Decision Making in Fracture Repair Flashcards
Which fractures require most urgent tx? (3)
- Open
- Skull
- Spine
How quickly should articular # and dislocations be dealt with?
24-48hours
Within what time period should long bone # be treated within?
5-7 days
What happens if there is a delay in # repair of long bones?
There is an increasing risk that the fracture cannot be reduced (or reduction will be more challenging) due to developing callus and muscle contracture.
What are the main aims of fixation? (3)
- support #healing
- Allow early ambulation
- Patient return to normal asap
The aim with a bone fracture is to repair it with as simple and as reliable a method as possible. For a surgical repair, what would ideally be involved? (4)
- 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.
The decision as to which fixation technique to use depends on several factors. Can you think of some? (12)
1 The nature of the fracture (classification)
2 The size, age and nature of the animal
3 Circumstances and compliance of the owner
4 Type and quality of the bone(s) involved
5 Involvement of joint surfaces
6 Open or closed fracture
7 Single or multiple fractures
8 Single or multiple limb involvement
9 Magnitude and direction of forces acting at the fracture site
10 The availability of equipment
11 The experience of the surgeon
12 The expense of the procedure.
Name possible stabilisation options (5)
- External coaptation
- Plate and rod fixation
- Interlocking nail
- Plate and screws
- ESF
Where can you NOT use external coaptation?
Upper limb
Where can you NOT use IM pins?
Radial #
Mandibuar #
What type of implant are IM pins?
Auxiallry (not primary)
Where are ESF best suited?
Lower limb
Where should we avoid ESF?
Where large muscles
What are the options for non-reconstrutvie #? (3)
OBDNT - Open but do not touch
Cosed application f ESF
MIPPO/MIPO - minimally invasive ‘percutaneous’ plating osteosynthesis
Non reconstructive # repair:
A) What is the bone length aim?
B) Angle malalignment aim?
A) spatial realignment with maintenance of bone length
B) Less than 5 degree of angular/rotational malalignment
Why can small + weaker implants be used in young animals?
Young animals (less than 6 months of age) heal rapidly. Smaller and weaker implants can be used as stability does not need to be maintained for such a long period
How does an open physes affect # repair decision making?
Open physes require special consideration. An implant should be selected that will minimally damage these and allow continued growth, such as K-wires applied perpendicular to the growth plate.
When is a more rigid fixation required? (2)
Active - anticipate slow bone
Older
How does the O affect # repair technique?
The circumstances and likely compliance are important factors with the overall potential to define the overall success of the treatment.
When do you expect a higher risk of implant related problems?
- Young animals with soft bone
- Osteopenic bone with poor screw holding
- Underlying dx e.g. cushings
- Chondrodystrophic
What are the principles of articular repair? (4)
- Anatomic reduction of the articular surface
- Rigid internal fixation
- Interfragmentary compression of the fracture gap (this usually involves the use of lag screws +/- plates)
- Early mobilisation and use of the joint to minimise joint stiffness.
What is a grade 1 open #?
Small wound with minimal soft tissue/muscle damage resulting from the bone itself penetrating the skin. Severe bruising (as in the image) can result in loss of a normal skin barrier and can be classified according to a type 1 open fracture.
What is a grade 2 open #?
Larger skin wound caused by external trauma
What is a grade 3 open #?
Extensive loss of skin and bone after severe fractures
True or false?
Grade 1 open fractures can’t be treated as closed fractures.
False
True or false
Grade 2 open fractures can be treated as closed fractures.
False
True or false:
For Grade 3 open fractures a fixation that is away from the fracture site is recommended.
True
What type of fixation is needed for multiple #?
Most rigid
When considering the treatment options for a fracture, it is important to consider what forces?
Those acting across the fracture once it has been reduced.
What degree do transverse fractures can resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion
A) -
B) +
C) +++
D) -
What degree do oblique/spiral fractures can resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion
A) +
B) -
C) -
D) +
What degree do comminuted fractures can resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion
A) -
B) -
C) -
D) -
What needs to be considered when choosing an implant to use?
To neutralise the forces acting across reduce #
What degree do IM pins resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion
A) +
B) -
C) -
D) -
What degree do interlocking nails resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion
A) +
B) +
C) ++
D) +
What degree do ESF resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion
A) ++
B) +
C) +
D) +
What degree do plates and screws resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion
A) +
B) ++
C) +++
D) ++
Should a transverse fracture that cannot resist torsional forces should be repaired with an IM pin?
NO - it also cannot resist torsion force
