ischial and 3
fracture pubic fractures
11 Feline 10 MN DSH 4.2 Right oblique ilial Right ischial and 5
fracture pubic fractures
12 Feline 2 FN DSH 3.2 Right oblique ilial Right ischial and 15
fracture, pubic fractures,
moderate left sacroiliac
comminution luxation
13 Feline 2 FN DSH 2.9 Right oblique ilial Right ischial and 3
fracture pubic fractures
14 Feline 1 FN Maine 4.8 Right oblique ilial Right ischial and 3
Coon fracture pubic fractures
15 Canine 5 MN YT 1.8 Right oblique ilial Left sagittal 3
fracture fracture of sacral
wing
16 Feline 2 MN DSH 4.0 Left oblique ilial Left ischial and 7
fracture pubic fractures
17 Canine 2 FN JRT 3.0 Left oblique ilial Left ischial and 5
fracture pubic fractures,
left hip luxation

Abbreviations: DLH, Domestic Longhair cat; DSH, Domestic Shorthair cat; FN, female neutered; JRT, Jack Russell Terrier; MN, male neutered; YT,
Yorkshire Terrier.

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 460

Appendix Table 2 Surgical repair and follow-up results

Case Plate used and Other surgical Pelvic alignment Number Screw Number Screw Days to Postopera- Change in Loss in
orientation for procedures following of screws purchase of screws purchase follow-up tive sacral sacral screw
repair of ilial performed fracture repair in cranial (mm) in caudal (mm) index index (%) purchase
fracture fragment fragment (mm)
1 7-hole 2.4 mm Good 3 13.5 3 19.3 28 1.03 1.0 0
T caudal
2 6-hole 2.4 mm Good 3 11.4 3 20.8 28 1.02 0 0
T cranial
3 5-hole 2.4 mm Transilial pin Near anatomic 2 17.8 2 13.0 28 0.93 6.1 0
T caudal
4 8-hole 2.0 mm Good 4 28.0 3 27.8 28 0.94 0 0
T caudal

Veterinary and Comparative Orthopaedics and Traumatology

5 6-hole 2.0 mm Transilial pin Good 3 21.0 2 9.3 270 0.83 0 0
Locking Plates for Repair of Ilial Fractures

T caudal
6 6-hole 2.4 mm Sacroiliac screw, Good 3 22.1 3 15.2 42 0.96 0 0

Vol. 30
T caudal pantarsal arthrodesis
7 6-hole 2.0 mm 5-hole 2.0-mm PAX Fair 3 13.4 3 17.6 56 1.07 0 0
T caudal plate on acetabulum

No. 6/2017
8 5-hole 2.0 mm External fixator to Anatomic 2 17.2 2 12.2 28 1.00 2.0 0
T caudal repair metacarpal
Scrimgeour et al.

fractures
9 6-hole 2.0 mm Good 2 11.0 2 17.2 56 0.80 0 0
T caudal
10 6-hole 2.4 mm Anatomic 2 9.9 2 10.8 56 0.98 0 0
T cranial
11 6-hole 2.0 mm Anatomic 3 18.6 2 13.9 42 0.94 -2.2 0
T caudal
12 7-hole 2.0 mm Sacroiliac screw Fair 3 18.6 2 13.0 70 0.91 4.2 0
T caudal
13 6-hole 2.0 mm Fair 3 18.1 3 17.9 56 0.99 0 0
T caudal
14 7-hole 2.0 mm Anatomic 3 17.1 2 12.6 42 0.93 0 0
T cranial
15 4-hole 2.0 mm 6-hole 2.0-mm PAX Anatomic 2 8.5 2 10.5 42 0.99 0 0
T caudal transilial plate
16 6-hole 2.0 mm Good 2 9.5 2 10.5 60 0.85 0 0
T caudal
17 7-hole 2.4 mm Femoral head and Fair 2 12.5 3 19.0 56 1.04 0 0
T cranial neck ostectomy

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