Auer Ch 92 93 Mc Mt

Front 1

Mosts common condylar fracture:

Back 1

lateral; MC more common in TB than STB

Front 2

Most common location of lateral condylar fracture:

Back 2

mid to midaxial in sagittal plane propagating dorsolaterally to exit the cortex 1-3 cm proximal to physeal scar

Front 3

Radiographic projection for condylar fracture:

Back 3

slight flexion with beam aimed proximal or more flexion and horizontal beam to identify comminution at palmar-plantar articular surface

Front 4

Surgical management of non-displaced lateral condylar fractures:

Back 4

lag screw fixation or conservative therapy if economic concerns

Front 5

Describe non-displaced lateral condylar fracture repair:

Back 5

2 4.5 or 5.5 screws placed in lag fashion through stab incisions, first screw is place in the lateral epicondylar fossa, 2nd screw placed 1.5-2 cm proximally, arthroscopic visualization of fracture reduction

Front 6

How is the epicondylar fossa located?

Back 6

Midpoint of a line drawn from the proximal palmar-plantar eminence of P1 and dorsal aspect of lateral condyle

Front 7

What is the advantage of using 4.5 screw for repair of lateral condylar fracture?

Back 7

Can be replaced with 5.5 if stripped

Front 8

Most common errors in non-displaced lateral condylar fracture repair:

Back 8

inadequate compression, incorrect drill/ screw placement

Front 9

How is inadequate compression prevented in non-displaced lateral condylar fracture repair?

Back 9

Drilling thread hole folly through far cortex and completely tapping far cortex

Front 10

Disadvantage of acutrack screw in condylar repair:

Back 10

less compression than cortex screws, variable compression based on thickness of fragment, lack versatility in repair compared with cortex screws

Front 11

Describe displaced lateral condylar fracture repair:

Back 11

fracture reduced with bone reduction forceps, 4.5 guide hole drilled in epicondylar fossa, insert drill sleeve and pin placed in guide hole, arthroscopic guided reduction of fracture and bone reduction forceps reset, lag screw placed and reduction verified before complete tightening, palmar reduction verified arthroscopically, 2nd screw placed 1.5-2cm proximally

Front 12

What is done if displaced lateral condylar fracture can not be reduced?

Back 12

Insert drill guide with pin is used as a handle to distract fracture and allow arthroscope into fracture bed and removal of palmar-plantar fragments that are preventing reduction

Front 13

How is displaced lateral condylar fracture repair modified for severe displaced or more comminuted fractures?

Back 13

5.5 screws used, 3 screw triangular pattern

Front 14

What injury can occur with more complicated displaced lateral condylar fractures?

Back 14

Axial PSB fractures with disruption of the intersesamoidean ligament

Front 15

How are displaced lateral condylar fractures with axial PSB fractures treated?

Back 15

Condylar fracture can be performed with no expectation of return to athletic performance, fetlock arthrodesis should be considered for salvage

Front 16

How do medial condylar fractures differ from lateral condylar fractures?

Back 16

Nearly always propagate axially and either spiral up diaphysis or remain sagittal to the mid-diaphysis where oblique fractures can develop

Front 17

Treatment options for medial condylar fractures:

Back 17

open or minimally invasive internal fixation repair with screws or plate and screws

Front 18

Disadvantage of screw fixation of medial condylar fracture:

Back 18

no adequate for fixation of spiral component or with risk of oblique fracture

Front 19

Describe open medial condylar fracture repair:

Back 19

dorsolateral incision starting proximally and ending at the level of the fetlock joint without penetration of joint down to the level of the bone, periosteum elevated, 2 4.5 or 5.5 cortex screws placed (1) epicondylar fossa (2) 1.5-2cm proximal similar to lateral condylar approach, LCP or DCP applied just above 2nd screw using 4.5 or 5.5 cortex screws, SQ tissues closed, skin closed

Front 20

Recovery for medial condylar fractures:

Back 20

hind limb full limb cast, fore limb Robert jones bandage, better if pool or sling available

Front 21

Describe minimally invasive medial condylar fracture repair:

Back 21

dorsolateral 2 cm incision made adjacent to CDE at proximal MC/MT3, plate with sharped end and handle is used to create a SQ tunnel, LCP slid into tunnel, 2 4.5 or 5.5 screws are placed in condyle, screws are placed in plate through stab incisions over plate holes, stab incisions are closed

Front 22

Contra-indications for minimally invasive medial condylar fracture repair:

Back 22

not used for fracture with obvious proximal spiraling

Front 23

Disadvantages of minimally invasive medial condylar fracture repair:

Back 23

inadvertent injury to splint bones, difficulty in measuring screw hole depths, and verification screws are fully inserted in plate

Front 24

Post-op care for lateral condylar fractures:

Back 24

stall rest 2 months, paddock rest 3rd month, return to exercise in 4th month if non-displaced and longer if displaced

Front 25

Post-op care for medial condylar fractures:

Back 25

diaphyseal screws removed 3-4 months post-op, plates removed 2.5-3 months post-op, after implant removal horse is walked for 60-90 days before resuming training

Front 26

How are plates removed?

Back 26

Stab incision made over screws, screws backed out but not removed until all identified, screws removed, osteotome placed between proximal bone and plate to pry off plate from bone, plate grasped with vise grips and pulled proximally out of 2 cm incision over proximal aspect of plate, incisions are closed

Front 27

Prognosis for condylar fractures:

Back 27

good (70-80%) for non-displaced and minimal pre-existing joint disease, fair (50%) if displaced, lower for medial, comminution, and PSB involvement

Front 28

Factors favoring successful repair of MC/MT diaphyseal fractures:

Back 28

access and exposure to entire diaphysis making reduction and internal fixation feasible, strong bone to which screws and plates can be affixed, immobilization by external coaptation

Front 29

Factors against successful repair of MC/MT diaphyseal fractures:

Back 29

minimal soft tissue covering leading to open fractures, no adjacent muscle for extraosseous blood supply, spares distal limb vascularity, frequent comminution

Front 30

Surgical management of MC/MT diaphyseal fractures:

Back 30

dorsolateral, dorsomedial double plate fixation +/- intrafragmentary compression with 3.5 cortex screws, using all plate holes, cancellous bone graft

Front 31

Plate selection for adult MC/MT diaphyseal repair:

Back 31

2 broad 5.5 plates

Front 32

Plate selection for foal MC/MT diaphyseal repair:

Back 32

1 broad, 1 narrow plate

Front 33

Recommended coaptation for MC/MT diaphyseal repair:

Back 33

in foals less than a year, cast only for recovery if necessary, in adults, cast for recovery and then only maintained if fixation is less than secure

Front 34

Complications associated with MC/MT diaphyseal fracture repair:

Back 34

infection, implant failure

Front 35

Reasons for infection associated with MC/MT diaphyseal fracture repair:

Back 35

poor vascularity, poor soft tissue coverage, large metal to bone ratio

Front 36

Post-op care for MC/MT diaphyseal fractures:

Back 36

staged removal of plates, in foals first plate removed at 3 months, 2nd 45-60 days later; in adults, first plate removed at 4 months

Front 37

Most common MC/MT physeal fracture:

Back 37

salter-harris type 2

Front 38

Treatment of MC/MT physeal fractures:

Back 38

in neonates or foals less than 6 weeks, cast for 2-3 weeks followed by bandaging for 2-3 weeks; in older foals or foals with less stable fractues, compression screws +/- transphyseal bridging and cast

Front 39

When are physeal fracture implants removed?

Back 39

In neonates, 3-4 weeks; in older foals, 2-3 months

Front 40

Types of proximal articular fractures:

Back 40

sagittal, frontal/ dorsal

Front 41

Treatment of proximal articular fractures:

Back 41

displaced frontal fracture fixed with lag screw, other managed conservatively

Front 42

Most common configuration of dorsal cortical fractures?

Back 42

Line coursing proximally at 30-20 degree angle from surface of mid-distal dorsolateral cortex on left MC3

Front 43

Non-surgical management of dorsal cortical fractures:

Back 43

rest, NSAIDs until radiographically healed

Front 44

Indications for non-surgical management of dorsal cortical fractures:

Back 44

located in distal or proximal metaphyseal region

Front 45

Surgical options for dorsal cortical fractures:

Back 45

osteostixis +/- unicortical screw

Front 46

Advantages of osteostixis in dorsal cortical fractures:

Back 46

avoid surgery to remove screw

Front 47

Advantage of unicortical screw in dorsal cortical fractures:

Back 47

more consistent results than osteostixis alone

Front 48

Describe dorsal cortical screw fixation:

Back 48

4-6 cm incision made over fracture, usually between lateral and CDE, periosteum elevated, position screw with countersinking placed with imaging guidance, 6-8 oblique drill holes made to medullary cavity for osteostixis separated by at least 10 mm

Front 49

Post-op care for dorsal cortical fracture repair:

Back 49

stall rest with hand walking for 2-4 weeks, paddock rest for 4-6 weeks, screw removed at 60 days, hand walking for 1 month, jogged for 6-8 weeks before training

Front 50

surgical options for proximal splint bone fractures:

Back 50

standing wound debridement & fragment removal, internal fixation, segmental ostectomy, removal of entire MT4

Front 51

when is internal fixation of proximal splint bone fractures indicated?

Back 51

when there is high probability of lunation or subluxation of the proximal fragment and it is too proximal for removal

Front 52

describe internal fixation of proximal splint bone fractures:

Back 52

3.5 DCP, LCP, semitubular or reconstruction plates with screws engaging only the splint bone applied to the palmar-plantar aspect of the bone

Front 53

tension surface of splint bone:

Back 53

palmar-plantar abaxial surface

Front 54

post-op care for surgically treated proximal splint bone fractures:

Back 54

stall rest 1 month, hand walk or paddock for 2 months

Front 55

recovery for removal of entire MT4:

Back 55

full limb cast to prevent lunation or subluxation during recovery

Front 56

complications of proximal splint bone fracture repair:

Back 56

excessive callus formation or non union with fragment removal, infection with internal fixation, excessive callus formation, instability of proximal fragment, and sequestration of the distal fragment with segmental ostectomy

Front 57

Management options for mid body splint fractures:

Back 57

removal of distal fragment or conservative therapy

Front 58

indications for non-surgical management of mid-body splint fractures:

Back 58

chronic fractures with minimal callus formation or non-displaced fractures

Front 59

complications of mid-body splint fractures:

Back 59

excessive callus formation +/- suspensory desmitis for both surgical and conservative options, non-union for conservative option

Front 60

management of distal splint bone fractures

Back 60

removal of distal fragment or conservative therapy

Front 61

complications of distal splint bone fractures:

Back 61

excessive callus formation +/- suspensory desmitis