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Vet 415 - Clinical Skills > Exam 2 - Orthopedics > Flashcards

Exam 2 - Orthopedics Flashcards

1
Q

Macrostructure (shaft function)

A
  • designed for high bending and torsion resistance
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2
Q

Microstructure (fx of collagen cables)

A
  • resist tension
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3
Q

Microstructure (fx of crystals)

A
  • resist compression
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4
Q

Fracture Patters (4 of them + respective causative forces)

A
  1. Transverse – tension
  2. Oblique (short and long) – compression
  3. Butterfly – bending
  4. Spiral – Torsion
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5
Q

Properties of Bone (Viscoelastic)

A
  • higher rate of loading increases bone stiffness

- high energy load causes greater damage to bone

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6
Q

Properties of Bone (Anisotropic)

A
  • stiffness depends on direction of loading

- bone is weakest in bending

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7
Q

Bone Quality (mature vs immature)

A

Mature – strong, stiff, brittle

Immature – weak, compliant, ductile

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8
Q

Displacement (corticol vs cancellous)

A

Corticol – lower displacement

Cancellous – higher displacement

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9
Q

What is the function of bone in a non- vs reconstructable implant?

A

reconstructable – bone shares the load

non-reconstructable – implant does all the work

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10
Q

What is the primary resisting force in Intramedullary Pins? What if we add cerclage wires too?

A

+++ bending (bad at everything else)

w/ wires => adds ++ torsional resistance

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11
Q

What is Wolff’s Law?

A
  • bone will adapt to its environment

- bone remodeling over time

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12
Q

Fracture Classification (5 Descriptive Parts)

A
  1. Open or Closed
  2. Geometry of Fracture
  3. Location in the bone
  4. Bone affected
  5. Displacement of distal segment
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13
Q

Fracture Geometry (simple vs comminuted)

A

Simple – two pieces

Comminuted – many pieces (>2 at least)

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14
Q

T/F: A butterfly fracture is a type of comminuted fracture.

A

True

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15
Q

Alphanumeric Fracture Classification

A
  • First number describes the affected bone
  • Second number tells us where on that bone
  • Letter tells us what type of fracture

Example: 11A - Humerus, Proximal, Simple

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16
Q

Open Fracture Classficiation (Numbers)

A
  1. small lasceration (<1cm), clean
  2. larger lasceration (>1cm), mild soft-tissue trauma, o flaps/ avulsions
    3a. vast soft-tissue damage, but available for repair
    3b. bone exposure, vast soft-tissue damage, periosteum stripped
    3c. arterial blood supply damaged
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17
Q

Salter-Harris Fractures

A
  1. S - Slip
  2. A - Above the physis
  3. L - Lower than the physis
  4. T - Through the physis
  5. R - Rammed together
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18
Q

Examples of Reconstructable (3) vs Non-reconstructable (2) Fractures

A

Reconstructable

  1. simple, transverse
  2. simple, oblique (long or short)
  3. Mild comminuted fractures w/ large fragments

Non-reconstructable

  1. mild comminuted w/ small fragments
  2. sever comminuted
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19
Q

When to use ancillary cerclage wire? / 4 general rules for cerclage wire

A
  1. Only reconstructable fractures
  2. Long oblique/ spiral fractures only
  3. must use at least 2 wires
  4. wire must be tight => no soft tissue present
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20
Q

Functional difference between a positional and a lag screw

A

Positional – engages both cortices to hold the bones where they are

Lag – only engages the distal cortex to apply a compressive force that will bring the two pieces together in apposition

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21
Q

Fracture forces that can be neutralized by in Intramedullary Pin?

A
  • resists the bending force

addition of interlocking nails will also add torsion

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22
Q

Basic components of an External Skeleton Fixator

A
  1. Connecting rods – distribute fracture forces
  2. Clamps
  3. Fixator pins – at least 3 on each side of the fracture
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23
Q

Fracture Support (Non-locking plate)

A
  • screws provide compression to pull the plate up against the bone an hold it fast
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24
Q

Fracture Support (Locking plate)

A
  • screws allow plate to be held a distance away from the bone (not required to be pressed up against)
25
Q

Fracture Support (External Skeleton Fixator)

A
  • provides protection from all directions/ forces
26
Q

Fracture Support (Interlocking nails)

A
  • upgrade to the IM pin

- provides bending and torsional resistance

27
Q

4 functions of a plate

A
  1. Compression
  2. Neutralization
  3. Bridging
  4. Buttress
28
Q

Why use compression vs neutralization vs bridging?

A

compression - transverse fracture

neutralization – long oblique; plate is placed to protect the cerclage wires

Bridging - plate will take all the fracture forces;
use in reconstructable that will not be reconstructed or a non-reconstructable fracture

29
Q

Radiographic appearance of Malunion, delayed union, Non-union

A

Malunion – fracture healed in a non-anatomic position
Delayed – not healed by expected time frame
Non – all evidence of osteogenic activity has stopped (at least for 6 months)

30
Q

3 Treatment principles for Non-union

A
  1. Recognize and treat underlying reasons
  2. Rigid stabilization of fracture
  3. Restore healing potential
31
Q

3 Bone graft strategies

A
  1. Osteoinduction – stim. of osteoprogenitor cells
  2. Osteoconduction – provide framework for new bone
  3. Osteogenesis – direct bone formation from graft cells (osteoblasts)
32
Q

Treatment of open fractures?

A
  1. Prevent infection
  2. promote fracture healing
  3. restore function
33
Q

Parts of the Canine long bones

A
  • diaphysis
  • metaphysis
  • epiphysis
  • physis (growth plate)
34
Q

Strength of the growth plate

A
  • roughly 20-25% the strength of the diaphysis
35
Q

What percentage of fractures in growing dogs are at the growth plate/ physis?

A
  • 30%
36
Q

Where do physeal fractures occur specifically?

A
  • across the hypertrophic zone (theoretically)
37
Q

SALTeR- Harris Fractures

A 
S - slipped physis
A - above the physis
L - lower than the physis
T - through the physis
eR - rammed together
38
Q

Fracture Management (Conservative vs Internal Fixation)

A

Conservative:

  • unpredictable outcome
  • labor intensive
  • $???

Internal Fixation:

  • predictably successful
  • convenient
  • $$$
39
Q

Treatment Principles (2 for Metaphyseal and physeal fractures)

A
  1. Stabilization w/ kirshner wires across the growth plate

2. Internal Fixation w/ screws

40
Q

Two types of physis

A
  1. Epiphysis – work in compression (longitudinal bone growth)
  2. Apophysis – work in tension (longitudinal growth of apophysis)
41
Q

Risks w/ physeal fracture repair

A
  1. Failure of Fixation
  2. Loss of joint motion
  3. Development of limb deformities
42
Q

Premature growth plate closure

A
  • generally result in deformities from a unilateral growth plate injury
43
Q

Components of growth plate deformities

A
  1. Angulation
  2. Length Deficit
  3. Rotation
  4. Translation

Also, joint subluxation

44
Q

Deformity management

A
  1. conservative for minor deformities
  2. surgical for major
  • osteotomy
  • plate fixation (efficient, stable)
  • external fixation
45
Q

Postoperative Care general rules

A
  • be caring
  • make it manageable
  • streamlined
  • affordable
46
Q

Things to avoid in post-op care

A
  • avoid unecessary care

- avoid external coaptation (bandaging)

47
Q

Sources of post-operative risk

A
  • patient profile
  • medical program
  • living conditions
48
Q

The 3C’s of Pain Assessment

A
  1. C.R.E.P.I.
  2. Comorbidities
  3. Chronicity
49
Q

What does C.R.E.P.I. stand for?

A 
Crepitus
Range of Motion
Effusion
Pain
Instability
50
Q

Possible causes of pain post-operatively

A
  1. Loss or lack of implant stability

2. Infection

51
Q

Pain Assessment (Chronicity)

A
  1. limb disuse
  2. loss of muscle mass
  3. loss of joint motion
  4. chronic pain, allodynia
52
Q

Things of concern in hospitalization

A
  • run or cage
  • nutrition
  • urination of defecation
  • transportation
53
Q

T/F: Post-operatively, all walks should be done on a short leash to limit any hyper-activity.

A

T

54
Q

Re-evaluations

A
  • important to keep in contact with owners

- rapidly evolving situation = rapid re-evaluation

55
Q

Complications post-operatively

A

Mechanical - failure of fixation

Biological - infection, loss of joint motion, denervation

56
Q

How to best solve loss of joint motion?

A
  • stretching is best =)
57
Q

4 A’s

A
  1. Alignment - how well the bone lines up with the og orientation
  2. Apposition - overlap of fracture fragments
  3. Apparatus - appropriate choice?
  4. Activity - fracture healing (callous, fx line, blood supply, motion)
58
Q

Rad. signs of DJD

A
  1. increased synovial mass
  2. osteophytes and enthesiophytes
  3. decreased joint space
  4. subchondral bone sclerosis
59
Q

Rad signs of Aggressive bone Sclerosis

A
  1. osteolysis
  2. cortical lysis
  3. periosteal rxn
  4. long zone of transition
  5. rate of change

Vet 415 - Clinical Skills (3 decks)

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