Exam 3: Lecture 25 - Principles of Orthopedic Surgery Flashcards
What was the first case group that Orthopedics was first practiced in?
First practiced to treat childhood spinal deformities such as polio or scoliosis
What are resons to perform orthopedic surgery
- Stabilize fractures bones
- Explore, debride, and stabilize injured joints
- Replace damaged joints
- Stabilize spinal column injuries
- Decompress the spinal cord
- Resect musculoskeletal tumors
- Repair tendon and ligament injuries
As a veternarian it is important to understand your limitations and when to _________
refer complicated cases when necessary
In the clinic what is the first way to identify lameness
orthopedic exam
What challenges arise in regards to Orthpedic surgery
- Assess patient
- Classify Fracture
- Develop plans for fixation to produce predictable and consistent results
Define Allograft
Bone transplant from one animal to another of same species
Define Apophyseal Osteotomies
Procedures to enhance surgical exposure of a joint
Define Autograft
Bone transplant for one site to another in the same animal
Define Avulsion Fracture
Insertion point of a tendon or ligament is fractured and distracted frm rest of the bone
Define Bridging Plates
Span cominuted fracture
Define Cerclage Wire
Orthopedic wire placed around circumference of bone to compress an oblique fracture
Define CLosed Reduction
Fractured bone alignment performed without surgical exposures
Defire Compression Plates
Plates that act to compress the fracture
Define Corrective Osteotomies
Diaphysis or Metaphysis of a bone is cut, realigned and stabilized until union occurs
- Elective procedure
Define Cranial Drawer
Abnormal movement of stifle joint elicited during physical examination
What test can be done to test to see if there was a cranial cruciate ligament deficient stifle (Most common in dogs)
Cranial Drawer Test
What test is used to check if the tibia sliding cranially in relationship to femur
Cranial Drawer
Define Crepitation
“Grating feeling” or sound with manipulating a fractured bone or arthritic joint
Define Delayed unions
Fractures that heal more slowely than anticipated
Define Direct Bone Union
Bone formed without evidence of callus
Define Endochondral bone formation
Bone formed on cartilage precursor
Define External Coaptation
Fracture fixation with casts or splints
Define External Fixation
Fracture fixation in which pins penetrate bone and skin and connected tissue
Define Greenstick fracture
Incomplete fracture where portion of cortex is intact
Define Hemicerclage Wire or Interfragmentary wire
Wire placed through predrilled holes in bone
Define Indirect Reduction
Process of restoring fragment and limb alignment by distracting major bone segments
- usually animals weight
Define Internal Fixation
Fracture fixation using internal implants to secure bone
Define Intramedullary Pins
Implants positioned in the medullary canal of long bones
Define Intramembranous bone formation
Direct differentation of mesenchymal stem cells into osteoblasts
What type of bone formation is done without a cartilaginous precursor
Intramembranous bone formation
Define Luxation
Complete dislocation of a joint
Define Malunions
Healed fractures where anatomic bone aligment not achieved or maintained during healing
Define Neutralization plate
Support a reconstructed fracture
Define nonunion
Fracture with an arrested repair process
What fracture healing method requires surgical intervention to create environment conductive to bone healing
Nonunion
Define Normograde placement
Pin started at one end of bone, driven to fracture area, then seated at other end of fractured bone
Define Open Fracture
Fracture is exposed to external atmosphere
Define open (direct) reduction
Fracture repair performed after surgical approach to bone
Define Ortolani Maneuver
Manipulation used to sublaxate a dysplastic hip
Define Ostectomies
Removal of a segment of bone
Define Osteomyelitis
Inflammatory condition of bone and medullary canal
Define Osteotomies
Procedures where bone is cut into two segments
Define Procurvatum
Cranial Bowing of bone
Define Subluxation
Partial dislocation of a joint
Define Valgus deformity
Angulation of distal portion of limb LATERALLY
DefineVarus deformitiy
Angulation of distal portion of limb MEDIALLY
What is this orthopedic exam testing
testing the lateral collateral ligaments
What are the goals when treating fractures, nonunions and bone deformities
- Bone union (bone healing)
- Patients return to normal function
What are the 3 main desioin making goals you should have during surgery
- Choose implants and plant
- Evaluate fracture, patient and client
- Ensure selected fixation able to counteract forces applied to stabilize bone
What assessment score can be done for fratures during the decision making process of evaluating the fracture, patient and client
FAS Score
- Fracture assessment score
Throughout your surgical planning you need to make a detailed plan for the entire surgical operation which includes?
- Method of fracture reduction
- Sequence of implant application
- Possibilities for bone grafting
Failure to plan procedures results in?
- Prolonged operating time
- Excessive soft tissue damage
- Technical errors
Ultimate outcomes of improper planning results in?
- Implant failure
- Delayed healing
- Infection
- Nonunion
PLANNING IS IMPORTANT
Why is fracture classification important
It allows accurate communication with owners and colegues to aid appropiate treatment planning
- to do this limb and radiographs evaluated to accuratley classify fracture
T/F this fracture classification can be used to describe fracture
- Open, complete, displaced, severly comminuted, nonreducible fracture of the diaphysis of the femur
true
Give the 5 Basis of Fracture classification
- If the fracture is open to the enviornment (fracture closed or open to external environment)
- Degree of damage and displacement of fragments
- Type of fracture
- If fracture fragmetns can be reconstructed to provide load bearing (reducible or non reducible)
- Location of fracture
What twp types of fractures may be complete or incomplete
Greenstick fracture
Avulsion fracture
What type of fracture is described as:
- Occurs in immature animals
- incomplete fracture where portion of cortex is intact
- partially stabilizes bone
Greenstick fracture
What type of fracture is described as:
- Occurs when insertion point of tendon or ligament is fractured and distracted from the rest of the bone
- May be nondisplaced or displaced
Avuslion Fracture
What type of fracture is described as:
- Fracture line perpendicaulr to long axis of the bone
Transverse fracture
What type of fracture is described as:
- Lines run at an angle to line perpendicular to long axis of bone
Oblique fracture
Define Short Oblique fractures
fractures 45 degrees of less
Define Long Oblique fractures
fractures 45 degrees or more perpendicular to long axis of bone
What type of fracture is described as:
- Similar to long oblique fracture, but wraps around long axis of bone
Spiral fractures
What type of fracture is described as:
- Have one fracture line
single fracture
What type of fracture is described as:
- Have multiple fracture line ranging from
3 piece fractures with butterfly fragments (fragment with 2 oblique fracture lines resemling butterflies)
to highly comminuted fractures with 5 or more pieces
Comminuted fractures
What type of fracture is number 1
transverse
What type of fracture is number 2
Oblique
What type of fracture is number 3
spiral
What type of fracture is number 4
Comminuted / reducible
What type of fracture is number 5
Comminuted / nonreducible
What type of fracture is described as:
- Single fracture line or fractures with no more than 2 large fragments
Reducible
What type of fracture is described as:
- Fractures with multiple fragments
nonreducible
Classification of fractures by location can be seen as?
Diaphysis
Metaphysis
Physical
Articular
Velocity of forces dictates?
- Number of fragments
- Damage to surrounding soft tissue
What type of force creates single fractures with little energy dissipated into soft tissue
Low velocity forces
What type of forces create comminuted fractures with high energy dissipated through fracture propagation and surrounding soft tissue injury
High velocity forces
Open fractures are classified according to?
- Mechanism of puncture
- Severity of soft tissue injury
What are the three classification of open fractures
Grade I, II, and III
What Grade of open fracture is described as
- Small puncture hole located in skin proximity of fracture cause by bone penetrating to outside
- typically around 1 cm
- Bone may or may not be present
Grade 1
What Grade of open fracture is described as
Grade 1 open fracture
What Grade of open fracture is described as
-Variable sized skin would associated fracture that resulted from external trauma
- More damage to soft tissue
- While extent of soft tissue damage varies fracture is mininally (or not) comminuted
Grade 2
What Grade of open fracture is described as
Grade 2
What Grade of open fracture is described as
- Severe bone fragmentation with extensive soft tissue injury (with or without skin loss)
grade 3
What Grade of open fracture is described as
- Usually high-velocity comminuted fractures
Ex: Gunshot injuries or searing type of injuries of distal extremities
Grade 3
What Grade of open fracture is described as
Grade 3
What Grade of open fracture is described as
Grade 3
What Grade of open fracture is described as
Grade 3
What type of Harris Classification of physeal Fractures is number 1
Type 1
What type of Harris Classification of physeal Fractures is number 2
Type 4
What type of Harris Classification of physeal Fractures is number 3
Type 2
What type of Harris Classification of physeal Fractures is number 4
Grade 5
What type of Harris Classification of physeal Fractures is number 5
Grade 3
What type of Salter - Harris Classification of physeal Fractures is described as
- Fractures run through physis
type 1
What type of Salter - Harris Classification of physeal Fractures is described as
- Fractures run physis and portion of metaphysis
2
What type of Salter - Harris Classification of physeal Fractures is described as
- Fractures run through physis and epiphysis and are generally articular
3
What type of Salter - Harris Classification of physeal Fractures is described as
- Fractures are also articular running through epiphysis, across physis and through metaphysis
4
What type of Salter - Harris Classification of physeal Fractures is described as
- Fractures are crushing injuries of physis
- Not visible radiographically become evident several weeks later when physeal function ceases
5
What type of Salter - Harris Classification of physeal Fractures is described as
- Classification used to describe physeal closure from damage to a portion of a physis
- causing asymmetric physeal closure
- Angular limb deformities
6
What type of forces are acting on the fractured bone 1
Bending forces
What type of forces are acting on the fractured bone 2
Torsional forces
What type of forces are acting on the fractured bone
Axial loading
What type of forces are acting on the fractured bone A
bending
What type of forces are acting on the fractured bone B
bending and Axial compression
What type of forces are acting on the fractured bone C
Axial compression
What type of forces are acting on the fractured bone D
Torsion
What type of forces are acting on the fractured bone E
High energy
What is the FAS - Fracture assessment score
Preoperative data analyzed to start decision making proces
Data included in the FAS score is?
Patient information
- age
- weight
- general helath
- Activity level
- Presence of other orthopeic pathology
Radiographs
- fractured and other corresponding contralateral intact bones (including proximal and distal joints)
Client information
- Expectations
- Ability to perfrom postoperative care
Data summarized as FAS score reflects what 3 factors
- Mechanical factors
- Biological factors
- Clinical factors (clinical enviornment where implants must function)
GUIDES THE TYPES IMPLANTS CHOSEN
Is the left or right nonreducible and multiple limb injury
- Maxamize stress on implant system
- Requires careful implant choice and application
Left
Is the left or right less stress to implant system
- Reduced risk of complications because not severe
Right
What type of fracture is number 1
Nonreducible Fragment
What type of fracture is number 2
Reducible Fragments
What type of fracture is number
Compression
Does the following condition favor rapid healing or not favor rapid healing??
- Old patient
- Poor health
- Poor Soft tisse envelope
- Cortical bone
- High velocity injury
- Extensive approach
Poor - does not favor rapid healing
implant system must function for prolonged period
Does the following condition favor rapid healing or not favor rapid healing??
- Juvenile
- Excellant health
- Good soft tissue envelope
- Cancellous bone
- Low velocity injury
- Closed
Favors rapid healing
Implant only needs to function for a short time
Give examples clinical facotrs that require comfortable implant system
- Poor client compliance
- Poor patient Compliance
- Wimp
- High comfort level required
- Requires little postoperative maintenance
Give examples of Clinical Factors that can use any implant system
- Good client compliance
- Good patient compliance
- Stoic
- Comfort level not a consideration
- Regardless of postoperative maintenance
FAS assigned on a scale of ?
1 to 10
FAS score of high is?
8 to 10
FAS score of Moderate is?
4 to 7
FAS score of low is?
1-3
What FAS score would you give an animal that is young and easily healed
high: 8 to 10
What FAS score would you give an older and not easily healed animal
Low: 1 to 3
Do fractures with low or high scores generally heal successfully with few complications
high
Do fractures with high or low score potentially less successfully with more complications
lower
