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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
Fracture Support (External Skeleton Fixator)
- provides protection from all directions/ forces
26
Fracture Support (Interlocking nails)
- upgrade to the IM pin | - provides bending and torsional resistance
27
4 functions of a plate
1. Compression 2. Neutralization 3. Bridging 4. Buttress
28
Why use compression vs neutralization vs bridging?
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
Radiographic appearance of Malunion, delayed union, Non-union
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
3 Treatment principles for Non-union
1. Recognize and treat underlying reasons 2. Rigid stabilization of fracture 3. Restore healing potential
31
3 Bone graft strategies
1. Osteoinduction -- stim. of osteoprogenitor cells 2. Osteoconduction -- provide framework for new bone 3. Osteogenesis -- direct bone formation from graft cells (osteoblasts)
32
Treatment of open fractures?
1. Prevent infection 2. promote fracture healing 3. restore function
33
Parts of the Canine long bones
- diaphysis - metaphysis - epiphysis - physis (growth plate)
34
Strength of the growth plate
- roughly 20-25% the strength of the diaphysis
35
What percentage of fractures in growing dogs are at the growth plate/ physis?
- 30%
36
Where do physeal fractures occur specifically?
- across the hypertrophic zone (theoretically)
37
SALTeR- Harris Fractures
``` S - slipped physis A - above the physis L - lower than the physis T - through the physis eR - rammed together ```
38
Fracture Management (Conservative vs Internal Fixation)
Conservative: - unpredictable outcome - labor intensive - $??? Internal Fixation: - predictably successful - convenient - $$$
39
Treatment Principles (2 for Metaphyseal and physeal fractures)
1. Stabilization w/ kirshner wires across the growth plate | 2. Internal Fixation w/ screws
40
Two types of physis
1. Epiphysis -- work in compression (longitudinal bone growth) 2. Apophysis -- work in tension (longitudinal growth of apophysis)
41
Risks w/ physeal fracture repair
1. Failure of Fixation 2. Loss of joint motion 3. Development of limb deformities
42
Premature growth plate closure
- generally result in deformities from a unilateral growth plate injury
43
Components of growth plate deformities
1. Angulation 2. Length Deficit 3. Rotation 4. Translation Also, joint subluxation
44
Deformity management
1. conservative for minor deformities 2. surgical for major - osteotomy - plate fixation (efficient, stable) - external fixation
45
Postoperative Care general rules
- be caring - make it manageable - streamlined - affordable
46
Things to avoid in post-op care
- avoid unecessary care | - avoid external coaptation (bandaging)
47
Sources of post-operative risk
- patient profile - medical program - living conditions
48
The 3C's of Pain Assessment
1. C.R.E.P.I. 2. Comorbidities 3. Chronicity
49
What does C.R.E.P.I. stand for?
``` Crepitus Range of Motion Effusion Pain Instability ```
50
Possible causes of pain post-operatively
1. Loss or lack of implant stability | 2. Infection
51
Pain Assessment (Chronicity)
1. limb disuse 2. loss of muscle mass 3. loss of joint motion 4. chronic pain, allodynia
52
Things of concern in hospitalization
- run or cage - nutrition - urination of defecation - transportation
53
T/F: Post-operatively, all walks should be done on a short leash to limit any hyper-activity.
T
54
Re-evaluations
- important to keep in contact with owners | - rapidly evolving situation = rapid re-evaluation
55
Complications post-operatively
Mechanical - failure of fixation | Biological - infection, loss of joint motion, denervation
56
How to best solve loss of joint motion?
- stretching is best =)
57
4 A's
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
Rad. signs of DJD
1. increased synovial mass 2. osteophytes and enthesiophytes 3. decreased joint space 4. subchondral bone sclerosis
59
Rad signs of Aggressive bone Sclerosis
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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