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59 Cards in this Set
- Front
- Back
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A client comes in and the animal has a fracture, what are you going to do?
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Stay calm, show concern, take a quick history, perform a complete PE, evaluate the fracture, prepare the client for a larger bill, stabilize the patient and the fracture and then take a good history
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What are the 3 general rules in the first steps to dealing with an emergency fracture?
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1) Keep animal calm
2) Do not move the animal until fracture is splinted 3) Stop bleeding |
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What do you want to make sure to include in the history of a fracture?
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Duration**
High speed vs low speed injury (Degree of comminution) Any wounds present? (open VS closed) -financial commitment |
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Why do you need to be really careful with animals in severe pain?
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Have abnormal behavior too
USE CAUTION -adequate restraint, stabilize limb, manage pain, determine cardiovascular status, treat for shock (fluids), refer for repair |
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What should you do when performing an orthopedic exam on a dog that comes in with a fracture?
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look for dangling swollen limb first
carefully look everywhere else Discuss PE findings w/ owner Look for skin wounds Use gloves for palpation |
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What are the 4 treatment choices related to a fracture?
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*to repair or euthanize
-consider patient factors -call specialist -prognosis |
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What are the objectives of first aid treatment of a fracture? (5)
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Bandage & splint the leg to:
1) prevent damage to nerves & vessels 2) Prevent penetration of skin by fracture fragments 3) Prevent further contamination through skin defects 4) Relieve anxiety associated with an uncontrolled limb 5) Minimize further damage to the fracture |
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What are the 2 components of initial fracture management of an open fracture?
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1) Clip, clean, topical antibiotics, sterile dressings, systemic broad spectrum antibiotics
2) Bandage & splint -double the cost, half the prognosis |
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What should you do for initial fracture management of a closed fracture?
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Bandage +/- splint depending on location
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What should you do for initial fracture management for region 1 fracture (below fetlock)?
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Dorsal splint (from ground to carpus/tarsus) to align dorsal cortices
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What should you do for initial fracture management of a fracture in region 2 in a horse (from fetlock to carpus)?
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Caudal and lateral splint (From ground to elbow/calcaneus or stifle)
-robert jones |
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What should you do for initial fracture management of a fracture in region 3 (carpus to elbow) in a horse?
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Lateral splint (From ground to shoulder/tuber coxae) unless very proximal
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What should you do for initial fracture management of a fracture in region 4 (Elbow to shoulder) in a horse?
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Caudal splint (From ground to elbow) to fix carpus or no splint
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When a large animal has a fracture it needs a bandage and a splint, otherwise no splint =_____.
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Death/ malpractice
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What are additional diagnostics that can be performed once a fracture is stabilized?
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*RAdiographs (minimum of 2 views)
Others: ultrasound, CT/MRI |
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What should you do for initial fracture management of a fracture in region 2 in a horse (from fetlock to carpus)?
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Caudal and lateral splint (From ground to elbow/calcaneus or stifle)
-robert jones |
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What should you do for initial fracture management of a fracture in region 3 (carpus to elbow) in a horse?
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Lateral splint (From ground to shoulder/tuber coxae) unless very proximal
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What should you do for initial fracture management of a fracture in region 4 (Elbow to shoulder) in a horse?
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Caudal splint (From ground to elbow) to fix carpus or no splint
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When a large animal has a fracture it needs a bandage and a splint, otherwise no splint =_____.
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Death/ malpractice
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What are additional diagnostics that can be performed once a fracture is stabilized?
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*RAdiographs (minimum of 2 views)
Others: ultrasound, CT/MRI |
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What should you do for initial fracture management of a fracture in region 2 in a horse (from fetlock to carpus)?
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Caudal and lateral splint (From ground to elbow/calcaneus or stifle)
-robert jones |
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What should you do for initial fracture management of a fracture in region 3 (carpus to elbow) in a horse?
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Lateral splint (From ground to shoulder/tuber coxae) unless very proximal
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What should you do for initial fracture management of a fracture in region 4 (Elbow to shoulder) in a horse?
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Caudal splint (From ground to elbow) to fix carpus or no splint
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When a large animal has a fracture it needs a bandage and a splint, otherwise no splint =_____.
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Death/ malpractice
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What are additional diagnostics that can be performed once a fracture is stabilized?
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*RAdiographs (minimum of 2 views)
Others: ultrasound, CT/MRI |
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What are the 5 components of classifying a fracture?
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1) Complete VS incomplete
2) Displaced Vs non-displaced 3) Open vs closed 4) Configuration 5) Location -diaphyseal, metaphyseal, physeal, epiphyseal, intra-articular? |
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What is at Type I open fracture?
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Small skin laceration without bone exposure, no gross contamination
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What is a type II open fracture?
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Skin laceration w/ little tissue loss, minimally exposed bone, minimal gross contamination
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What is a type III open fracture?
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Extensive laceration, significant tissue loss, extensive gross contamination
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What are the different types of fracture configurations?
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-fissure/hairline/greenstick
-transverse, oblique, spiral, comminuted/compound, multiple, impacted/impression, avulsion |
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What are the 4 goals of fracture treatment?
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1) Early return to total limb function
2) Rapid bone union 3) Prevention of fracture disease 4) Cost effective |
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What are 4 options for treating fractures?
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1) Rest
-very few selected fractures 2) External coaptation -splints, casts 3) External fixator -transfixation pin-casts -external skeletal fixator 4) Internal fixator -screws placed in lag fashion -plates: DCP, LCP, DC-LCP -cerclage wire -steinmann pins -interlocking intermedullary nails |
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What are the 2 mechanical features (advantages) of external skeletal fixators?
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-adjustability/ variability
-good stabilization |
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What are 3 drawbacks of external skeletal fixators?
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1) apparatus care
-clamp or pin loosening, postop bandaging 2) Entry-hole care -pin-track sepsis -thermal necrosis 3) Higher incidence of malalignment |
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What are 3 advantages of transfixation pin casts?
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1) Simple, easy to perform
2) Relatively inexpensive 3) Biologic osteosyntehsis |
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What are 3 disadvantages of transfixation pin casts?
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1) Sometimes hard to keep in reduction while placing cast
2) Battle b/w loosening of pins and fracture healing 3) Osteopenia of distal limb |
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What are 2 advantages of an intramedullary pin?
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Resists bending
Axial alignment |
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What are 3 disadvantages of IM pins?
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1) Torsion
2) Pin migration 3) Collapse |
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What are IM pins used?
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Lighter animals, usually in conjunction with another form of fixation
-not usually enough by itself in LA |
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What is "bridging plate fixation"?
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IM pins with buttress plates
-anatomic alignment -two beams -reduction of strain twofold compared w/ plate alone -10 fold increase in fatigue life of plate |
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How do interlocking nails work?
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Large IM pin with holes
Screws lock pin to bone |
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What are the 3 advantages of interlocking nails?
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1) Provides axial alignment
2) Rotational stability 3) Rigid frame |
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What are 3 disadvantages of interlocking nails?
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1) No thread tension
2) Need access to end of long bone, usually through joint 3) Special apparatus to assure proper alignment of screws (a jig) |
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What did force studies on interlocking nails find?
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~have higher max (failure) loads
-compression, bending, rotation ~Longer-term resistance to fatigue failure |
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What is the "gold standard" of veterinariy orthopedics?
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Plates
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Explain how dynamic compression plates work.
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-screws are precisely placed in bone through ramped slows in the plates
-the screw is forced down the ramp and moves the bone towards the fracture= compression |
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What type of bone plating technique has the best chance of primary bone healing?
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compression plates
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What does it mean if a plate is a compression plate?
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Compresses fracture ends together
-some screws placed in "loaded" or compression aspect of plate holes -best chance of direct bone healing |
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What are 3 bone plating techniques?
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Compression, neutralization, buttress
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What is a neutralization bone plating technique?
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No active compression of fracture by screws in plate
-keeps fracture fragments in neutral position |
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What is a buttress plating technique?
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"bridges" or provides buttress for comminuted fracture or gap
-no strut or bone touching -no screws through fracture site |
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How does a locking compression plate work?
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Fixed angle b/w screw and plate increases pull out strength (decreases dependence on quality of bone)
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What are 4 advantages of locking compression plates?
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1) Not necessary to accurately contour plate (no friction necessary)
2) protects local blood supply 3) Amenable to minimal invasive fracture repair 4) Angular stability of screws largely increases area of resistance to bending load |
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What is the disadvantage of locking compression plates?
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Expensive
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What is lag screw fixation?
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One or more screws placed in lag fashion across the fracture line
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Give 3 examples of fractures in horses that is repaired using lag screw fixation?
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1) Lateral (distal MC3) Condylar fracture
2) Nondisplaced P1 fracture 3) Slab fracture of third carpal bone |
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What type of screw is generally used for a lag screw technique?
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Typically use cortical screw rather than true lag screw
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What are the 6 steps of performing a lag screw technique?
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1) Drill glide hole
2) Drill far cortex (small drill) 3) Countersink 4) Measure distance for screw length 5) Tap to cut threads in far cortex 6) Insert screw and tighten |
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What are 5 possible complications of fracture repair?
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1) infection
-usually open fractures, severe soft tissue damage 2) refracture -insufficient immobilization, delayed healing 3) Delayed healing -motion, infection 4) Nonunion -hypertrophic (Excessive motion) -atrophic nonunion (loss of blood supply) |
