A5 Appendicular fractures

Question 1

What are the 4 steps you should go through when deciding on a long bone fracture repair?

Answer 1

1) List all possible stabilisation options
2) Rule outs e.g. no external coaptation for upper limb bones
3) Compare and contrast the choices e.g. costs, likelihood of complications, experience of surgeon
4) Decide on the best option (or an A,B,C list) - final decision may be ultimately made at surgery

Question 2

What are the characteristics of an ideal surgical repair?

Answer 2

Minimal disruption to the blood supply of the bone
Minimal cost of implants
Implants that do not need removal OR implants that can easily be completely removed once the fracture has healed with no need for a second operation
Minimal rechecks required of the patient

Question 3

What are the most common diaphyseal fractures?

Answer 3

Humeral (most frequently in the distal half to third of the bone)
Distal Radial and Ulna
Femoral

Question 4

What are the four principles of articular fracture repair?

Answer 4

1. Perfect reduction of the articular surface
2. Use rigid internal fixation
3. And interfragmentary compression of the fracture gap - using lag screws (+/- plates)
4. Early mobilisation and use of the joint is important to minimise stiffness

Question 5

Why are cast fixation and ESF fixation contraindicated in humeral diaphyseal fractures?

Answer 5

Because they’re inappropriate for upper limb fixation

Although in severely comminuted unreconstructable fractures, ESF may be considered best

Question 6

Distal radial and ulna diaphyseal (metaphyseal, epiphyseal) fractures:

(a) commonly occur proximal to growth plate in which breeds
(b) 2 indicated stabilisation corrections include
(c) 2 contraindicated stabilisation corrections include
(d) complication if correction is suboptimal

Answer 6

(a) small/toy breeds
(b) Open reduction and internal fixation (ORIF), external skeletal fixation (ESF)
(c) external coaptation, cast fixation
(d) non-union - occurs if the limb is still able to rotate

Question 7

What is the principle of avulsion fracture repair?

Answer 7

Counteract active disrupting forces and convert them into compressive forces using the tension band principle.

Question 8

Name the two most common avulsion fractures and their standard repair procedures.

Answer 8

(a) Patella avulsion fractures in the cat (traumatic or spontaneous)
Repair with encircling wire + patella-tibial suture

(b) Tibial tuberosity avulsion fracture (young sight hounds)
Repair with figure of 8 TBW (tension-band wiring) and 2 K wires (remove in an immature animal).