13 – External Coaptation Flashcards
1
Q
What is external coaptation?
A
- Limb splinting
2
Q
What is external skeletal fixation?
A
- Bone splinting
3
Q
What forces can be neutralized by external coaptation?
A
- Bending
- Torsion (depends on fit of coaptation device)
4
Q
What are some forms of external coaptation?
A
- Casts
- Splints
- Bandages
- Slings
- Braces
5
Q
Casts
A
- Rigid material completely encircles limb
- Minimal padding
- Most rigid form of external coaptation
6
Q
What are some appropriate uses for casts?
A
- Definitive stabilization of some fractures
- Joint immobilization
- Support after arthrodesis (fusing a joint)
- Protection of repair for recovery (large animals, ex. horses waking up from anesthesia)
7
Q
Splints
A
- Padding and compressive layers encircle limb, but rigid splint is not circumferential
- Less rigid but easier to check and change
8
Q
What are some appropriate uses for splits?
A
- Definitive repair of relatively stable fractures (ex. adjacent bone intact, well-rounded transverse fracture)
- Repair of fractures in young animals
- Support of operative repairs/reduced luxations
- Temporary stabilization
9
Q
Braces (orthotics or orthoses)
A
- Like splits but with minimal padding
- Designed to be worn part time (otherwise would get rub sores)
- May allow motion in one plane, but not another
- Can be custom-made or off the shelf
o *need to fit well in order to work - Currently minimal evidence as to efficacy
10
Q
Prosthetics
A
- Used to replace a missing body part
- Need to be custom-made
- Best function comes when the level of amputation is at/distal to carpus or distal tibia
11
Q
Bandages
A
- Supply only minimal support
- Can cover wounds, may help control swelling
- NOT for fracture immobilization
12
Q
Slings
A
- Nonrigid supports that alter limb position or weightbearing
- Padding is generally minimal
13
Q
Ehmer sling
A
- Produces flexion and internal rotation of hip
- Keeps hind limb non-weightbearing
- Used mostly after hip luxation reduction
- Can produce wicked pressure sores if not carefully monitored (no longer than 10 days)
14
Q
Velpeau sling
A
- Forelimb non-weightbearing sling
- Used after reduction of medial should luxation, scapular fractures, miscellaneous shoulder repairs
- Alternative/substitute: stockinette (or a tee shirt) and tape
15
Q
Sciatic sling
A
- Used to discourage knuckling in limbs with incomplete sciatic palsy
16
Q
What are the indications for external coaptation?
A
- Transverse fractures that can be adequately reduced (at least 50% overlap of fragments)
o But NOT in toy breed dogs (bad blood supply to distal radius and ulna) - Fractures stabilized by an adjacent intact bone (ex. fibula, ulna, or metatarsals/metacarpals)
- Fractures in young animals with an intact periosteal sleeve (ex. greenstick or fissure fractures)
- Some joint injuries (Ex. collateral ligament teras; luxation’s that feel stable after reduction)
- Temporary support until definitive repair can be done
- To augment or support surgical repairs
- For immobilization/protection of concurrent soft tissue injuries
17
Q
What are the advantages of external coaptation?
A
- Minimal disruption of blood supply
- Minimal interference with physeal growth
- Nonsurgical placement
- Moderate expense (re-checks and changes add up)
18
Q
What are the limitations of external coaptation?
A
- Poor control of tensile and compressive forces
- Less rigid stabilization than with internal
- Alignment and reduction can be difficult or impossible to attain closed
- Can be hard to get a splint to stay on certain patients
- Inappropriate for some bone (femur, humerus, pelvis)
19
Q
What are some complications with external coaptation?
A
- Joint immobilization can lead to stiffening, muscle atrophy or contracture, osteoarthritis
- Constrictive coaptation can lead to congestion or necrosis of extremity
- Rub sores and dermatitis=common
20
Q
What are the principles of application: casts and splints?
A
- NEED to immobilize the joint above and the joint below the fracture
- Should conform closely to the limb and be applied firmly enough to prevent motion of padding against skin
- Coapt limbs in a NORMAL walking position
o Neutral position or with slight varus tendency
21
Q
If you are aiming to immobilize a JOINT, where should the external coaptation go from?
A
- The foot to the proximal aspect of the bone above the affected joint
- *the joint above the one you are treating does not need to be immobilized (and shouldn’t be
