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106 Cards in this Set
- Front
- Back
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Fractures
-what is the proper protocol to take when a patient comes into the clinic with a possible fracture? |
-Stabilize the patient
-physical exam -pain control -radiograph |
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Radiographic imaging of a fracture is required in order to....
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-detect the fracture
-describe the fracture -plan repair of the fracture -evaluate repair -monitor healing -look for complications |
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How are fractures described?
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-location
-type -complexity -potential complications |
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Radiograph view
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DMPLO
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Radiograph view
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DMPLO
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What should you make sure to do when radiographing a fracture?
-why |
-include the cartilage proximal and distal to the fracture
-make sure that there isn't an articular fracture because the prognosis for them is much worse than a regular fracture |
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What are reasons why a fracture would be missed on a radiographic exam, when it showed signs on a physical exam?
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-poor radiographic technique
-superimposition -not tangential to beam -minimal to no displacement -early cortical stress fractures -physeal fractures (areas of normally lucent lines) |
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What are different options when a fracture cannot be detected by radiograph?
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-use additional views (different technique, oblique views, compare to the contralateral limb)
-Repeat the study in 1-2 wks -Bone scintigraphy -computed tomography -possibility that there is no fracture |
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Why would a radiograph be repeated in 1-2 wks of the initial?
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-radiolucent line becomes apparent in 7-10 days
early callous formation in 10-14 days |
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What are some pitfalls to normal fracture detection?
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-normal radiolucent lines
-superimposed gases (packing defects or gases from within soft tissues) |
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-which one is fractured?
-what kind of fracture is it? |
-left image
-avulsion fracture of the tibial tuberosity |
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How to describe fracture location
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-right/left
-fore/hind -bone fractured -location in the bone (diaphysis, metaphysis, epiphysis,....) |
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Describe the fracture location
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-distal diaphysis of the right radius and ulna
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How to describe the fracture type
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-open v. closed
-simple v. comminuted -complete v. incomplete -traumatic v. pathologic -acute v. cronic |
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How to describe fracture orientation
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-transverse
-short/long oblique -spiral -segmental |
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What is the fracture type?
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-open fracture
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What are the fractures types?
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-left: simple
-right: comminuted |
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Greenstick fracture
-definition |
-only one part of the cortical bone breaks, causing the other to bend
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what type of fracture
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-incomplete fracture (not through the caudal cortex of the tibia)
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What is the main difference between these two fracture types?
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-left: traumatic fracture
-right: pathologic fracture |
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How can you tell if a fracture is pathologic?
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-there is a loss in sharp margin
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How can you tell if a fracture is acute or chronic?
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-acute: sharp margins, well defined, no remodeling
-chronic: rounded margins, remodeling |
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What is the orientation of this fracture?
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-transverse
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What is the orientation of this fracture?
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-long oblique
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What is the orientation of this fracture?
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-short oblique
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What is the orientation of the fracture?
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-spiral (due to torsional trauma)
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What type of fracture is this?
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-segmental fracture (at least 2 breaks on the same bone)
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What are different types of fracture alignment?
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-displacement
-angulation -rotation |
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Describe the fracture?
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-comminuted fracture with caudal and medial displacement
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Fracture alignment
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-overriding cranially
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How do you describe angulation in a fracture?
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-name it according to the direction of the smallest angle between fragments
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Describe
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-caudal angulation
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Describe alignment
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-rotation
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What is the red line pointing to?
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-fissure
(this is a spiral fracture of the tibia) |
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Why are fissures important?
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-they can lead to additional damage when repair is attempted
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How can you tell when there is soft tissue swelling?
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-lack of visualization of the fascial planes
(always soft tissue swelling around fractures) |
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Salter-Harris facture
-define |
-a fracture involving the open physis of a young animal
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Salter-Harris Fracture
-Complications that it can cause |
-growth disturbance
-joint abnormalities |
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Salter-Harris Fracture Types:
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-Type I: complete physeal fracture
-Type II: physeal fracture extending through the metaphysis -Type III: physeal fracture extending through the epiphysis -Type IV: fracture of the physis, epiphysis, and metaphysis -Type V: compression fracture of the growth plate |
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Which Salter-Harris fracture is most common?
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-Type II
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Fracture type
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-Salter-Harris Fracture type II
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Fracture type
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-Salter-Harris Fracture Type III
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What can result from a Salter-Harris Type V fracture?
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-angular limb deformity
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Avulsion fracture
-cause |
-excessive forces at the attachments of tendons/ligaments/joint capsule
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Fracture Type
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-chip fracture
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Fracture type
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-Slab fracture
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How to differentiate a chip fracture from a slab fracture
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Chip Fracture:
-monoarticular Slab fracture: -biarticular -usually a fracture of a cuboidal bone |
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Fracture type
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-depression fracture
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Name these condylar fractures (left to right)
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-lateral condylar fracture
-medial condylar fracture -"Y" Fracture -"T" Fracture |
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Names these 2 fractures
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-left: Salter-Harris Fracture Type IV
-right: Condylar "Y" fracture |
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Name the fracture
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-Monteggia fracture
-fracture of the proximal 1/3 of the tibia with a luxation of the radial head |
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Types of bone healing
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-direct
-indirect |
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Most common type of bone healing
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-Indirect
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Indirect bone healing
-cause |
-lack of rigid fixation
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Indirect bone healing
-pathogenesis |
-hematoma
-granulation tissue -fibrous connective tissue -fibrocartilage -bone |
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Indirect bone healing
-phases (% of healing time) |
-inflammatory phase (10%)
-repair phase (40%) -Remodeling phase (70%) |
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Tissues needed for bone healing (why)
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-Periosteum (source of osteoprogenitor cells)
-soft tissues (blood supply) |
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Factors affecting Callus size
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-stability of the fracture
-fracture configuration -apposition of fracture fragments -vascular supply |
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General radiographic timeline f normal indirect healing
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-widening/decreased distinction of the fracture gap and fracture edges (5-7 days)
-appearance of a bony callus (10-12 days) -disappearance of the fracture line (within 30 days) -bridging cortices soon after -complete remodeling (smooth, opaque, well defined margins) of the callus (90 days after repair) |
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Factors affecting the time required for fracture healing
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-fracture configuration and location
-stability of repair -status of adjacent soft tissues -patient (age, species, health status) |
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Direct bone healing
-occurs when |
-after rigid fixation results in absolute stability
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Direct bone healing
-morphology |
-no callus formed
-difficult to detect radiographically |
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Types of Direct healing
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-gap healing
-contact healing |
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Size of gap in gap healing
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< .3 - .5 mm
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Bone Structure
-name the points |
-cancellous bone
-periosteum -haversian system (functional unit of compact bone) |
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Cutting cone
-process |
-osteoclasts remove old bone
-blood vessel (central vessel) moves in -osteoblasts form osteocytes |
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Factors that can affect bone healing
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-patient age and breed
-type of fracture -location of fracture -quality of anatomic reduction -stability of repair -vascularity -infection -systemic disease |
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Post-operative imaging
-when to take images |
-after surgery
-4-6 weeks or when needed clinically -repeat until healed |
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ABCDs of Radiographic Evaluation
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-Alignment/Apposition: fracture ends must have 50% contact; change could indicate instability
-Bone: progression of healing; evidence of complications -Cartilage: evaluation of joints involved in a articular fracture -Device: stable, loosening, bending, breakage, infection -Soft tissue: swelling, mineralization, increased synovial mass |
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How to confirm radiographic union
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-bone continuity at 4 cortices (2 views)
-complete calcified and ossified bridging callus -no remaining visible fracture line |
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Complications associated with fracture healing
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-mal-union
-delayed union -non-union -infection -sequestrum formation -disuse osteopenia -joint complications -angular limb deformity -implant failure |
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Malunion
-definition |
-a healed fracture with abnormal anatomical alignment
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Malunion
-due to |
-poor initial reduction
-shifting of fragments post reduction -premature removal of fixation device |
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Malunion
-effect |
-may result in lameness
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Malunion classifications
-top left to bottom right |
name by direction of distal part of bone
-valgus (lateral) -Varus (medial) -translational -recurvatum (cranial) -antecurvatum (caudal) -torsional |
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Delayed healing
-outcomes |
-should eventually heal if it is stable and there are no complications
-may be a nonunion if it is poorly vascularized and there is a lot of motion |
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Non-union
-how to determine |
-lack of callus progression
-remodeling of the callus at fracture ends with no bridging |
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Main reasons for non-union
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-excessive motion
-compromised blood supply Others: -distraction of fracture fragments -infection -age, breed, metabolic state,... |
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Nonunion
-types |
-viable (hypertrophic)
-nonviable (atrophic) |
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Viable nonunion
-morphology |
-vascular supply present
-fracture margins are viable |
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Nonviable nonunion
-morphology |
-minimal to no vascular supply
-non-viable fracture margins |
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Hypertrophic nonunion
-definition |
-large callus at the fracture ends with a persistent radiolucent gap
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Hypertrophic nonunion
-cause |
-vascularity is present but motion is excessive
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What is this?
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-atrophic nonunion
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Atrophic nonunion
-morphology |
-no callus
-increased fracture gap -Tapered fracture margins |
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What is this?
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-osteomyelitis
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Osteomyelitis
-causes |
-bone infection
-contamination (open fracture, extended surgery, severe soft tissue damage, foreign object) |
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Osteomyelitis
-radiographic findings |
-periosteal reaction with or without lysis
-indistinct periosteal proliferation -can be confused with a callus (but rougher in appearance) |
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Clinical signs associated with osteomyelitis
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-pain
-heat -swelling |
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What is this?
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-lucency at implants
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What can cause lucency at implants?
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-infection/osteomylitis
-motion -heat necrosis -migration |
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Implant migration
-cause |
-infection
-motion |
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What is this
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-sequestrum
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Sequestrum
-define |
-fragment of bone that is no longer viable
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Sequestrum
-radiographic findings |
-surrounded by pus and granulation tissue
-sclerotic involucrum forms around the pus -draining tract (cloaca) may be present |
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Disuse osteopenia
-radiographic findings |
-thin cortices
-coarse trabeculation -more apparent distal to the fracture |
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Demineralization seen in disuse osteopenia may be due to:
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-chronic disuse
-limb immobilization -stress protection from orthopedic implants |
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What is this
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-disuse osteopenia
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Disuse osteopenia
-sequela |
-pathologic fracture
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Joint complications from fractures
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-articular fracture
-(sub) luxation -angular limb deformity -intra-articular implant -septic arthritis |
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What is this
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angular limb deformity
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Angular limb deformity
-can be due to |
-malunion
-Salter-Harris fracture Type V |
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Angular limb deformity
-most common cause |
-premature closure of the distal ulnar physis
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What is this?
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septic arthritis
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What is this?
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Implant failure
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Implant failure
-causes |
-broken implant
-bending of implant -loosening of implant -migration |
