Diaphyseal Tibial Butterfly Fracture Repair with Intramedullary Pin and Bridging Plate in a Maltese
Tierklinik Wiener Neustadt · Left Tibia · Primary Fracture Repair
Case Summary
A 7-year-old male Maltese presented with a 2-day-old closed diaphyseal butterfly fracture of the left tibia, otherwise in good general condition. Surgical stabilisation was performed with an intramedullary pin and bridging plate.
Simini Protect Lavage (10 ml) was applied to the wound prior to closure, with a 1-minute dwell time followed by 500 ml sterile saline rinse. Perioperative amoxicillin-clavulanate was used. Sutures were removed at 14 days with no signs of redness, inflammation, or swelling at the incision site. Telephone follow-up has been unremarkable.
Clinical Presentation
History and Physical Findings
The patient presented with a 2-day-old closed diaphyseal butterfly fracture of the left tibia. The fracture had occurred 2 days prior to presentation. Clinical examination was otherwise unremarkable, with no concurrent injuries or systemic issues identified. Surgical stabilisation was indicated.
Fig. 1 — Pre-operative lateral radiograph, left hindlimb. Diaphyseal butterfly fracture of the tibia visible at mid-shaft. 2-day-old closed fracture. Surgical stabilisation indicated.
Fig. 2 — Post-operative radiograph. Intramedullary pin with bridging plate fixation of the diaphyseal tibial butterfly fracture. Satisfactory alignment and implant position confirmed.
Surgical Protocol
Fracture Fixation and Closure Stage Lavage
Fracture stabilisation was achieved using an intramedullary pin combined with a bridging plate. Prior to wound closure, Simini Protect Lavage was applied to the wound and allowed to dwell for 1 minute, followed by thorough irrigation with 500 ml of sterile saline. Perioperative amoxicillin-clavulanate was administered intravenously at the start of surgery and repeated 90 minutes into the procedure.
| Step | Description |
|---|---|
| 01 | General anaesthesia induced. Left hindlimb prepared and draped. IV amoxicillin-clavulanate (15 mg/kg) administered at start of surgery |
| 02 | Fracture approached. Intramedullary pin placed |
| 03 | Bridging plate applied and secured. Fracture alignment confirmed |
| 04 | Amoxicillin-clavulanate repeated IV at 90 minutes into surgery |
| 05 | SiminiSimini Protect Lavage applied (10 ml) to the wound. Left to act for 1 minute, then flushed with 500 ml sterile NaCl |
| 06 | Layered wound closure performed |
Simini Protect Lavage was applied at the closure stage as part of the standard wound closure protocol. A 1-minute dwell time was used, followed by 500 ml saline rinse prior to layered closure. Simini reduces bacteria, biofilms, and resistant bacteria at the surgical site. No change to the existing perioperative antibiotic protocol was required.
Outcomes
14-Day Suture Removal and Follow-Up
Sutures were removed at 14 days post-surgery. At that appointment, the incision showed no redness, inflammation, or swelling — consistent with uncomplicated healing. Telephone follow-up beyond this point has been unremarkable.
Suture Removal
Sutures removed at 14 days. No redness, no inflammation, no swelling at the incision site. Uncomplicated wound healing.
Telephone Follow-Up Unremarkable
Ongoing telephone follow-up reported as unremarkable. No concerns raised. In-clinic recheck appointment pending.
This case represents early clinical experience with Simini at this clinic. Formal in-clinic follow-up is pending.
Follow-Up Timeline
Post-Operative Course
Tibial Fracture Repair
Intramedullary pin and bridging plate applied. Simini Protect Lavage 10 ml with 1-minute dwell, followed by 500 ml saline rinse. Layered closure. Amoxicillin-clavulanate at induction and at 90 minutes.
Suture Removal
Sutures removed. No redness, no inflammation, no swelling. Incision healing uncomplicated.
In-Clinic Follow-Up
Formal follow-up appointment pending. Telephone follow-up to date has been unremarkable.