Auer Ch 98 Tibia

Front 1

Location of tibial stress fractures:

Back 1

distal caudolateral metaphysis, caudal diaphysis, proximal caudolateral metaphysis

Front 2

Treatment of tibial stress fractures:

Back 2

rest until sound at walk then paddock rest, judicious use of NSAIDs, re-radiograph at 60-90 days

Front 3

Healing time for tibial stress fracture:

Back 3

minimum 2 months

Front 4

Treatment of tibial fissure fractures:

Back 4

rest on tie line for incomplete or non-displaced complete until radiographic evidence of advanced healing usually 3-4 months, judicious use of NSAIDs

Front 5

Most common proximal physeal fracture:

Back 5

SH type 2

Front 6

Fracture configuration of SH type 2 proximal physeal fracture from lateral trauma:

Back 6

medial proximal soft tissue ruptures resulting in tension on medial aspect of limb, fracture of epiphysis propagates from medial to lateral for about 2/3 of the bone, then medial bending forces changes fracture orientation from transverse to vertical so lateral physis is intact but fracture breaks through lateral metaphysis

Front 7

Biomechanical forces creating proximal tibial SH type 2 fracture:

Back 7

tension medially

Front 8

How is a proximal tibial SH type 2 fracture best neutralized:

Back 8

reestablish support of medial aspect of limb

Front 9

How long for healing of proximal tibial SH type 2 fracture?

Back 9

3-4 weeks (if fixation is stable)

Front 10

Surgical approach for proximal tibial SH type 2 fractures:

Back 10

reduction with 4.5 screw in epiphysis and metaphysis with tension band wiring, medial plate fixation using a 4 hole T plate, right angle L plate, 5 hole broadLCDCP, or 5 hole LCP using 5.5 cortex screws (+/- LHS), 5.5 cortex screw placed proximal to distal from epiphysis to metaphysis and in the metaphysis as tension band screw & wire to stabilize tibial crest

Front 11

What is the purpose of the screw & wire tension band on the tibial crest with fixation of proximal tibial SH type 2 fracture?

Back 11

Neutralize distracting forces of the quadriceps muscle transmitted to the tibial crest

Front 12

How is axial compression achieved with plate fixation of proximal tibial SH type 2 fracture?

Back 12

With T plate, distal screws are placed after application of tension device or are placed in load; with LCP, 2 LHS used in epiphysis then 5.5 cortex screw in load

Front 13

How are screws oriented in repair of proximal tibial type 2 fracture?

Back 13

Parallel to caudal cortex in a transverse plane (not perpendicular to plate)

Front 14

What improves lateral stability of fixation of proximal tibial type 2 fracture?

Back 14

Pass at least one screw accress proximal metaphysis into lateral metaphyseal fragment

Front 15

Post-op care for proximal tibial SH fracture:

Back 15

stall rest 4 weeks, radiographs at 4 weeks, implants removed at 8 weeks

Front 16

Complications of proximal tibial physeal fractures:

Back 16

failure of fixation, sepsis, wound dehiscence

Front 17

What is the most common cause of proximal tibial physeal fracture fixation failure?

Back 17

Loss of purchase in epiphysis

Front 18

Most common configuration of tibial diaphyseal fractures:

Back 18

spiral, comminuted

Front 19

Recumbency for tibial diaphysis repair:

Back 19

dorsal or lateral with injured tibia uppermost

Front 20

Approaches to tibial diaphyseal repair:

Back 20

medial, lateral, cranial

Front 21

Location of cranial tibial artery:

Back 21

craniolateral aspect of tibia

Front 22

Disadvantages of medial approach to tibial diaphyseal repair:

Back 22

minimal soft tissue covering

Front 23

Where is the lateral tibial diaphyseal approach located?

Back 23

Between long DE and cranial tibial m

Front 24

Where is the cranial tibial diaphyseal approach located?

Back 24

Over the cranial tibial muscle

Front 25

Advantage of cranial tibial diaphyseal approach?

Back 25

Eliminates exposure/ encountering vessels

Front 26

Surgical approach for for tibial diaphyseal repair?

Back 26

Comminuted fragments are lagged to parent bone to create a 2 fragment fracture using cortex screws, LCP or DCS placed craniolateral spirallying distally to cranial tibia, 2nd plate placed craniomedially

Front 27

Post-op care for tibial diaphyseal fracture:

Back 27

6-8 weeks rest, foals radiographed at 6 weeks, adults radiographed at 8 weeks

Front 28

Complications of tibial diaphyseal fracture:

Back 28

fixation failure due to torsional forces and multiple drill holes, sepsis, incisional infection

Front 29

Treatment of distal tibial physeal fracture:

Back 29

cast +/- screw placement

Front 30

Most common tibial crest fracture:

Back 30

non-displaced, non-articular

Front 31

Treatment for non-displaced, non-articular tibial crest fracture:

Back 31

rest for 60 days, radiographs at 60 days

Front 32

Treatment of displaced or articular tibial crest fracture:

Back 32

cranially applied screw and wire tension band, obliquely placed plate on tibial crest with screws directed medially and laterally in an alternating pattern

Front 33

Surgical approaches to internal fixation of the tibia in cattle:

Back 33

medial, lateral

Front 34

Plane of lateral approach to internal fixation of the tibia in cattle:

Back 34

cranially between long DE, fibularus longus and lateral digital extensor

Front 35

What structure should be avoided with lateral approach to tibia:

Back 35

superficial peroneal nerve

Front 36

Where is the deep peroneal nerve located?

Back 36

Laterally between long DE and cranial tibial

Front 37

What structures should be avoided with medial approach to tibia:

Back 37

saphenous vein, artery, nerve

Front 38

Methods of internal fixation of tibial fractures in ruminants:

Back 38

craniolateral and craniomedially placed plates & screws, interlocking nails for diaphyseal fractures, same repair of SH type 2 fractures as foals

Front 39

Ideal fixation of tibial fractures in ruminants:

Back 39

TPC or ESF

Front 40

What is the difficulty with TPC or ESF in tibial fractures in ruminants?

Back 40

Difficult to place pins correctly because of extensive soft tissue covering

Front 41

How are pins placed in ruminant tibial fractures for TPC or ESF?

Back 41

2 to 3 pins proximal and distal to fracture from lateral to medial direction between fibularis longus and lateral DE and lateral DE and long DE (but ultimately placed based on fracture configuration), cast material spanning just the tibial with a cut out for the hock in calves; with distal metaphyseal fractures distal pins are placed in MT3 with cast spanning transarticularly; in adults a full limb cast is placed