Axial fractures Flashcards
Clinical presentation of mandibular and maxillary fractures
Most commonly trauma such as HBC, fall, or head first impact into a solid object
Diagnosis is not usually too complicated
○ Swelling, haemorrhage/ptyalism, inappetence
○ Malocclusion, overt instability
With any head trauma, remember the neuro exam!
Careful examination (under sedation) is often very helpful
Radiography demands optimal patient positioning, and CT may be advantageous
Treament/management of mandibular and maxillary fractures
Primary treatment goal is to re-establish normal occlusion
Open fractures require broad spectrum antibiotic cover
Jaw movement creates instability, so consider pharyngostomy intubation and placement of a feeding tube.
Mandibular symphyseal separation
Very common, particularly in cats
Not usually a challenging diagnosis - can range from minimal displacement to a gaping chasm!
Repair technique involves simple materials - hypodermic needles (16-21G) and cerclage wire (18-24G)
Tweak the repair to get perfect occlusion
Be careful not to overtighten wire and crush tissues
Considerations for mendibular symphyseal separation
Straightforward and often no need for post operative x-rays as reduction and stability are apparent
Wire is removed after 4-6 weeks under sedation or GA
Heavy gauge PDS can be an alternative to wire and avoids the need for repeat sedation/GA
If there is caudal instability or comminution, consider intraoral splinting
Management of injury below the gumline
Best managed with extraction
Pelvic fractures
Account for up to 25% of fractures seen in GP
Box shape so usually >1 fracture
Abundant soft tissues
○ Rarely open fractures
○ Good healing potential
○ Surgical access can be tricky
What structures can be damaged in pelvic fracture?
Sciatic nerve
Rectum and urogenital tracts
- Full neuro exam including anal and bladder tone
- Provide analgesia
- Stabilise the patient
- Thoracic radiographs
- Abdominal radiographs
- Abdominal ultrasound
□ +/- abdominocentesis
□ +/- retrograde urethrocystogram
Indications for surgery on a pelvic fracture
Fractures along the weight-bearing axis
§ SI joint (not always), ilial body and acetabulum
Articular fractures
§ Acetabulum
Significant (>30%) narrowing of the pelvic canal
Severe pain
Nerve entrapment
Concomitant ipsilateral fractures
Working/athletic/breeding dogs where function must be optimal
Ilial body fractures
Usually result in pelvic canal narrowing
On the weight bearing axis
Lateral approach
Lateral plating
Dorsal plating also possible in cats
Lag screws useful in oblique fractures
Sacroiliac luxation
Can be managed conservatively if unilateral and <50% displacement
Most commonly a lag screw is placed
§ Must engage >60% of width of sacrum
Trans-ilial bolts or pins are another option
Acetabular fractures
Must be perfectly anatomically reduced
Trochanteric osteotomy usually required for access
Osteoarthritis will develop
Salvage surgery - femoral head and neck ostectomy or total hip replacement can be considered
