Case Report: Distal tibial physeal fracture secondary to septic physitis and osteomyelitis in a Boxer puppy

Salter-Harris fracture secondary to septic physitis has been reported in foals but not puppies. In this case, a 19-week-old, 13.4 kg male intact Boxer puppy was presented with a 2-day history of acute non-weight-bearing lameness of the left pelvic limb, accompanied by distal limb swelling and lethargy. Orthogonal tibial radiographs were performed, and irregular widening of the distal tibial physis with severe edema of the surrounding soft tissues consistent with septic physitis were identified. Fifteen hours later, distal tibial radiographs were repeated, and a Salter-Harris type I fracture of the distal tibial physis, presumed to be pathologic in origin, was diagnosed. Surgical exploration revealed a subperiosteal abscess, which was drained and cultured. The physeal fracture was stabilized with cross-pin fixation, which was reinforced with a splint and bandage for the duration of recovery. Pasteurella spp. was isolated, and amoxicillin-clavulanate was prescribed for 72 days. Resolution of swelling, radiographic fracture healing, and return to normal limb function were achieved after 14 weeks postoperative, at which time the pins were removed and submitted for aerobic and anaerobic culture and susceptibility. No bacterial isolates were identified. This is the first documented case of an appendicular physeal fracture secondary to suspected septic physitis in a dog, and septic physitis should be considered a differential for puppies with spontaneous Salter-Harris fracture.