Choosing Best Fracture Treatment Options Flashcards
what is fixation longevity?
length of time that a given fixation can maintain fracture zone stability before the fixation begins to fail
what is the predictable fixation longevity of IM pin+ coaptation?
very short
what is the predictable fixation longevity of IM pin + wire?
short
what is the predictable fixation longevity of ESF?
very short to moderate
what is the predictable fixation longevity of ILN?
moderate to extended
what is the predictable fixation longevity of a bone plate?
moderate to extended
what does reducible vs non-reducible mean?
reconstructable vs non-reconstructable
not necessarily choosing can i, more like SHOULD I reconstruct
you see a 6 y/o dog that was playing in the backyard for a long oblique, closed femoral fracture. what reconstructive approach are you taking?
circlage wire + IM pin: long oblique and closed, able to achieve perfect reconstruction! could also use a bone plate
forces it would help with: bending + rotation
what is a sequestrum?
piece of bone that has become devitalized and can act as a source of infection. these can occur if you move pieces of a fracture back into place and thus strip off pieces of soft tissue attachments: where the bone gets blood supply from
what using buttress/bridge plating, what criteria need to be present in order for it to succeed in healing?
6 intact cortices where the screws go through! on either side of the fracture zone!
why are loose implants worse than no implants?
they are affecting the blood supply, cause further damage, etc
T/F: bone is a tissue
true! is a living tissue and need to preserve biology
when is a fracture reconstructable?
2 piece fracture or single large butterfly fragment
what is a nonreconstructable fracture?
multiple fragments, especially small fragments
what is FCAS?
fracture-case assessment score:
- mechanical factors
- biological factors
- clinical factors
scale of 1-10, higher the number = better/happier
what biologic factors are considered in FCAS?
- systemic health: patient age, patient health, comorbidities
- fracture zone health assessment: fracture pattern (comminuted, obl/transverse, spiral/grn stick)
- limb condition: mild swelling vs severe/diffuse contusions
- fracture stability: moderate, stable vs bag o bones
- open fracture? closed, grade 2/1, grade 3
what are compliance factors?
- follow-up: willing/able? unwilling? questionable?
- activity restriction: crate? backyard of 5 acres?
- young active puppy bouncing of walls vs older, quiet dog?
then have a number from 1-10 to use
how do you use FCAS?
- preoperative decision making tool
- mechanics vs biology prioritized?
- do i treat or refer?
- measure your growth as an orthopedist
- client education: complications, challenges, healing road, etc
the higher the FCAS =
the happier we are
- less rigid fixation
- less demand
- shorter healing time
- balance less critical
- complications rare
the lower the FCAS =
sad
- rigid fixation required
- great mechanical demand on fixation
- longer healing time
- balance critical
- experienced surgeons
what 3 steps are used to improve fracture treatment success?
- what forces are acting on the fracture? what fixation is needed to resist those forces?
- reconstructable vs non-reconstructable
- fracture case assessment score (FCAS)
