Exam 1 Flashcards
Two Advantages of which Type of Distant Flap:
Flap Remains attached to the Donor site at Both Ends- Likelyhood Of Vascular Compromised is Reduced
Flap itself helps to Support the Leg along the Side
Pouch Flap
______ Profile Threaded Pins for External Skeletal Fixators:
Strongest of 3 Styles
Increased Bone Purchase compared to Smooth Pins
Increased Strength in Bending due to Uniform Pin Diameter
Threads are Outside of the Core Diameter (Not cutting into Pin to Create Threads)
Positive
*Three Types of External Skeletal Fixator Pins- Smooth Pins, Positive Profile Threaded Pins, Negative Profile Threaded Pins
*Almost Always use Positive Profie Threaded Pins when placing External Skeletal Fixators
Match these Open Fracture Classifications to Description:
A. Adequate Soft Tissue for Wound Coverage/ Large Soft Tissue Laceration or Flap
B. Extensive Soft Tissue Loss/Bone Exposure/Stripped Periosteum
C. Arterial +/- Nerve Supply to Distal Limb Compromised/Requires Microvascular Anastomosis or Amputation
1. Type IIIB
2. Type IIIA
3. Type IIIC
A. Type IIIA
B. Type IIIB
C. Type IIIC
Indications for _____:
Dead Space Cannot be Obliterated
Fluid Accumulation Likely
Infection
Surgical Drains
*Drains are used to Remove Fluid/Exudate from Wounds. Drains are Also used to Remove Exudate from Infected Wounds
Two most commly used Antiseptics for Wound Lavage
Chlorhexidine
Povidone-Iodine
______ Review of Bone Repair and Healing is useful for Assessment of Outcome of Repair and to See if any changes are Required
Radiographic
*Recheck Radiographs are done every 4-6 Weeks to see if the Bone is Healing, If the Implants are Stable, and if Any other Changes are Occuring
True/False: Elbow Dysplasia is Heritable- Do NOT Breed
True
Presentation for which Disease of the Elbow?
Elbow Dysplasia
True/False: Proper Postoperative Managment is Essential to successful Skin Grafting
True
_____Profile Threaded Pin for External Skeletal Fixator:
Threads are Cut into the Core Diameter of the Pin
Decreased Strength
Negative
Drains should NOT Lie directly under Suture Line. Drains that Lie Directly under Suture Lines or Exit through them can Interfere with Wound Healing and Result in Wound ______
Dehiscence
True/False: Lateral Shoulder Luxation is more Common
False
*Medial Shoulder Luxation is more Common
Cerclage Wires need to be Placed _____ to the Bone
Perpendicular
*Apply wires Tightly to achieve rigid fixation of fracture segments- Twist the Wire
A ____ MUST be present to achieve benefits of Dynamization
Callus
Puckering of Skin that can occur at the ends of a Suture Line during Wound Closure. This occurs because the Two Sides of the Wound are of unequal length or because the direction of movement of the Skin to Close the Wound causes the Surrounding Skin to Pucker
Dog Ears
External Skeletal Fixator that is a:
Combination of a Linear and Circular External Skeletal Fixator
Useful for Treatment of Metaphyseal Fractures
Thin Wires or Circular Fixator allows for Multiple Sites of Bone Purchase in a Smaller Bone Fragment
Hybrid Fixator
Screws with these Characteristics:
Best for use in Dense, Cortical Bone
Decreased Outer Diameter
More Shallow Thread
Decreased Pitch
Cortical Screws
*Most commonly used Screws. Best for use in Dense Bone- Most Fractures will be Diaphyseal
Decreased Outer Diameter- More Likely to Pull out
What type of Bone Fracture must be Fixed with:
Internal Fixation with Open Anatomic Reduction/Reconstruction
Primary Bone Healing
Articular Fractures
*Open Anatomic Reconstruction is REQUIRED for Articular Fractures
Four A’s used in Assessment of Post Op Fracture Repair Radiographs
Apposition
Alignment
Apparatus
Activity
*KNOW These for the Exam!
Common Wound Lavage Solutions
Balanced Electrolyte Solution (Most Common)
Tap Water
Antiseptic Solutions
Antibiotics
____ is Typically Recommended at 6 weeks Post Repair with External Skeletal Fixators
Dynamization
*Roughly at about 6 weeks is when we start considering Dynamization (Destabilization)
Indications for ______:
Skin Defects on Extermities- Ex. Degloving
Extensive Burn Wounds
Large Wounds Resulting from Excision of Masses
Skin Grafts
Plate Function Described Below:
Plates that are used in Addition to Primarily Placed Lag or Positional Screws
Plate Acts to Promote/Neutralize Against Shearing, Bending, and Rotational Forces which would otherwise damage the Interfragmentary Repair Achieved by the Screws
Neutralization Mode
*When you Place a Lag Screw, it needs to be Perpendicular to the Fracture Line
*The Plate itself isn’t stabilizing the Fracture- The plate is only meant to Neutralize/Protect the Lag or Positional Screws
Screw Type that has a Wider Outer Diameter and is:
Less Likely to Pull out
More Likely to Bend
Cancellous Screw
Closed Mid-Diaphyseal Spiral Comminuted Fracture with Medial and Proximal Displacement
*Spiral Fracture- Can see Butterfly Fragments (Diamond Shaped Fragments)
*Whatever the Top Segment of Bone is doing, Consider that to be Normal
True/False: When an animal is Presented with an Open Wound, the urge to “Take a Peak” should be Resisted
True
Most common cause of Sinus Tracts (Draining Tracts)
Plant Material Foreign Bodies
When use of External Skeletal Fixation, Fractures will heal by ____ Bone Healing
Secondary
Postoperative ____ can have Devastating Results. ____ between the Graft and Recipient Bed may result in Dissolution of the Fibrin Seal, or the Graft may be Physically Elevated from the Graft Bed by Exudate Produced
Infection
Steinmann Pin Technique:
Used to Stabilize Salter Harris Type I Fractures of the Proximal Humerus and Femoral Head
_Must Achieve anatomical Reductio_n
Diverging Pin Technique
*Pins placed across fracture in order to engage the Femoral Head
True/False: A Sugar Paste for Wound Management can be made from Castor Sugar, Icing Sugar, Glycerin and 3% Hydrogen Peroxide
True
*Alternatively the wound can be covered with a thick layer of Granulated sugar
When Performing the Walking Suture Technique, Sutures must engage _____ and _____ to have Adequate Holding Power
Dermis
Fascia
*These Sutures must engage the Dermis and Fascia otherwise they will likely pull out when the knot is tied
*First Suture Bite - Dermis
Second Suture Bite- Fascia
True/False: Bite Wounds, where Puncture wounds and small Lacerations are the only apparent Injury should be cleaned and the Patient should be given antibiotics for a few days
False
*There is often Tremendous Damage to the underlying subcutaneous Tissue and Muscle which will later Necrose and provide and excellent enviornment for Bacterial Growth and Abscess Formation
*Bite wounds are often called “Iceberg Lesions” because most of the Trauma is hidden below the Surface
Gold Standard Treatment for Fragmented Coronoid Process and OCD with Elbow Dysplasia
Arthroscopic Treatment
*Fragment Removal and Debridment of Lesion Bed
If an Animal has a Developmental Joint Disease, it is Probably ____ with a ____ Age Grouping
Bilateral
Biphasic
Bone Plate with the Following Characteristics:
Similar to DCP Except, Contoured Underside the Allows Stress to be more evenly Distributed Across the Plate
Less Disruption of Periosteal Vascularity
Limited Contact DCP
*Less Contact with Bone = Less Disruption of Periosteal Vascularity
*Scalloped Bottom
Most Traumatic Wound Healing Occurs by which Method?
Repair
*Repair- Replacement of Damaged Tissue with Nonfunctional Scar Composed primarily of Fibrous Tissue and Blood Vessels
When Placing a Caudal Superficial Epigastric Axial Pattern Flap, Making the Flap ____ to the side of the wound is Perferred when there is a Shorter Distance and Results in Less Risk of Kinking Vessels
Contralateral
*Placing Flap on Same (Ispilateral) Side of the wound has a Greater Risk of Kinking Vessels
In order to ____ the Graft, Leave the Graft attached to the Sterile Cardboard and Cut Staggered Rows of Parallel Slits in the Graft. The Distance between the Slits and Between Rows is usually 1cm
Mesh
Degloving Injury where Skin is Partially or Completely torn away creating an Open Wound
Anatomic
In Normally Healing wounds, Wound Contraction Ceases for which Three Reasons
1. The Wound Edges are apposed and healing is Complete
2. The Tension on the Skin Surrounding the wound is Greater than the Pull of the Myofibroblasts
3. The Granulation Tissue is Chronic with a High Content of mature Collagen and Ground Substance and Few Fibroblasts
Complication of Second Intention Healing, where Scar Tissue Forms that Interferes with Normal Function of that Structure
Wound Contracture
Steinmann Pins placed in Medullary Cavity of Bone to Help Restore Length and Maintain Alignment
Intramedullary Pins
Surgical Treatment for Traumatic Shoulder Luxation
Arthrotomy to Evaluate Joint
Glenohumerual Ligament Reconstruction
Since the Cutaneous Trunci Muscle is closely attached to the skin and many Blood Vessels pass from the Muscle to the Subdermal Plexus, Undermining the Skin on the trunk should be performed in the Loose Connective tissue ____ the Cutaneous Trunci Muscle
Below
Antiseptic used for Wound Lavage that has:
Chlorhexidine
*Sideffects are Uncommon
*Use a 1:40 Dilution
Surgical Treatment for Arthritis Characterized Below:
Remodeling of Joint without Replacement- Ex. Femoral Head and Neck Excision (FHO)
Less Technically Challenging
Less Specialized Instruments/Training
Arthroplasty- Partial Excision
*Arthroplasty- Removing Part of the Joint rather than Removing all of the Joint
Best Diagnostic Technique for Evaluating Shoulder Instability
Arthroscopy
*Best for Evaluating Joint
Incisions made ____ to Skin Tension Lines gape Less and are Easier to close because the Tension will cause the Tissue to want to separate more in the direction ____ to these Lines.
Parallel
*Make Incision Lines or Wound Closures on the Trunk PARALLEL to Skin Tension lines- Gape Less and Heal Faster
*Skin Incisions made across Skin Tension Lines gape open more widely and are under greater tension during Closure
The Cutaneous Trunci Muscle and Superficial Subcutaneous Tissue must be Removed from the Graft before it is Applied to Enhance _____
Revascularization
True/False: Vast Majority of Elbow Dysplasia Cases will Progress to Osteoarthritis Despite Treatment
True
Best Diagnostic Technique for Biceps Brachii Tendinopathy
Arthroscopy
*Diagostic and Therapeutic
Core Diameter of Screw Determines _____ Strength
Bending
Steinmann Pin Technique Indicated for:
Simple, Transverse Fractures close to the Joint
Typically Youg Animals with Salter Harris Type 1 and II Fractures
Uses Smaller Diameter Steinmann Pins or K Wires
Engage Near and Far Cortex with K Wire
Pins Cross above Fracture Line
Cross Pinning
True/False: While Radiographs are widely used for Diagnosing Arthritis, sometimes you can have fairly advanced Disease with Minimal Radiographic Change. Therefore, Radiographs are not a Great way for Diagnosing Arthritis
True
*Radiographs don’t always reflect the Clinical Picture
Indications for which Type of Fracture Fixation:
Fractures Below the Knee and Elbow
Fractures Expected to Heal Rapidly
External Coaptation
*Only use Casts on Fractures that are Below the Knee and Elbow
Transverse Fractures are more Amenable to External Coaptation- Cast will Prevent Collapse at the Edge
Post Op Fracture Assessment that asks:
Is the Fixator/Implants Appropriately Positioned?
Is there Evidence of Implant Lossening or Failure?
Apparatus
*You can Tell that a Screw is Loose if there is Radiolucency around the Screw
Injuries Resulting from Shear Forces which Sever Cutaneous Vessels supplying skin
Degloving Injuries
*Physiologic- Skin Devitalized by still in Place
*Anatomic- Skin Avulsed from Underlying Tissue
Postoperative Managment of which Arthritis Surgical Treatment:
Coaptation (Splint or ESF)- 6-8 weeks
Activity Restriction until Bony Fusion
Prolonged Healing Common- 3 Months Minimum
Arthrodesis
Diagnosis based on this Radiograph
Osteochondrosis (OCD)
In Cases of Open Fractures, once the Patient is _____:
Assess Tissue Damage, Vascular and Nerve Supply
Assess Neurovascular Status of Distal Limb
Imaging
Clean Wound, Collect Culture, Start Treatment
Stable
Diagnosis based on this Radiograph
Ununited Anconeal Process
Skin Flaps Characterized Below:
Semicircular Flaps that are Best Suited for Triangular or Circular Shaped Defects
Flap moves about a Pivot Point
Rotation Flaps
Name Three Disease Modifying Agents used to Treat Arthritis
Polysulfated Glycosaminoglycan (Adequan)- Most Common
Pentosan Polusulfate
Hyaluronic Acid- Synovial Fluid/Restores Joint Viscosity
Outer Diameter of a Screw Determines _____ Strength
Pull Out
How to Apply _____ Wires:
Reduce Fragment and Drive 2 K Wires across Fracture
Drill Hole through Both Bone Cortices Distal to Fracture
Pass Wire through the Hole and Around the Ends of the Pin and Back to the Other end of the Wire Creating a Figure 8
Tighten Wire via Twist Method
Bend the K-Wire and Cut (2-3 Twists Remain)
Tension Band Wire
Type ____ External Skeletal Fixator:
Unilateral-Biplaner- Pins are only being Placed Externally though One side of the Bone. Another Set of Pins are Also Unilateral that are in a Different Plane then the First set of Pins
Pins are Placed 60-90 Degrees from Each Other
Uses Half Pins
Type 1B
Law that States:
Bone Remodels based on the Forces that are Applied:
Bone Remodels and Thickens in Response to Increased Forces
Bone Resorbs and Weakens in Response to Decreased Forces
Wolff’s Law
*Healing Fractures- we need Forces Applied across the Bone in order for Bone to Remodel and Thicken
Tracking Drains in the Wound with _____ Suture is NOT Recommended because of the potential that a piece of the Drain might Break off and be retained in the Wound as a Foreign Body
Buried
When using _____ Plates, the Plate should be Precisely Contoured to Match the Normal shape of the Bone in order to:
Maximizes Contact between Bone and Plate to Increase Strength of Repair
Prevents Distraction of Fracture Ends during Screw Placement
Conventional Plates
*Need Bone and Plate Contact to generate Friction and lend Stability to the Plate
What is the Best Option for Repair of this Fracture?
External Skeletal Fixator
Immediate Closure of a Wound for:
Clean Wounds
Clean-Contaminated Wounds
Primary Closure
True/False: Prophylactic Antibiotic Administration should be considered when Procedures are anticipated to last more than 90 Minutes, when nonabsorbable implants are Placed, and when Infection would be Catastrophic to the outcome of the Procedure
True
Closed Mid-Diaphyseal Short Oblique Simple Tibial Fracture with Proximal and Lateral Displacement
*Simple = Non Comminuted
Plate Function described Below:
Plate Spans Fractures Area which cannot be Anatomicaly Reconstructed (Comminuted Area)
Plate Bears all Load at level of Fracture
Longer Plate with Fewer Screws
Mode used in Biological Osteosynthesis/MIPO
Bridging Mode
*Plate must Bridge Fracture Gap
More Expensive Type of Bone Plate that is:
Less Stiff/Strong
Have Better Fatigue Resistance (Longer Elastic Phase)
Less Reactive
Titanium Plates
*Have more of an Elastic Component
Noninflammatory ____ Osteoarthritis:
Developmental- OCD, Hip Dysplasia
Acquired- Trauma, Neoplasia
Secondary
When using a Conventional Plate, a Stable Repair requires Screw Purchase of at least ___ Cortices above and Below the Fracture
6
*When we are placing screws, we place them Bi-Cortically- Through the Cis Cortex (Near Cortex) and then again through the Trans Cortex (Far Cortex)
*Ideally we want Three Screws Above and Three Screws below the Fracture = 6 Cortices
Passive Drains are Sometimes Placed with ____ Exit Sites. Making Two Stab Incisions facilitates Placement of the Drain in the Fluid Cavity. To Remove Drains placed in this Manner, Cut the Dorsal Fixation Suture while Holding the Drain with Forceps. Gently Pull on the Drain to Stretch it and Cut off the Portion of the Drain that has been Outside the Wound at the Level of the Skin. Remove the Remainder of the Drain through the Ventral Opening
Two
*Penrose Double Exit Drain
*Avoid Dragging any of the Exteriorized Portions of the Drain through the Wound
Treatment for a Closed Reduction Shoulder Luxation (Recent Injury/No Fractures)
Under General Anesthesia
Distract Limb- Move Humerus Toward Glenoid
Stabilize Joint- Apply Coaptation for 2 Weeeks (Velpeau Sling)
True/False: Ability to Undermine Skin is Influenced by:
1. Species- Differences in Blood Supply to Skin
2. Breed (Dogs)- Some Breeds have a lot more Loose Skin than Others
True
In General, _____ Antibiotics are preferred for Prophylactic and Preventative Administration
“Cidal”
*Dead Bugs Don’t Mutate
For Fixation of Short Oblique Fractures, we can use Cerclage Wire with _____, to aid in Maintenance of Reduction and Promote Compression across Fracture Line
Skewer Pins
*Place Skewer Pin Perpendicular to Fracture Line
In Patients with Ununited Anconeal Process, there is a Separate Anconeal Center of _____
Ossification
*The Ulna usually Fuses at 16-20 Weeks, therefore if you have a Dog that is Older than 24 weeks with a Separate Anconeal Process then the Dog has Ununited Anconeal Process
Grafts Transferred between Individuals of the Same Species
Allografts
Best Prophylactic Antibiotic to use for Non-GI Tract Related Surgeries
Cefazolin
First Priority in Cases of Open Fractures
Systemic Stabilization
*If Wound is Highly Contaminated- Rinse with Water and put a Sterile Bandage on it
Technique used to Slowly Stretch the skin surrounding a Chronic Wound. Where there has been Increased Collagen Deposition and Thickening of the Skin, a Continuous Intradermal Pattern is Placed. The Suture exits out onto the Skin Surface and through a Button. The Suture is Tightened from both ends until the Tension is even along the entire length of the suture line. A this point, Split-Shot is Crimped Across the Suture to Maintiain the Tension. Each day more Tension is applied to the suture and Split Shot is Replaced.
Adjustable Horizontal Mattress Sutures
*Works better with Chronic Wounds with Established Granulation Tissue
Bone Plate with the Following Characteristics:
Screw Holes designed to Allow Screw Placement that Promotes Compression of Fracture Ends
Oval Screw Holes allow for Screw Angulation
All Plate Surfaces are Flat
Dynamic Compression Plate (DCP)
*Screw Holes are Oval and there is a Graduated Drop into the Screwhole- Tightening the Screws moves Fracture Ends Closer Together
External Force Applied to any Cross Sectional Area
Stress
*Stress- Actual Force that is being Applied to something
True/False: When Initially Managing a Traumatic Wound it is important to do a Physical Exam and check Neurologic Status of Limb Injuries prior to Administering Pain Meds
True
*Make sure Superficial and Deep Pain is Adequate
_____ is the Most Common Cause of Active Drain Failure, caused by Tissue Debris left in the Wound at Closure
Obstruction
Approach for Internal Fracture Fixation characterized by:
Primary Bone Healing (< 1mm Gap at Fracture Ends)
Perfect Bone Reconstruction
Rigid Fixation with Compressions at Bone Ends
Open Anatomic Reduction/Reconstruction
*Perfect Bone Reconstruction and Rigid Fixation
During the Placement of Active Drains, the Exit hole must be kept ____ to Minimize Air Leakage
Small
*An Airtight Skin Closure is Necessary
I_f the Incision is too Large, air leakage into the wound is more likely when suction is applied_
True/False: Plant Fiber Foreign Bodies can be Difficult to Diagnose and even when suspected they can be difficult to find and Remove
True
*Plant Fiber Foreign Bodies tend to Migrate A lot
Porcine Small Intestinal Submucosa is most commonly applied as a sheet after wound Debridement and Lavage. It should be Sutured to the edges of the wound with the ____ Side Down
Rough
*Rough Side needs to be in contact with Wound Surface
Physical Exam findings with which Shoulder Disease
Shoulder Instability
*Increased Abduction Angle of the Limb!!- Medial Instability
Plate Function described Below:
Used for Transverse or Short Oblique Fractures
Axial Compression is Achieved through Eccentrically Loading Screws
Load is Carried Mostly by the Bone and to a lesser Extent by the Plate
Compression Mode
*When plates are Applied to Achieve Compression across the Fracture Ends
Bone Disease Described Below:
Developmental Orthopedic Disorder
Defect in Endochondral Ossification
Starts from Epiphyseal Center of Ossification and Travels Outward- Ossification Wave
Osteochondrosis
*Endochondral Ossification- Process by which Epiphyseal Cartilage Becomes Bone
When Applying Tension Band Wires, you Reduce the Fragment and Always Drive ___ K-Wires Across the Fracture
2
*Wires are Driven Perpendicular to the Fracture Line. The Wires are Parallel to Eachother
In some Instance the Wound is Left Open until Healing is Complete. Healing by this method is called ______
Contraction and Epithelialization (Second Intention Healing)
Deformation of a Loading Material as Compared to its Original Form
Strain
*Strain- Actual Calculated Change in a Material
Topical Wound Medication that generates “Inhibines” such as Hydrogen Peroxide and Phenolic Acids during its Metabolism that provide Antibacterial Activity
Honey
Portion of Skin that is Completely detached from its Original Location and transferred to a Recipient Site where it Becomes Revascularized by the ingrowth of Blood Vessels from the Recipient Bed
Skin Graft
*Blood Vessels from the Recipient Site may create new Vascular Channels within the Dermis or may Anastomose directly with Existing vessels within the Graft
Drains are Removed when the Amount of Drainage Decreases and it becomes Serous in Appearance, which is typically ____ Days after Placement
3-7 Days
Some _____ Dressings are Impregnated with Antimicrobials (Ex. Keralix AMD Sponges). These Sponges are useful in wounds producing a lot of Exudate because they are applied Dry but Elute the Antiseptic into the wound as they Absorb Wound Fluid
Dry-to-Dry Dressings
Inflammation in Several Joints Simultaneously
Polyarthritis
Moisture Retentive Dressing that is made from a Highly Absorbent semiocclusive sponge like material that can be used as a primary Dressing on wounds in either the Inflammatory or Reparative Stage.
Polyurethane Foam Dressing
Two Surgical Treatments used for Ununited Anconeal Process
Fragment Excision
Osteotomy + Fixation (Ulna Lengthens)
Advantages and Disadvantages of ______
Steinmann Pins
*Only used for Very Specific Fractures and have Minimal Application as a Primary Fixation
Three Disadvantages of Second Intention Healing
1. The Legth of time needed for Complete Healing to Occur
2. Contraction and Epithelialization may Cease Before the Wound is Closed
3. Wound Contraction can interfere with normal Function (Wound Contracture)
When performing Axial Pattern Flaps, a Drain can be Placed if there is concern about ____ Formation
Seroma
*Drains can be placed to Control Seroma Formation
Classification of Wound:
Surgically Created Wound
Organ Normally Containing Bacteria is Opened but No Contents are Spilled
Minor Break in Technique Occurs- Ex. Hole in Glove
Clean-Contaminated
*GIT is the Most common type of Clean-Contaminated wound Encountered
____ Bone has a Low Porosity of 5-10%, characterized by:
Steep and Short Elastic Phase
Higher Yield Point- Takes Higher Stress to reach Yield Point
Cortical
*Takes a Very Strong Force for Cortical Bone to Reach Yield Point, and begin to enter Plastic Deformation
*Cortical Bone has Low Elastic Deformation- Cannot Strech and Recover
Two Types of Moisture Retentive Dressings that are Better than Adherent Dressings for Wounds in late Debridement/Proliferative Phase because they optimize the body’s inherent wound healing abilities
Hydrocolloid
Polyurethane
Most Common Passive Drain used in Veterinary Medicine
Penrose Drain
*The Drain allows Fluid to escape from the wound and for us to asses what kind of Exudate is being produced. If the Exudate begins to look Purulent, the wound may be Infected
This is a Radiograph of a ____ Fracture
Complete
*Fracture through all Cortices
Prognosis for Biceps Brachii Tendinopathy
Medical Treatment- Good to Poor
Surgical Treatment- Good to Excellent
*Tenotomy- Excellent Results Reported
Plates should be applied to the ____ Side of the Bone
Tension
Tension Side- Side of the Bone where the Fracture wants to Open up when Load is Applied
When using ____ Plates, Minimal to No Contouring is Required. Stable Repair Requires Screw Purchase of at least ____ Cortices above and Below Fracture
Locking Plate
4
*For a Locking Plate, you only need Purchase of 4 Cortices Above and Below the Fracture (2 Screws Above and 2 Screws Below)
Removal of Devitalized Tissue and Foreign Bodies
Debridement
Screws with these Characteristics:
Largest Core Diameter
Self Tapping
Threaded Head Locks into Threaded Hole in Locking Plate
Locking Screw
*Only for use with Locking Plates
Type of Biological Osteosynthesis Approach:
Implants are Placed through Incisions distant to the Fracture
Fracture is Not Approached
Intra-Operative Fluroscopy is used to Guide Placement of Implants and to Confirm Fracture Reduction and Alignment
Minimally Invasive Osteosynthesis
*Not Making an Incision over the Fracture or Touching the Fracture Ends
*Difficult to Do- Steep Learning Curve
Skin Flap Characterized by:
Three-Sided Flap that can be used when Donor Skin is Available in the Same Plane as the Wound
One Side of the Wound becomes the Leading Edge of the Flap
Single Pedicle Advancement Flap
*Very common in the reconstruction of Upper Eyelids
When Cutting Cerclage Wire, cut the Wire leaving ____ Twists in Place on the Bone
2-3
*Don’t bend the Twist over- Loosens the Wire
A Permanent Change in Shape, where Material Does NOT return to Original Shape when Load is Removed
Plastic Deformation
Topical Wound Medication that Provides the Following:
Sugar
*Effect is due to Osmolality
This is a Radiograph of a _____ Fracture
Incomplete (Greenstick)
*One Cortices is still Intact
Which Two Types of External skeletal Fixators can be used on the Humerus and Femur?
Type 1A and Type 1B
Chemical Debridement Agent that contains:
Granulex
If Fracture Ends do not Line up then Fracture is Considered _____
Displaced
*Displacement is Described based on the Location of the DISTAL Segment
When Blood Supply is Considered, Skin Flaps in small animals are classified as ____Flaps, if a Direct Cutaneous Artery and Vein are NOT Included
Subdermal Plexus Flap
_____ Grafts contain all Adnexal Component making them:
More Likely to Resemble Normal Skin
Grow Hair Better
Able to Withstand Trauma as well as Surrounding Skin
Full Thickness
*Full Thickness Grafts have several Advantages over Split Thickness Grafts
*Generally Recommends use to Full Thickness Grafts
Secondary Implants that are:
Small Steinmann Pins
Easily Bent
Come in Various Lengths
Kirschner Wires (K Wires)
Sling worn for 2-4 Weeks Post Op after Medial Glenohumeral Ligament Reconstruction for Repair of Shoulder Instability
Velpaeu Sling
Signalment for which Bone Disease?
Osteochondrosis/Osteochondritis Dissecans
In Patients with Plant Fiber Foreign Bodies, Many Times ______ are initially treated with Antibiotics with apparent success but Frequently the Draining Tract re-develops when the Antibiotics are Discontinued
Sinus Tracts
*Sinus Tracts will heal Rapidly when Foreign Body is Removed
_*_Common Presentation- Animal came in with a wound and was treated with Antibiotics and the wound healed. Antibiotics were discontinued and weeks later a new wound has opened up- Plant Fiber Foreign Body
_____ Drains Depend on Gravity and Capillary Action to Move Fluid
Passive
*Ex. Penrose
_____ Flaps can be Constructed without the Length Limitations of Subdermal Plexus Based Flaps
Axial Pattern
______ Implants Include:
Bone Plates
Interlocking Nails
External Skeletal Fixators
Primary
*Primary Implants- Fixation that Maintains Bone Length and Provides Rigid Support while the Bone is Healing
Degloving Injury where Skin Surface remains Intact but the Blood Supply is Destroyed, where skin typically becomes Black, Hard, and Cool to the touch and begin to slough away within a few days
Physiologic
Technique that is useful in managing open wounds and prior to excising masses on the distal part of the limbs where skin is Limited. This Technique takes advanged of Creep and Stress Relaxation. The Skin is typically stretched over a 24 hour period
Presuturing
*Mattress Sutures placed prior to Surgery to Distribute the Tension. Creates more Loose Skin for Closing during Surgery
*The limb should be bandaged until the sutures are removed just prior to surgery
With Regards to Orthopedic Wire, the Thicker the Wire, the ____ the Gauge
Lower
*The Thicker the Wire, the Stronger the Wire
*We generally are using 18-24 Gauge Wire
Two Axial Pattern Flaps that have the Most Clinical Application
Thoracodorsal
Caudal Superficial Epigastric
*Thoracodorsal and Caudal Superficial Epigastric Flaps are the most Useful for Closing Wounds on the Limbs
When Placing Intramedullary Pins, DO NOT Penetrate the ____ Surface
Joint
*End point for Positioning the Pin is always going to be the Distal Metaphysis. Do not Drive Pin into Joint because it will Damage the Joint and the Animal will be in Pain and not want to Bear Weight
When Placing Pins for External Skeletal Fixation (Transfixation), the Pins should be placed ____ Bone Diameter away from Fracture and Each Other
1/2
Topical Wound Medication that provides the Following:
Honey
*Ex. Manuka Honey
*Main Advantage of Honey- Produces agents that have Antibacterial Effect
Physical Exam Findings for which Shoulder Disease
Congenital Shoulder Luxation
*Typically NOT very Painful
How does the Healing of Superficial Wounds Differ in Dogs and Cats?
In Cats with Traumatic Wounds, if the Subcutaneous Tissue is gone it will take longer for Granulation tissue to Form and Longer for the Wound to Heal
*In a Dog with the Same wound, the Healing process would not Take as Long
How to Perform a _____ Flap:
Toes to the Shoulder and Lateral Abdomen must Be Clipped and Prepped
Place Sterile Glover over the Foot helps to Reduce Contamination to the Surgical Site
Leg is Placed along the Side to determine best Location and Size of Flap Necessary to Cover Defect
Edges of Flap are Oriented in the Dorsoventral Direction
Leg is Inserted through Pouch and Edges are Sutured to the Edge of the Wound
Pouch Flap
Topical Wound Medication with the Following Indications:
Calcium Alginate
Antiseptic used for Wound Lavage that has:
Povidone Iodine
*Residual Activity- 4-6 Hours, so repeated doses are necessary to maintain maximum Activity
*Needs to be Diluted to 1:10 or Less
Always place AT LEAST ___ Cerclage Wires to Stabilize Fracture
2
*Used to Hold Fragments in Position
Methods to _____ External Skeletal Fixator Rigidity:
Frame Type (II-III)
Double Bar
Interconnecting Bars
Reduce Bone-Connecting Bar Distance
Pins Close to Ends of Bone and Fracture
Increased Number of Pins
Larger Diameter Pins and Connecting Bar
Increase
*Pins Closer to Ends of Bone and Fracture = More Stable
The Passive Drain ____ Site must be Kept Clean and Dry to Minimize Maceration of Surrounding Skin
Exit
True/False: In Patients with Arrow Wounds and Impailment Injuries, you should Initially pull the object out of the Patient
False
*First Inclination is often to pull the object out but this should be avoided. The Object may be Tamponading off larger blood vessels so bleeding may become Uncontrollable if it is not removed in a surgical environment
Treatment for ACUTE Cases of Biceps Brachii Tendinopathy
Confinement for 4-6 weeks
Non Steroidal Anti-Inflammatory Drugs
+/- Physical Therapy
Technique for Removing _____:
- Incision is Extended through the Middle of the ___ to the End of the Puckered Skin
- The Triangle of Tissue formed on each Side is Excised at the Base
- The Skin is Sutured
Dog Ears
Advantages of _______:
Keep Wound Moist
Allow Excess Fluid to Drain
Do not Damage Newly Formed Reparative Tissue when Bandage is Changed
Nonadherent Dressings
Screws that are Preferred when Fixing Diaphyseal Bone Fractures (Hard Bone)
Cortical Screws
*Wider Core Diameter
Treatment for Recurrent/Persistent Biceps Brachii Tendinopathy
Intraarticular Corticosteroid Injection
Strict Confinement- 4-6 weeks
Physical Therapy
Incision that Connects Base of Flap and Recipient Site that is used to Avoid having to Tube Flap over Intact Skin
Bridging Incision
*Always use the Bridging Incision technique rather than Tubing the Flap
Rectangular Flaps that Turn on a Pivot Point to Reach the Defect. These Flaps are Created within 90 Degrees of the Long Axis of the Defect and are Generally 3x’s the Width of the Defect
Transposition Flap
*Transposition Flaps- Donor Skin in Different Axis from Wound!!!!
*In most Instances this Flap is Generated 60-90 Degrees from the Plane of the Wound
Method of Debridement that is Accomplished by the application of Enzymatic Agents in Animals that are Poor Surgical Risks or when Surgical Debridement may damage vital Structures
Chemical Debridement (Ezymatic)
*Common Chemical Debridment Solution- Granulex
When Placing Pins for External Skeletal Fixators, at least ___ Pins in Bone Segments are required
Two
*Three Pins per Bone segment is Ideal
Administration of Antibiotics PRIOR to Wound Contamination
Prophylactic
*Use of Antibiotics to Prevent Infection
*The Lower the Experience of the Surgeon, the Higher the Likelyhood that Prophylactic Antibiotics should be used
Which Suture Material would be most Appropriate for this Wound?
*Bite Wound to the Thorax
Absorbable Monofilament
*Absorbable Suture-
Short Lasting: 7-10 days
Intermediate Lasting: 10 days - 3 weeks
Long Lasting: > 1 Month
In Patients with Gunshot Wounds, Lead Fragments in ____ should be removed because they can be dissolved by Synovial Fluid Causing Periarticular Fibrosis and Hypertrophic Arthritis
Joints
Screw Type that has a Wider Core Diameter and is:
Less Likely to Bend
More Likely to Pull out
Cortical Screw
_____ Drains must Exit Dependent Area of Wound. A Single Exit Site if Preferred over Two Exit Wounds to Decrease the Risk of Ascending Infection
Passive
_____ Strain:
When Force is Applied Laterally on Either Side of a Column
Leads to Widening of the Material
Shear
True/False: Disadvantage of Surgical Drains is the Increased Risk of Secondary Infection
True
*There is a Risk of Ascending Infection associated with the Drain
Knowledge of the Normal Skin _____ Lines is important when planning Surgical Procedures. By choosing the Correct Direction for making a Skin Incision or Closing a Wound, the Surgeon can produce a wound that will Heal Better and Faster with Less Risk of Complications.
Tension
_____Strain:
Combination of Compressive, Tensile and Shear Loading Forces
Torsion
In Patients with Gunshot Wounds, Extenstive searching for Lead Fragments is unnecessary unless they lie within or close to a ____. Lead Fragments in soft tissue are relatively inert and usually become walled off
Joint
Up to 90% of Surface Bacteria on a Traumatic Wound can be removed by _____ when Large volumes are Delivered Under Moderate Pressure
Wound Lavage
*Wound Lavage is Done with Saline or Balanced Electrolyte Solution
True/False: Prophylactic Antibiotics should be Administered After Induction
False
*Prophylactic Antibiotics should be Administered PRIOR to Induction (30-60 minutes prior to skin incision). If the Patient has an Anaphylactic reaction to the Antibiotic it will be more apparent if the Patient is not Induced yet
Type of Non Surgical Fracture Fixation
External Coaptation (Ex. Splint/Cast)
Axial Pattern Flap with these Characteristics:
Anatomical Landmarks- Abdominal Midline, Mammary Thelia, Base of Prepuce (Males)
Can Reliably Extend into Caudal Thoracic Glands of Female
(# 4 in Diagram)
Caudal Superficial Epigastric Axial Pattern Flap
*Much more Reliable Flap in Female Dogs
Preparing the _____ for Grafting:
Lightly Scape Surface of the Granulation tissue with Scalpel Blade to Remove any Surface Debris and Expose Capillary Ends
All Epithelium Migrating from the Wound should be Removed
Apply Sponges moistened with the anitseptic Solution to the Surface to keep it Moist
Recipient Site/Bed
Goal of which type of Internal Fracture Fixation:
Goal is to Return Limb Alignment and Length to normal without Disruption of Fracture
Biological Osteosynthesis
During Evaluation of an Open Traumatic Wound we should Temporarily Close or Pack the Wound, Clip and Prep Surrounding Skin while wearing Caps, Masks and Gloves in Hopes of using Complete _____ Technique
Aseptic
Signalment for which Shoulder Disease
Traumatic Shoulder Luxation
Medical Treatment for Arthritis Described Below:
Reduces Signs of Arthritis
Calorie Restriction Reduces Prevalence
Delays or Prevents Radiographic Osteoarthritis
Reduces Need for Medication/Surgery
Good to Excellent EBM Support
Weght Management
*Reducing Obesity in Dogs with OA improves Lameness, and Decreases the Need for Surgery. Long Term Calorie Restriction also Delays or Prevents the Development of Hip Dysplasia
In Cases of Open Fractures, once you have Cleaned the Wound Appropriately, Start Treatment with _____
Cefazolin (Antibiotic)
Signalment and History of which Shoulder Disease?
Congenital Shoulder Luxation
*SMALL AND TOY BREED with no History of Trauma
Shoulder Disease characterized by the Following:
Abnormally Increased range of Motion
Laxity in Support Structures of Shoulder
Repetitive Microtrauma (“Overuse Injury”)
Shoulder Instability
*80% Medial Shoulder Instability
During Secondary Wound Closures, Lightly scrape the Surface of the Granulation bed with a Scalpel Blade and thoroughly Lavage the Wound to remove Surface Debris and Reduce _____ Counts
Bacterial
______ Strain:
Forces Applied in a Pulling Fashion that Leads to Lengthening of Bone
Tensile
Wound Classification used for Traumatic Wounds
Contaminated
True/False: The Potential for Pneumo/Hemo Thorax and the Necessity for Controlled Ventilation during Surgical Intervention should be considered when managing Bite Wounds on the Thorax
True
Disease Modifying Agents are Heparin Analongues and should not be used in Animals that have _____
Coagulopathies
Diagnoses Based on Radiograph
Osteochondrosis
The goal of ____ Technique is to Minimize the Incidence of Surgical Wound Infection
Aseptic
Which of the Following is False Regarding Active Drains:
A. Active Drains are More Efficient than Passive Drains
B. Decreased Risk of Drainage Macerating Surrounding Skin
C. Risk of Infection is Lower than with Passive Drains
D. Active Drains Enhance Healing
E. All of the Above are True
E. All of the Above are True
*Much more efficient than Gravity Drains in Removing Fluid Accumulations
*Risk of Ascending infection is Significantly Less than with Gravity Drains because the Surrouding Skin stays Drier creating a Less Hospitable Environment for Bacterial Growth
Adherent Dressing that is Primarily Indicated for Wounds producing a Low Viscous Exudate and for Wounds Containing Loose Necrotic Tissue and Foreign Materials
Dry-to-Dry Dressings
Property of Bone, where Elastic Modulus is Dependent Upon the Direction of Loading (Stress Application)
Anisotropic
*Ex. Bone is Stronger and Stiffer in Compression. Bone is Weakest when Shear Stress is Applied
Main Advantage of Moisture Retentive Wound Dressings
Autolytic Wound Debridement
Two Types of Surgical Fracture Fixation
External Skeletal Fixator
Internal Fracture Fixation (Pins, Wire, Plate/Screws)
*External Fixatory- Secures Bone to an External Rigid Fixator
Internal Fracture Fixation is used more Commonly
External Skeletal Fractures are very Useful with ____ Fractures
Open
*Open Fractures- One of the most useful Applications of External Skeletal Fixators
Conservative Treatment for which Bone Disease:
Small Lesions
Young Patient (
Clinically Silent or Mild Lameness
Diet/Exercise Restriction (Cage Rest)
Weight Control
+/- NSAID or other Therapies
Osteochondrosis
*Conservative Treatment is Suitable if you have a very small Lesion in a Young Patient that isn’t too sore as a Result
Best Prophylactic Antibiotic to use for Surgeries Involving the GI Tract, Particularly Colon or when Obstruction is Present
Cefoxitin
*Used for Procedures where a wider range of coverage to Include Anaerobes is Desired
Three Components that Make up the Construct of External Skeletal Fixators
Connecting Clamp- Secure Pins and Connecting Bars
Connecting Bar
Transfixation Pin- Inserted through the Near (Cis) and Far (Trans) Cortex
Radiograph of _____ Arthritis
Rheumatoid
*Non Infectious
Passive Drains should be Covered by a _____ to Absorb Exudate.
Bandage
*Bandaging also Reduces Soiling and Irritation of the Surrounding Skin by the Exudate
In ______ Plates, Tighetning the Screw generates Friction between the Bone and Plate. Loading of the Limb results in Forces shared between the Bone and Plate
Conventional Plates
Three Surgical Treatments for Biceps Brachii Tendinopathy
Arthroscopic Evaluation of the Joint
Tenotomy of Biceps Tendon- Cut Tendon
Tenodesis of Bicipital Tendon
Wounds converted to Clean or Clean-Contaminated status in 2-5 days by repeated lavage, debridement, and activation of host defense mechanisms can still be closed primarily but the closer is called a ______ Closure
Delayed Primary Closure
*Wound Left open for 2-5 Days
*Closed Prior to Visible formation of Granulation tissue
Plant Material Foriegn Bodies (Ex. Grass awns, Sticks) can Migrate significant Distances causing a _____ that is lined by Granulation Tissue
Draining Tract
Postoperative Care needed in ______ Includes:
Immediately After Surgery, Cover with Nonadherent Pad
Apply Broad Spectrum Antibiotic Ointment on Pad First
Apply Several Layers of Absorbent Material
Cover Bandage with Porous Adhesive or Elastic Tape
Skin Grafts
*If the Graft Crosses a Joint, immobilize the Leg with a Splint, Half Cast or Bi-valve Cast
After Performing Distant Flaps (Pouch Flap and Single Pedicle Direct Flaps), both of these Techniques necessitate Immobilization of the Leg along the Side for Approximately ____ Days
14
*The Temperament and the ability of the animal to walk on Three Legs should be considered before performing these Procedures
Signalment and History for which Shoulder Disease?
Shoulder Instability
*Poor Response to Medical Managment- NSAIDs!!!!!- Know this
*NSAIDs cannot Fix the Unstable Joint
Indications for Surgery in Cases of Traumatic Shoulder Luxation
Chronic/Recurrent/Unstable Luxation
Accompanying Fractures
Surgical Treatment for which Bone Disease:
Arthroscopic Fragment Removal and Subchondral Bone Debridement
Replacement of Articular Cartilage with Fibrocartilage
Osteochondrosis
*Surgery is the Recommended Method of Treatment in almost All Cases of Osteochondrosis/Osteochondritis Dissecans
Surgery is the Standard of Care- Debridment of Bone with Curette or Shaver
Three most Commonly used Skin Flaps in Small Animal Medicine
Single Pedicle Advancement Flap
Rotation Flap
Transposition Flap
____ Dissection is the most Easily performed by inserting Closed Scissors under the Skin and then Spreading the points to Separate the Tissues. ____ Dissection has the Advantage of Preserving the Direct Cutaneous Arteries and Veins so that large amounts of Skin can be undermined without affecting the blood supply to the skin edges
Blunt
Most Common Passive Drain, which is a Soft Latex Tubing that Collapses Easy and Conforms well to the Wound
Penrose Drain
Technique for Correcting Dog-Ears:
A. the Dog-ear is forming at the end of the suture line
B. The Incision is Extended through the Middle of the Dog-Ear to the end of the Puckered Skin
C. The _____ of Tissue formed on each side is excised at the base
D. The Skin is Sutured
Triangle
Three Infection Potentiating Factors (IPF) that interfere with Normal Host Defense mechanisms and Reduce the Number of Bacteria required to Cause Infection to as Few as 100
Montmorillinite
Kaolinite
Illite
*If you introduce any of these three components to a wound, the wound will become Infected
Post Op Fracture Assessment that Asks:
Are the Joints Above and Below the Fracture Aligned to Promote Normal Limb Use?
Alignment
*Remember to Include the Joints in all Radiographs
What are the Arrows pointing at in this Radiograph?
Osteophytes
Classification of Wound:
Surgically Created Wound
No Infections Encountered
Aseptic Technique Maintained during Surgery
No Structure normally Containing Bacteria Opened
Clean Wound
*This wound is NOT free of Bacteria- all wounds will have bacteria. In Clean Wounds the number of bacteria is very small. The risk of Infection after this type of procedure is very low
Place Cerclage Wire ___ cm from Fracture Ends
0.5
*Spaced 0.5-1x Bone Diameter Apart
Most Common Source of Operative Wound Infections
Patients Endogenous Flora
*Ex. Skin, GI Tract, Fur
Advantages of _____ Fixation:
Can be Placed with Minimal Disruption of the Fracture
Variety of Construct Options
All Implants are Removed once the Fracture is Healed
Useful for Treatment of Grade II and III Open Fractures
Implants can be Removed in Stages to Slowely Increase the Loading on Bone
External Skeletal Fixators
Type of Open Fracture Characterized by:
Open Wound > 1cm in Size
Wound from External Source
Mild Soft Tissue Trauma without Extensive Soft Tissue Damage
No Flaps or Avulsions
Type II
*Typically from an External Source
Therapy used to Seal Wounds after Surgical Debridement where Constant or Intermittent Suction is applied to the Wound that leads to Accelerated Granulation Tissue formation
Negative Wound Pressure Therapy (Vacuum Assisted Closure)
*These wounds tend to Progress More Rapidly towards Healing- Very commonly used in Acute wound Managment
*Adequate wound debridement and removal of forign bodies must be accomplished BEFORE utilizing this technique
*This Technique is primarily indicated for open wounds that contain little or no devitalized tissue for foreign material but are not yet ready for closure
After Physical Examination, what are the Next Two Steps in Initial Managment of Traumatic Wounds?
Debridement
Wound Lavage
Approach for Internal Fracture Fixation characterized by:
Avoid Disruption of Fracture Hematoma
Less Rigid Fixation
Secondary Healing
Biological Osteosynthesis
*Relies on Secondary Healing
True/False: The ability to Close Wounds by the Local Movement of Tissues is Controlled by the availability of Surrounding Skin for Movement and the Tension produced by that Movement
True
Special Kind of Subcutaneous Suture used to advance skin that has been undermined across the Surface of a Wound. These Sutures are used to help Close Skin Defects when Direct Apposition of the Skin Edges Results in Excessive Tension
Walking Sutures
*Tensions Distributed over Surface of wound rather than Being Concentrated at Primary Suture Line
The Following are Considered _____ Implants:
Orthopedic Wire
Kirschner Wires
Intramedullar Pins
Secondary
*Most often, these Materials are being used adjuctively with Plates or other types of Fixation Devices
The Blood Supply to ____ Flaps comes through the Extenisve Interconnection of Blood Vessels in the Dermis and Superficial Subcutaneous Tissue just below the Dermis
Subdermal Plexus Flap
*Direct Cutaneous Artery is NOT Included, so perfusion of the Flap is Dependent on the Driving Force (Blood Pressure) in Smaller Vessels
Etiology for which Elbow Disease:
Shortened Ulna Displaces Humerus Proximally leading to Radioulnar Incongruity
Ununited Anconeal Process
Drains are Indicated if ____cannot be sufficiently obliterated as a Wound is Closed
Dead Space
*Dead Space- the Potential Space created when tissue planes are separated or when Tissues have been Removed
Type _____ External Skeletal Fixator:
Unilateral-Uniplanar- Bar is Only on One side of the Bone and all of the Pins are in one Plane
Type IA
*Most Basic Type of External Fixator- Least Rigid of all the Constructs
When Performing a Single Pedicle Advancement Flap, Triangles of Skin are Removed at the Base of the Flap to prevent ____ from Forming when Flap is Advanced
Dog Ears
Transposition Flap that Incorporates a Direct Cutaneous Artery and Vein. Inclusion of these Vessels allows Large Flaps to be Elevated and Transferred in a Single Procedure
Axial Pattern Flaps
*Can make this flap much longer and expect it to survive because we are bringing a dominant blood supply with it
When using ____ Dressings, The Wet Dressings help Liquefy Viscous Exudates enhancing their absorption
Wet-to-Dry Dressings
Risks of ______:
Implant Failure- Loosening, Breakage, Migration
Osteomyelitis (Bone Infection)
Impingement of Nerves
Osteopenia (Bone Loss)
Internal Fixation
Method of Debridement performed by applying Adherent Dressings to a Wound. The Devitalized Tissue sticks to the Dressing Material and is Removed when the bandages are changed
Mechanical Debridement
_____ Bone has a High Porosity of 75-95% characterized by:
Long Elastic Phase- Maintain its shape for a Long Time
Lower Yield Point- Low Stress to Hit Yield Point
Cancellous
Granulation Tissue may be Slow to Cover Exposed ____. This is a Frequent Problem in Degloving Injuries. If ___ is Devitaized, Granulation Tissue will Rarely Cover it. If this Happens the ____ will usually have to be Removed unless it is Essential for Providing Stability or Function
Bone
Plate Function Described Below:
Used in Metaphyseal Fractures to Prevent Collapse of the Adjacent Articular Surface
Plate is subject to Full Loading
Most or all Screw Holes should be Filled
Buttress Mode
*Not used very Often
Indications for which type of Adherent Dressing
Dry-to-Dry Dressings
*Ex. Keralix Sponges
Three Methods of Wound Lavage
Bulb Syringe- Used for Keeping Tissue Moist Ineffective for Removing Bacteria and Foreign Bodies
Water Pik- Can Produce Pressure high Enough to Damage Tissue and Drive Bacteria Deeper into Wound
Syringe and Needle- Can achieve the Goal of Reduing the Number of Bacteria in the wound and flushing away foreign bodies without causing Significant damage to surrounding tissue (Best Method)
Shoulder Disease with the Following Presentation:
Biceps Brachii Tendinopathy
Unilateral Disease!!!- Traumatic
*Chronic Lowgrade Lameness at first, which Progresses and Worsens with Exercise
Disadvantages of ______ Fixators
Frequent Rechecks Required ($$)
Morbidity associated with Skin-Pin Interface
Pin Loosening- Implant Failure
Requires High Level of Owner Compliance
Additional Procedures required for Destabilization and Implant Removal
External Skeletal Fixation
Perferred Dilutent for Chlorhexidine
Sterile Irrigating Water
*Chlorhexidine diluted with Polyionic Solutions (Sodium Chloride) can form a Percipitate (Chlorhexidine Chloride Salt). Preference is to use Sterile Irrigating Water as the Dilutent to avoid getting percipitate in the Wound
Post Op Fracture Assessment that Asks:
Is there Evidence of Bone Healing, Infection, Osteopenia, or Malunion?
Activity
True/False: There is Evidence that Continuation of Prophylactic Antibiotics beyond 24 hours has added Benefit for Prophylaxis
False
Skin ____ retain a Blood Supply throughout the Healing Process, While Skin _____are Segments of Skin that are Completely Detached from the donor, prepared, and the placed on the Recipient Site
Flaps
Grafts
Almost any Geometry of Wound will Heal well, except for _____ Wounds
Circular
*Avoid creating Circular Wounds and Avoid leaving wounds with a Circular Configurations
Biological Dressing that contains natural components, such as Collagen (Types I, II, an V) and Transforming Growth Factor Beta and Beta Fibroblast Growth Factor
PSIS
Porcine Small Intestinal Submucosa
*Conducive to smart tissue remodeling of organ augmentation and reconstruction with reduced scar formation
Surgical Treatment for Arthritis Described Below:
Complete Removal of ALL Articular Cartilage
Cancellous Bone Graft
Rigid Fixation (Usually DCP)
Standing Angle
Arthrodesis
Type of Biological Osteosynthesis Approach:
Fracture is Surgically Approached and Visualized
Fracture Ends are NOT Manipulated during Placement of Implants
Fracture Reduced via Traction or Manipulation of Bone Away from Fracture
Minimal Distrubance of Fracture Hamatoma, Periosteum and Blood Supply
Open but do Not Touch
*Don’t Manipulate Pieces of the Fracture or Hamatoma
Surgical Treatment for Arthritis characterized below:
Technically Challenging
Highly Specialized Instrumentation/Training
Hip, Elbow, Stifle, Shoulder
Expected Outcome dependent upon Joint
Intent is to Allow/Preserve Normal Joint Function
Joint Replacement Arthroplasty
Etiology of which Bone Disease:
Most common in Larger Breed Dogs (Great Danes)
Rapidly Growing Breeds
Males Predisposed
Hereditary- Within Blood Line (Animals with OCD- Do NOT Breed)
Nutritional- Rapid Growth, Calcium/Vitamin D
Osteochondrosis
*By Far most Common in Large Breed Dogs, including Great Danes
Nutrition influences Manifestations of Osteochondrosis- Breeds Predisposed to OCD have Rapid Growth. Oversupplying with Energy during the Rapid Growth phase has been shown to Predipose to OCD
If Recipient Bed has Irregular Edges, a _____can be made to make sure the Graft will cover the Defect. To make a _____:
Place Absorbent Material (Gauze or Towel) on the Surface to Obtain Blood Imprint of the Recipient Site
Transer the Pattern to Donor Site
Pattern
Most Common Type of Bone Plate that are Very Stiff and Fail by Bending
Stainless Steel
*Stainless Steel Bone Plates tend to Fail by Bending
Type of Orthopedic Wire that is:
Placed like “Sutures” Holding Bone Fragments Together
Indicated in Simple Fractures of Flat, Non Weight Bearing Bones that Interdigitate Well
Most Commonly used for Mandibular and Maxillary Fractures
Interfragmentary Wire
Flaps that are used to Reconstruct Distal Limb Wounds when Axial Pattern Flaps cannot be extended Far enough to cover the Defect and when Skin Grafting is not Deemed a Viable Option
Distant Flaps
When Constructing an Axial Pattern Flap, If the edge of the Defect is not Adjacent to the Donor Site, and Incision can be Made between the Donor Site and the Wound (Bridging Incision) or the Flap passing over Intact Skin can be sutured into a _____
Tube
*Tubing the Flap has the Disadvantages of Requiring a Second Surgery to excise the Tube portion of the Flap
*His Preference is to make Briding Incisions in almost all instances
*Picture Below- Thoracodorsal Artery Axial Pattern Flap
List Three Neutraceuticals- Food or part of Food that Provies Medical Benefit in Treatment of Arthritis
Glucosamine
Omega 3 Fatty Acids
Avocado
For Degloving Injuries, Devitalized Tissue and Foreign Material are Debrided but an Effort should be made to conserve as much skin as possible to aid in the reconstruction. _____ Adherent Dressings are often used Early to help Debride the Wound
Wet-to-Dry
Cartilage is always being Broken Down or Synthesized. In Arthritis the Balance is Shifted towards Destruction. The point of ______ agents are to Slow Down, Stop or Reverse the Breakdown of Cartilage as much as possible
Disease Modifying Agents
*Building Blocks for Articular Cartilage and Joint Fluid- Promote Synthesis over Breakdown
Name these Fracture Configurations from Left to Right
Transverse- Straight Line Across
Oblique
Spiral
Comminuted/Reducible
Comminuted/Nonreducible
*Comminuted- More than 2 Bone Segments
The Time Between Wounding and the Development of Infection
Golden Period (4-6 Hours)
*Number of Organisms are Low enogh that Primary Closure can still be Performed
Indications for ______:
Fracture Fixation of Appendicular Skeleton- Below the Stifle or Elbow
Spinal Fractures/Luxation
Mandibular Fractures
Correction of Angular Limb Deformities
Limb Lengthening
External Skeletal Fixator
True/False: For Active Drains, Continuous Suction should be Maintained by Emptying the Container before it is completely full and Retrograde Flow back into the wound should be Prevented by Temporarily Occluding the Drain while the Container is being Emptied, unless the Canister has a One-way Valve to Prevent Backflow
True
_____ Sutures help to eliminate Dead Space and Distribute Tension over the Entire Surface of the Wound rather than Concentrating it at the Wound Edges
Walking Sutures
In Patients with Degloving and Crush Injuries, when you initially evaluate these Patients, you need to check _____ Sensation prior to Analgesic Administration
Pain
*When Initially evaluating, check Pain (Neurologic) Sensation. Once you start Analgesics, it becomes harder to assess Pain Sensation
If the Patient has Deep pain sensation- Neuronal Sheath is Intact
Complications of _____ Flaps Include:
Flap Edema
Seroma
Infection
Partial Dehiscence
Vessel Thrombosis with Flap Loss
Axial Pattern Flaps
*Most Worrisome- Vessel Thrombosis leading to Loss of Flap
NSAIDs reduce pro Inflammtory Mediators by Inhibiting ______
Cyclooxygenase
*COX2- Responsible for creating all the Inflammatory Mediators. Most NSAIDs used for the Treatment of Arthritis are selectively Suppressing COX2
*All NSAIDs have Side Effects!
Fractures and Unstable Joints resulting from Degloving Injuries are best stabilized by an External Fixator (Ex. Kirschner-Ehmer Apparatus). External Fixators allow some _____
Joint Motion
*Use an external fixature that allows a small amount of joint movement
Noninflammatory ____ Osteoarthritis:
No Underlying Cause
Highly Unusual in Dogs
More common in Cats
Primary
*Dogs will Almost always have Secondary Osteoarthritis- Secondary to Something Else
____ Strain:
Forces Applied that lead to Shortening of Bones
Compressive
When Blood Supply is Considered, Skin Flaps in small animals are classified as ____Flaps, if a Direct Cutaneous Artery and Vein ARE Included
Axial Pattern Flap
Treatment/Managment for Burn Wounds
Fluid Resuscitation- Important (Ex. Hydrotherapy)
Initial Burn Managment- Aloe Vera, Silver Sulfadiazine
Cool Injured Tissue
Surgical Debridment
*Burn Wounds are very likely to become Infected- Therefore need to use Topical Antibiotic such as Silver Sulfadiazine. Aloe Vera and Silver Sulfadiazine work Synergystically
Two Distant Flaps most Applicable to Small Animal Medicine
Pouch Flap
Single Pedicle Direct Flap
Review Card: Anatomy of Bone
Characteristic Posture for patients with Elbow Dysplasia
MCD
“Toed Out”
*Foot Turned out to the Side and Elbow is Abducted
_____ Implants Include:
Kirshner Wire (K Wires)
Cerclage Wire
Interfragmentary Screws
Secondary
*Secondary Implants- Devices that we use to help maintain Reduction while you are Putting on Primary Implants
Best type of Bone Plate to use on:
Geriatric Patients
Very Comminuted Fractures
Osteoporotic Bone
MIPO- Minimally Invasive Plate Osteosynthesis
Locking Plate (LCP)
*Used on Fractures that will take a Long time to Heal
*Would NOT use LCP on Young Animals who Heal Faster
Treatment for Congenital Shoulder Luxation with Normal Glenoid
Open Reduction/Capsulorrhaphy Only
Glenohumeral Ligament Reconstruction
How to Perform a ____ Skin Flap:
Intial Incision is Made 2-2.5 Times the Width of the Defect
Skin is Undermined Deeply to Perserve Blood Supply
Arcing Incision is Incrementally lengthened and Undermined until the Flap can be Advanced with little Tension
Rotation Flap
*Back Cut Incision- Increases mobility of the Flap but also Increases the Risk of Vascular Compromise
Pros and Cons of which Type of Fracture Fixation:
External Coaptation (Ex. Splint/Cast)
*Cons- Require Frequent Rechecks, which Drives up the Cost
Immobilization of Joints
Methods to _____ External Skeletal Fixator Rigidity:
Decrease Frame Type
Decrease Number of Pins
Smaller Diameter of Pins and Connecting Bar
Decrease
*As a patient begins to heal, we Choose to Decrease Rigidity to let that bone bear more Weight and Forces to Promote Healing- Wolfes Law: The more Forces that a Bone experiences, the more likely that it is to Heal and create new Bone
Bone Disease Described Below:
Necrotic Cartilage Induces Repair
Inflammation is the First Stage of Repair
Defect in Joint Surface Accelerated Degenerative Joint Disease
Pain of Clinical Disease is a result of Inflammation
Osteochondritis Dissecans
Topical Wound Medication that is Produced from Kelp (Seaweed) that is very good for Wounds in the Early Stages of Wound Healing that do Not need Further Debridement but are Producing a lot of Exudate. This Topical Medicine is Exteremely Hydrophilic and will absorb a lot of Fluid from the Wound
Calcium Alginate
*Promotes Autolytic Wound Debridement and wound Healing
True/False: To be Effective, Prophylactic Antibiotics should be Administered at least 30 minutes but no more than One hour before the Skin Incision
True
Physical Exam findings with which Should Disease?
Biceps Brachii Tendinopathy
Prognosis with Osteochondrosis/Osteochondritis Dissecans
Expect Near Normal to Normal Function with Surgery
Biological Dressing that is a Natural, Resorbable, Biocompatible Scaffold which potentiates appropriate tissue remodeling, Reinforces Wound Tissue, and is absorbed by the body as it is replaced by Host Tissue
Porcine Small Intestinal Submucosa (Vet BioSISI)
*Takes on the characteristics of the tissue that you put it in
Bite Wounds that extend into the _____ should be Explored when the Patient is Stabilized because of the High Risk of Penetrating Injuries to the GI Tract
Abdominal Cavity
Developmental Orthopedic Disease, such as Osteochondrosis, almost always have what is referred to as a ______age Distribution, when you talk about Age of Onset
Biphasic
*Immature- Inflammatory Arthritis
Mature- Secondary Degenerative Arthritis
Bone Plate with the Following Characteristics:
Fixed Angle Implants
Threaded Lock Screw Head Locks Into Threaded Screw Hole on Plate
Prevents need for Plate-Bone Contact
Little to No Contouring Required
Locking Plates (LCP)
Once the Graft is Placed on the Recipient Bed, the Graft should be Manipulated as little as possible to Avoid Disrupting the ____seal that begins to form soon after the graft is placed on the Recipient Bed
Fibrin
Mainstay Drugs used for the Treament of Arthritis
NSAIDs (Tramadol, Gabapentin)
*These Drugs are not Treating the Underlying Cause of the Disease, Rather they are Diminishing the Signs of it
Easiest way to Assess the Extent of Burn Injuries
Rule of 9s
A Reversible Change in Shape, where Material Returns to Original Shape when Load is Removed
Elastic Deformation
____ can be Successfully Placed on:
Freshly Created Surgical Wounds with Sufficient Blood Supply to Produce Granulation Tissue
Healthy Granulation Beds
Skin Grafts
*Prefer to Allow Healthy Granulation Bed form before Grafting
A Patient has Bite Wounds to the Thorax and a Positive Test for Hemothorax (Blood within the Thorax). What is the Significance in seeing if this Blood has Clotted or Not?
Ongoing Bleeding- Blood will Clot
Old Bleeding- Blood will Not Clot
*If the Blood does Not Clot then the blood is old and you don’t have to be worried about current bleeding in the Thorax
If Reconstruction of the Wound is Delayed for Prolonged Period, the _____ Granulation Tissue is not Conducive to Successful Grafting
Chronic
*Chornic Granulation tissue should be Excised to its Base, and Fresh Granulation bed allowed to form before any Skin-Grafting Procedure is Performed
True/False: Intraoperative Administration of Antibiotics has NOT been shown to Decrease Incidence of Infection
True
Incremental Destabilization of the Construct of an External Skeletal Fixator, that Allows Increased Axial Loading of the Fracture to Enhance Callus Hypertrophy and Remodeling of the Fracture
Dynamization
If Bone is Viable, Granulation Tissue coverage of the Bone can be Encouraged by performing _____. Multiple Holes are Drilled through the Cortex of the Bone into the Medullary Cavity. Blood Clots that form will act as Scaffold for Granulation Tissue Formation
Cortical Fenestration
Retraction of Skin Edges after Tissue is cut
Primary Contraction
Bone Plate in which the Plate Surfaces are Flat, where Friction Between Bone and Plate Creates Stability
Dynamic Compression Plate (DCP)
*By Creating Friction between the Bone and the Plate, the Plate is Stabilizing the Bone
Axial Flap that is Made based on the Following Landmarks:
Patient in Lateral Recumbancy with Limb in Relaxed Extension
Spine of the Scapula
Caudal Border of the Scapula
Vessel Originates at the Caudal Shoulder Depression
(Flap #3 in Diagram)
Thoracodorsal Artery Axial Pattern
*Origin of Vessel in Caudal Shoulder Depression
If Wounds are left Open for Longer than 5 Days, Granulation Tissue will begin to fill the wound. Closure of wounds after Granulation tissue has Formed is called ______
Secondary Closure
*Secondary Closures are easies to perform when the Wound is Deep and Narrow
_______ System can be used with Both Active and Passive Drains to perform Wound Lavage or Injections into wounds
Ingress/Egress System
*Ingress- Fluids go into the Wound Site
Egress- Fluids come out of the Wound Site
One way System- Do NOT Inject into Egress Drain
True/False: Glass, Gravel, Pellets, and Carbon Material Foriegn Bodies are commonly Inert (Immobile)
True
Bone Disease characterized by:
Aberrant Repair that Leads to Degradation of Articular Cartilage
Altered Subchondral Bone Metabolism
Periarticular Osteophytosis
Synovial Inflammation
Osteoarthritis
Screws with these Characteristics:
Best for use in Metaphyseal and Epiphyseal Bone (Trabecular Bone)
Increased Outer Diameter
Deeper Thread
Larger Pitch
Cancellous Screws
*Cancellous Screws have a Smaller Core Diameter- More likely to Bend
Cancellous Screws- Better in Bone that is Softer/Less Dense (Ex. Metaphyseal Bone)
In Patients with Plant Material Foreign Bodies, Instilling Dilute _____ into the Tract prior to surgery stains the tissue and can make following the tract easier
Methylene Blue
Planned Decrease of the Stability of an External Skeletal Fixator is Termed _______
Dynamization
True/False: Since Drains are Foriegn Bodies, Drainage will Rarely Completely Cease until it is Removed
True
Fractures that Only occur in Skeletally Immature Animals
Physeal Fractures
*Physis (Growth Plate) is only Present in Young Animals
*Salter Harris Fractures- Physeal Fractures in YOUNG Immature Animals
*Physis- Area of Weakness in Young Animals
Most Common Area of the Body that Leads to Clean-Contamined Wounds during Surgery
GIT
In _____ Plates, Tightening the Screws Locks the Screw into the Plate Creating a Construct that Converts Shear and Bending Stress into Compressive Forces at Bone-Screw Interface
Locking
*The Plate is locked into the Screw and the Screw is very Well Seeded within the bone. The Force is able to go up through the Screw and go across the plate at the Area of the Fracture
*No Load sharing at the Level of the Fracture
Full-Thickness Skin Grafts may Develop ______, especially if Revascularization is Delayed. This is generally the Result of the Overgrowth of Normal Skin Flora on an abnormal skin and does NOT Markedly affect Graft take
Superficial Infection
Screw Diameter should Not Exceed _____% of Bone Diameter when Used in Diaphyseal Bone
40%
*Most of the time use screws that are closer to 25-30% of the Bone Diameter
Initial Event in Osteochondrosis is Related to ____ to the Developing Epiphyseal Cartilage as it Ossifies
Blood Supply
Mobile Fragment within a Joint
Joint Mouse
*Loose Osteophyte
Type of Orthopedic Wire Placed Circumferentially Around Bone Column that Causes Compression across Fracture ends
Cerclage Wire
*Place Circumfrentially around Bone to Restore the Bone Column
What Strain Types can External Skeletal Fixators Counteract?
Axial Compression
Rotation
Bending
Tension
If you are Concerned about Infection at a Drain Site, a sample can be Collected on a ____ swab. If Bacteria are seen on Cytology, the Swab can be Submitted for Sensitivity Testing
Culture
*Cut off/Swab end of Drain from Deepest part of Wound after Removal
Intramedullary Pins Resist ____ Forces Only
Bending
True/False: Open Traumatic Wounds should Initially be Considered Clean-Contaminated at Best
False
*Traumatic Wounds = Contaminated at Best
Negatively Charged Particles with Large Surface Area that are a Clay and Organic Soil Component that Inhibit Phagocytosis and Bacterial Killing
Infection Potentiating Factors (IPF)
*IPF- Increases the Risk of Infection within a Wound. If Clays or Organic Soils are within the Wound you want to do a good job trying to flush them out
Physical Exam results for which Disease of the Elbow?
Elbow Dysplasia
After Axial Pattern Flaps are Placed, ____ in the Flap is common during the First week after Surgery because of the Change in Orientation of the Venous Return and Disruption of the Lymphatics
Edema
Most Common Cause of Degloving Injuries
Hit by Car
*Combined Degloving and Crush Injuries are More common in Dogs and Cats
Classification of Wound:
Surgically Created Wound
Hollow Viscus is Opened with Gross Spillage
Major Break in Technique- Ex. Scratch Nose or Adjust Glasses
Contaminated
*Ex. Obstruction- More fluid contained in the GIT and greater Likelyhood that you will spill some of those contents
*Major Break in Technique- Scratch Nose or Adjusting Glasses
If you are using Intramedullary Pins in Combination with a Plate, you was the Intramedullary Pin to Fill _____% of Medullary Canal
30-40%
Neutraceutical that Competes with Arachidonic Acid as a Substrate for COX that Leads to Production of Less Proinflmmatory Mediators
Omega 3 Fatty Acids
Best Diagnostic Test for Diagnosing Plant Material Foreign Bodies
Ultrasound
*Plant-Based Foreign Bodies are Commonly Nonradioopaque and hard to diagnose on Radiographs
*Ultrasound can be used during surgery to help locate the Foreign Body- Intraoperative Ultrasoundography
Administration of Antibiotics after Infection is Present
Therapeutic
True/False: Orthopedic Wire can be used as Sole Method of Fracture Fixation
False
*You NEVER use Wire as a Sole means of Fraxture Fixation- Except on some Mandibular Fractures
Post Op Fracture Repair Assessment that asks:
Are Fracture Fragments Well Apposed?
Apposition
*Make sure the Fracture Fragments are Touching/Near Eachother
Granulation Tissue is Ready for _____ when:
Granulation Tissue is Pink and Glistening
Surface is Smooth
Wound is Contracting and Epithelial Migration is visible at Wound Margin
Grafting
In Patients with Gunshot Wounds, the Tissue Damaged Produced is greatly Influenced by the_____of the Projectile.
Velocity
*Low Velocity bullets generates Smaller amounts of Kinetic Energy so damage is usually confined to an area immediately around the path of the bullet
Possible Complications of _____ Fixators:
Pin Tract Drainage- Infection of Soft Tissues
Loosening of Pins/Wires- May Result in Bone Resorption
Osteomyelitis
Ring Sequestrum
Nerve or Vascular Damage
External Skeletal Fixators
______ Therapy helps animals to Move their Limbs through a Greater Range of Motion. Bouyancy Allows Activity while Reducing Stress on Joints
Underwater Treadmills
Prognosis for Traumatic Shoulder Luxation
Good to Excellent
Neutraceutical that Stimulates Proteoglycan Synthesis of Hyaline Cartilage and has Antiinflammatory Effects
Glucosamine
Deep Partial Thickenss Burn Wound. What is the Significance if the Hair does NOT Epilate (Pull Out) Easily?
Hair Follicle is Intact and Tissue will Survive
*Epilate- Pulling Hair Out
*Intact Hair Follicles provide more Epithelialization to the Wound Healing Process
Disadvantages of _____:
Bacteria can Flourish in Moist Environments
Wet Dressings can cause Maceration of Surrounding Skin
If Bandage soaks through, Bacteria can Move into or Out of Bandage (Strike-Through)
Adherent Dressings
_______ has been Found Helpful in the Treatment of Arthritis, Inlcuding Techniques such as:
Cold/Heat Therapy
Passive Range of Motion Exercise
Massage
Swimming
Treadmill Exercise
Acupuncuture
Physical Therapy/Rehabilitation
*Passive Range of Motion- Non Weight bearing Flexion and Extension of a Joint. The Joints are moves through as much of a Range of Motion as can be accomplished Comfortably. Helps Mantain and Improve Range of Motion and Promote Blood and Lymphatic Flow
_____ The Graft has the Following Advantages:
Allows Expansion of Graft to Cover Larger Defects
Allows Drainage of Blood and Serum from Under Graft
Allows Graft to conform bettern to Uneven Surfaces
Meshing
*The Degree to which a Mesh graft can be expanded is determined by the number of rows and slits and the length of each Slit. Increasing Either or Both Increases the Degree of which the Graft can be Expanded
Fixation that Uses Percutaneous Pins or Wires Attached to External Construct to Stabilize Fracture Fragments
External Skeletal Fixation
Radiograph of ____ Arthritis
Septic
*Infectious Arthritis
Adherent Dressings that are used on Wounds containing Necrotic Tissue and Foreign Material and are particularly useful on Wounds producing a High Viscous Exudate
Wet-to-Dry Dressings
*Wet-to-Dry Dressings should be Discontinued once the wound bed is Healthy
Only use Cerclage Wire on Which Two types of Fractures?
Long Oblique
Spiral Fracture
Single Most Important Element in the Treatment of Osteoarthritis
Weight Managment
Steinmann Pin Technique characterized by:
Use of 2 or More Smaller Diameter Pins rather than One Larger Pin
Higher Incidence of Pin Migration
Increased Damage to Medullary Blood Supply
Rarely Practiced
Stack Pinning
If your Patient has a Congenital Shoulder Luxation with Glenoid Dysplasia, which Treatment is Best?
Salvage Procedures
*Ex. Arthrodesis, Glenoid Excision, Amputation
The Risk of Infection _____ with Every 70-90 Minutes of Surgery
Doubles
*Rule of Thumb- Risk of Infection Doubles every Hour
Gold Standard of Diagnoses for Elbow Dysplasia
Arthroscopy
Review Card: Salter Harris Fractures
Type 1: Separation at the Level of the Physis
Type II: Fracture across Physis and Metaphysis (Above)
Type III- Physis and Epiphysis are Fractured (Lower)
Type IV: Fracture through the Metaphysis, Physis, and Epiphysis
Type V: Crushing Injury at Physis
*The Physis will be Involved in every Type of Salter Harris Fracture
Type II and Type III are Most Common
Prison (Physis) Makes (Metaphysis) Every (Epiphysis) Boy (Both) Crazy (Crush)
Removal of the _____ is Facilitated by suturing the Graft Subcutaneous Side up to a Piece of Sterile Cardboard to Stretch it back to its normal Dimensions
Subcutaneous Tissue
*The base of the Hair Follicles will be Visible when the Subcutaneous Tissue is Removed, giving the Graft a “cobblestone Appearance”
True/False: When Placing a Conventional Plate, you NEVER want to place a Screw through the Fracture
True
*Ideally you want the Screw to be a minimum of 5mm Away from the Fracture
When Placing External Skeletal Fixtures, the Connecting Rod should be as Close to the Bone as Possible, and the Clamps connecting the Pins and Rods should be at least ___cm away from the Skin
1 cm
Physical Exam findings for which Shoulder Disease?
Traumatic Shoulder Luxation
*Make Diagnosis based on- Malpositioning of Greater Tubercle
*Greater Tubercle will be more Prominant than Normal and the Limb will be Abducted
External Skeletal Fixator with the Following Characteristics:
Use of Small Diameter Fixation Wires and Transfixation pins- Optimized Bone Purchases in Small Fracture Fragments
Wires Connect to Rings
Rings are Connected by Rods
Circular External Skeletal Fixators (CERF’s)
_____ Strain:
Combination of Tensile (Lengthening) and Compressive (Shortening) Loading Forces
Bending
Common Causes of Nonhealing Wounds Include all of the Following, Except:
A. Foriegn Bodies
B. Immunodeficiency
C. Hard to Culture Pathogens (Actinomyces, Sporotrichosis)
D. Concurrent Disease
E. Nutritional Status
F. Drugs (Chemotherapy)
All of the Above are Causes of Nonhealing Wounds
Easiest Method for Harvesting _____:
Dissect from Donor Site deep to Cutaneous Trunci Muscle
Remove Cutaneous Trunci Muscle and Superficial Subcutaneous Tissue Prior to Applying Graft
Skin Grafts
*Harvest Graft at the Level of the Subcutaneous Tissue below the Cutaneous Trunci Muscle with Scissors
Most Commonly used Method of Surgical Debridement, where you begin with Superficial Layers (Skin) and Progress to the Deepest Extent of the Wound
Layered
*All Devitalized Skin, Muscle and Fat should be sharply Excised. Blood Vessels, Tendons, Ligaments and Nerves should be Spared unless Obviously Severed
Indications for _____:
Complicated Fractures of the Tibia and Radius
Distraction Osteogenesis- Bone Lengthening Procedures
Correction of Angular Limb Deformities
Circular External Skeletal Fixators (CERFs)
*Great for more Complicated Fractures of the Tibia and Radius
Classification of Wound:
Infected Wounds Containing Pus
Contain Contents of Perforated Hollow Viscus
Dirty
Topical Wound Medication that is a Hydrophilic Powder used to Cleanse Wounds and Promote Healing because it is:
Chemotactic for PMNs and Macrophages
Provides Energy for Cells
Stimulates more Rapid Granulation Tissue Formation
Antibacerial Properties
Maltodextrin
______ Tracking Suture should be used with Penrose Drains to Maintain the Position of the Drain
Percutaneous
*If Tracking Sutures are used to Maintain the Position of a Drain, they should be Passed Percutaneously so that the suture can be cut and Removed before the Drain is Pulled
*Do NOT use Buried Sutures
Moderate ____, such as Walking and Swimming, is Indicated in Patients with Osteoarthritis in order to Maintain Muscle Strength and Joint Flexibility without Increasing Pain
Exercise
*Exercise Reduces Pain
We only use Cerclage Wire on Long Oblique or Spiral Fractures. The Fracture line must be >/= ___x’s the Diameter of the Bone and you must be able to Reconstruct the Bone Column
2x’s
Technique where you Use a Cortical or Partially Threaded Screw as a ____Screw:
Used for Oblique Fractures
Screw Positioned PERPENDICULAR to the Fracture Line
Glide Hole Drilled in near Cis Cortex
Trans Cortex is Drilled to the Core for the Core Diameter of the Screw
Tightening of the Screw pulls the Trans Cortex Closer to the Cis Cortex Causing Compression across the Fracture
Lag
Drill One Wider hole through One Cortex (Cis Cortex)
Drill a Smaller Hole through the Other Cortex (Trans Cortex)
Physical Exam Findings common with which Bone Disease?
Osteochondrosis/Osteochondritis Dissecans
*Pain on Hyperextension of Shoulder Joint
Pain on Flexion of Shoulder Joint
Dressings that contain various Growth Factors and some also Inhibit Bacterial Growth, that actually contribute to the Wound Healing Process rather than just covering the Wound
Biological Dressings
*Ex. Equine Amnion
True/False: Fenestrating Penrose Drains Increase the Effectiveness by Reducing Surface Area
False
*Fenestrating Penrose Drains DO NOT Increase their Effectiveness and in fact, may decrease their Effectiveness by reducing Surface Area
How to Perform a _____ Skin Flap:
Parallel Incision are Made from the Corners of the Leading Edge
Incisions are made 1.5 times as Long as the Defect
Skin is Underminded to the Cutaneous Trunci
Advance Flap across the Defect
Suture the Skin Flap in Place
Single Pedicle Advancement Flap
*If Flap will not Reach Across Defect, the Incisions are Lengthened Incrementally.
Pathophysiology of which Bone Disease:
Focally Thicker Cartilage due to Failed Endochondral Ossification
Cleft between Calcified and Non Calcified Tissue
Force of Normal Activity Fractures Cartilage
Osteochondrosis
Shoulder Disease characterized by:
Congenital Shoulder Luxation
Goal with ____ is to Achieve as much Contact with Bone with a Sufficiently stable Implant of Minimal Size
Screws
*Goal of Screws- Sufficiently Stabilize the bone while using an Implant of Minimal Size_- Don’t want to Oversize Screw. If Screw is Oversized then you can Damage the Bone_
Change in Shape due to Application of a Force (Stress)
Deformation
*Change in Shape
Goals of ______:
Restore Length and Alignment to Promote Normal Bone Healing
Minimize Motion at Fracture Ends
Permit Early Ambulation with Use of as many Joints Possible during Healing Period
Balance the Forces that Promote Bone Healing vs. Those that Promote Bone Resorption
Fracture Fixation (Immobilization)
*Alignment does NOT mean Alignment of Fracture Fragments, but Rather Alignment of the Limb. Alignment = Normal Limb Alignment
Intramedullary Pins can be used in Humerus, Femur, Tibia, Ulna, Ect, but is CONTRAINDICATED in the _____
Radius
*Radius has a Cranial Bowing and if you try to pass the pin down the Medullary Canal, you will end up coming out of the Cranial Aspect of the Articular Surface
In Patients with Bite Wounds, Devitalized tissue should be extensively debrided and the wound thoroughly Lavaged. In Most cases _____ are Placed prior to wound Closure
Drains
*Drains are used to assess the character of the fluid coming from the wound
Clinical Applications for _____ Wiring:
Olecranon Fractures
Greater Tuberosity Fractures
Lateral Malleolus Fractures
Patella Fractures
Greater Trochanter Fractures
Tension Band Wiring
(Avulsion Fractures)
Most Common use of Skin Grafts
Reconstructing Degloving Injuries on Extermities
*Distal Limb wounds are often difficult to reconstruct with Local Flaps because of Limited Size of Flaps available Locally
In Patients with Degloving and Crush Injuries, If we know Implants will be needed, we should treat _____ wounds first in order to decrease the risk of Infection
Skin
*Treat Soft Tissue Injuries First
*Degloving combined with Crush Injury is more Common in Small Animals than just Degloving when the Distal Limb is Affected
True/False: An Assessment of the Severity of Bite Wounds can be assessed via a Good History and Physical Exam including Examining the Skin for Puncture Wounds, Bruising, and Probing the Wounds after Administrating Sedatives
True
Type _____External Skeletal Fixator:
Bilateral-Uniplanar with Combination of Full and Half Pins
Type 2B
*Only difference between 2A and 2B is that some Half Pins are Included in the 2B Fixator
Prefer ____ Skin Grafts for the Following Reasons:
Consists of Epidermis and Dermis
Includes Hair Follicles and Adnexal Structures
Best Cosmetic Apperance and Function
Full-Thickness
In many Degloving Injuries, Tendons, Ligaments and Joint Capsules are damaged beyond repair. In this Situation the Wound is left ____ because the Greater amount of Fibrous Connective Tissue formed during second Intention wound healing helps to stabilize the joint
Open
*If the Skin is closed, less fibrous connective tissue is formed so joint instability and pain are more likely to persist. Wound Closure can be Performed after healthy Granulation Tissue Covers the Wound
Technique with Steinmann Pins that is used most Commonly with Salter Harris Fractures
Cross Pinning
When Placing Pins for _____, the Pins are Placed Percutaneous through Small Incisions in Areas with Little Soft Tissue Coverage
External Skeletal Fixators
*Avoid Important Neurovascular Structures
Rank these Procedures from Least to Greatest Risk of Surgical Wound Infection
- Contaminated
- Clean-Contaminated
- Clean Procedures
- Dirty
Clean Procedures- Least Risk of Infection
Clean-Contaminated
Contaminated
Dirty- Greatest Risk of Infection
*Dirty- Implies Infection
Graft with the Following Characteristics:
Full-Thickness Plugs of Skin Placed in Granulation Bed
Not used often in Small Animals
Enhance Epithelialization
Poor Cosmetic Appearance
Punch (Seed) Grafts
Secondary Implant that is Often Referred to as Intramedullary Pins that come in a Variety of Lengths
Steinmann Pins
How to Apply _____ Graft:
Skin Biopsy Punch is used to Remove Plugs of Granulation Tissue at 5-7 mm Intervals over the Surface of the Wound
Grafts are Harvested using the Skin Biopsy Punch and placed into the Plug Holes
Fibrin Seal Forms between the Graft and Recipient Bed
Punch Graft
*Grafts are Press fit into Granulation Bed but not Secured otherwise
Key Points in Designing a ______ Flap:
- The Edge of the Defect should be Incorporated into One Side of Flap
- The Width of the Flap should be Equal to the Width of the Defect
- The Legth of the Flap is determined by measuring the distance from the Pivot Point to the Most Distant Point of the Defect (A-B = B-C)
Transposition Flaps
*Creating a Flap that is too short will create a Line of Tension across the Flap which can Interfere with Circulation and Result in Necrosis of the Flap Distal to this Point
*If the Flap is designed properly, there should be minimal Tension on the Closure
Screw Placed Across a Fracture line to Hold a Fragment in Place, where No Compression across the Fracture is Achieved
Position Screw
*Weaker repair compared to Lag Screw
Pros and Cons of which type of Fracture Fixation?
Internal Fixation
*By Placing something Internally and making the Fracture as Secure as Possible, you will Create More Stability and Promote Normal Muscle and Joint Function
Internal FIxation leaves the Joints Free to be Mobile
Cons- May have to Remove Implants due to Pain/Discomfort to Patient or Infection (Biofilm)
4 Diseases that lead to Elbow Dysplasia
Ununited Anconeal Process
Fragmented Medial Coronoid Process
Osteochondrosis Dissecans (OCD)
Joint Incongruity
Technique used to relieve tension on Primary Suture Line and to Facilitate Closure of defects on the Distal Aspects of Limbs. Typically make a complete Row of Incisions leaving 1-2 cm between each Incision. The Second Row of Incisions should be Staggered with those in the First Row.
Multiple Punctate Relaxing Incisions
*Primary Indication- Facilitate Closure of defects on the distal aspect of the Limbs
*The Smal secondary defects created heal more Rapidly by second intention then when one large wound is left to heal by second intention
Spontaneous Fusion of Joint which Signifies End Stage of Joint Disease
Ankylosis
True/False: In Order for Fractures to Heal, they should have Very Little/No Motion at the Fracture Ends
True
*Motion will cause Bone Absorption of Fracture Ends
Internal Fixation that Combines Benefits of a Intermedullary Rod and a Plate:
Used to Treat Diaphyseal Comminuted Fractures
Can be Placed to Adhere to Principles of Biological Osteosynthesis
Cannot be used for Fractures of the Radius
Interlocking Nail
Burn Wounds with ______% Coverage of the Patient are Often Associated with Significant Complications and Prolonged Treatment
> 50%
* < 15% Burn Coverage- Good Prognosis
* 15-50% Burn Coverage- Patient will be Okay, but Will take a Lot of Work- Reconstruction Procedures
Type ____ External Skeletal Fixator:
Bilateral-Uniplanar- Pin goes through the Both Cortices and Out through the Skin so that we can Place a Connecting Bar Medially and Laterally
Uses Full Pins
Stiffer than Type 1
Type 2A
Type of Orthopedic Wire that is used to:
Neutralize the Pull of Muscles/Tendons on the Fracture Fragment
Distractive Forces of Tendon or Ligament are Converted into Compressive Forces
Indicated for Avulsion Fractures and Some Osteotomies
Tension Band Wire
Mismatch in Articular Surfaces
Incongruity
_____ Drains Actively Remove Exudate by applying Suction
Active
*Much More Efficient than Gravity Drains in Removing Fluid Accumulations
When Placing a Pin for External Skeletal Fixator, The Pin Diameter should be no more than ____% of the Bone Diameter
25%
During Perioperative Preparation of a Traumatic Wound, if Sufficient skin is Present, the Wound can be Temporarity Closed with skin Staples or Suture before Clipping the Hair and Prepping the Skin. Otherwise, further contamination of the wound is prevented by packing it with saline moistened sponges or by covering it with ______ followed by sponges while the surrounding skin is Prepared
Lubricating Jelly (K-Y Jelly)
_____ a Skin Flap avoids making Bridge Incisions, but will require a Second Surgery to Cut the Flap free after it has Healed in the Wound Bed
Tubing
Treatment for Mild, Moderate and Severe Shoulder Instability
Mild- Rest, Physical Therapy
Moderate- Arthroscopic Thermal “Capsulorrhaphy”- Thermal Insult Induces Repair
Severe- Medial Glenohumeral Ligment Reconstruction
Type _____ External Skeletal Fixator:
Bilateral-Biplanar- Full Pins that go Through both Cortices of the Bone, in Addition to Half Pins coming in from a different Plane
Stiffer than Type I or Type II
Type 3
Which Two Components can be used as a Biological Bandage for Patients with Physiologic Degloving Injuries
Aloe Vera
Silver Sulfadiazine (Antibiotic Cream)
Grafts Transferred between Individuals of Different Species
Xenografts
True/False: Drains should NEVER Exit through the Incision Line
True
*Drains should ALWAYS Exit through a Separate Stab Incision, not the Primary Suture Line
*Drains that Lie Directly under Suture lines or Exit through them can Interefere with Wound Healing and Result in Wound Dehiscence
Point when Material begins to Deform Plastically. Strain Exceeds the Materials ability to Recover rendering it Permanently Deformed
Yield Point
*Occurs between Elastic and Plastic Deformation
Type of Open Fracture Characterized by:
Wound Smaller than 1cm (Very Small)
Typically Created by Bone Fragment from Inside that Retracts back Through Skin
Mild/Moderate Soft Tissue Contusion
Type I
Moisture Retentive Dressing that have become Popular in Wound Management because they create a more Ideal Environment for Wound Healing to occur. These Dressings contain Hydrophilic Materials attached to a water Impermeable Adhesive Backing
Hydrocolloid Dressings
*Dressing can be Maintained for up to One Week
In Shoulder Disease, if the Etiology is Repetitive Trauma or Overuse, it is Probably seen _____ in Adult Dogs
Unilaterally
*Ex. Biceps Brachii Tendinopathy
Allografts and Xenografts can be Temorparily used as _____in Patients with Extensive Burns or Denuded Areas, but they are Eventually lost due to the Rejection Phenomenon, unless Immunosuppressive Drugs are Administered
Biological Bandages
Shoulder Disease Characterized by:
Injury with Tendon Fiber Disruption
Acute to Chronic Inflammation of Tendon and Associated Synovial Tissues
Imperfect Correlation between Signs and Gross Appearance
Biceps Brachii Tendinopathy
*Repetative Strain on the Tendon
Grafts Transfered from a Donor Site to a Recipient Site on the Same Animal
Autograft
*Most Successful type of Graft since the Graft and Host are Immunologically Identical
