Common Fractures to Know

Question 1

What nerve is important to avoid when performing internal fixation of a scapular neck fracture?

Answer 1

Must avoid suprascapular nerve!

Question 2

What type of bone plate would be considered ideal for repair of an unstable scapular body fracture?

Answer 2

Locking plate

Question 3

What condition seen most commonly in spaniel breeds predisposes them to humeral condylar fractures?

Answer 3

Incomplete ossification of humeral condyle

Question 4

Which aspect of the humeral condyle fractures most commonly and why?

Answer 4

Lateral portion affected more commonly because its weight bearing and smaller epicondylar crest

Question 5

What is the primary means of repair of a lateral or medial humeral condylar fracture?

Answer 5

Lag screw and anti-rotational wire

Question 6

What is the primary means of repair of a T or Y fracture?

Answer 6

Plate application

Question 7

Why are distal radius/ulna fractures in small breed dogs more likely to experience healing complications?

Answer 7

They have a higher risk of delayed union or non-union

Question 8

Under what conditions should metacarpal or metatarsal fractures be surgically stabilized? What are the risks associated with external coaptation of these fractures?

Answer 8

• when all 4 metacarpal bones are fractures -more than 1 MC are fractures and there is severe displacement -Metacarpals 3 and 4 are fractured - if either 3 or 4 are fractured with severe displacement Risks: -malunion and bandage mobility

Question 9

What other injuries might one expect to see in a patient with pelvic fractures? Why is a thorough neurologic evaluation so important in these cases?

Answer 9

diaphragmatic hernia, pneumothorax, free abdominal fluid etc a neuro exam is important to look for pelvic limb function, anal tone and sensation, urinary continence, and tail sensation

Question 10

Surgical stabilization of pelvic fractures should always be recommended in certain cases. What are these fracture types or clinical scenarios?

Answer 10

• marked decrease in size of pelvic canal
• fracture of acetabulum
• instabiltiy of hip caused by fracture of the ilium, ishicum, and pubis
• unilateral or bilateral instability
• HIGHEST PRIORITY FOR ACETABULAR AND ILIAL FRACTURES AND SACROILLIAC LUXATIONS

Question 11

When is conservative management recommended for pelvic fractures? What are the risks associated with conservative management of fractures in which surgical repair is recommended?

Answer 11

Indications:

• stable miniamlly displaced fractures
• fractures that do no disrupt the continuity of the pelvic canl

Complications:

• Malunion with pelvic canal
• entrapment of sciatic nerve in callus
• non-union

Question 12

What are the 2 main goals of surgical repair of spinal fractures/luxations? What are the benefits of CT vs MRI with regards to imaging of the spine and providing information to help achieve these surgical goals?

Answer 12

Goals:

• Decompression of the spinal cord
• Stabilization of vertebral column

Benefits of CT vs MRI

CT- best for detecting bony lesions(better for multiple sites of injuries); requires limited patient manipuatlion

MRI- assessment of spinal cord and canal changes; better for assessing spinal cord compression secondar to traumatic disk extrusion