External coaptation Flashcards
External coaptation
Limb splinting
External skeletal fixation
Bone splinting
Forces that are neutralized by external coaptation
-bending
-torsion (depending on fit)
Forms of external coaptation
-casts
-splints
-bandages
-slings
-braces
Cast
Rigid material completely encircles limb
-minimal padding
-most rigid form of external coaptation
Appropriate uses of casts
-definitive stabilization of some fractures
-joint immobilization
-support after athrodesis (joint fusion)
-protection of repair for recovery (large animals)
Splints
Padding and compressive layers encircle the limb, but rigid splint is not circumferential
-less rigid but easier to check and change
Palmar splint
Spica splint
Appropriate splint use
-Definitive repair of relatively stable fractures (eg. adjacent bone intact, well-reduced transverse fracture)
-Repair of fractures in young animals
-support of operative repairs/reduced luxations
-Temp stabilization
Braces
-like splints but minimal padding
-designed for part time use
-may allow motion in one plane and not another-custom made or off the shelf
-minimal evidence for efficacy
Prosthetics
Used to replace a missing body part
-must be custom made
-best function when amputation is at/distal to carpus or distal tibia
Bandages
-supply minimal support
-can cover wounds and help control swelling
-not for fracture immobilization
Slings
Non rigid supports that alter limb position or weightbearing
-padding minimal
Ehmer sling
Produces flexion and internal rotation of hip to keep the hind limb non-weightbearing
*used mostly after hip luxation reduction
*can produce severe pressure sores if not monitored
Velpeau Sling
Used for forelimb nonweight bearing (shoulder repair, scapula fractures)
*can be made with tshirt and tape
Sciatic sling
Used to discourage knuckling in limbs within incomplete sciatic palsy
When can external coaptation be used?
- Transverse fractures that can be reduced (at least 50% overlap fragments)
*except toy breed dogs because poor blood supply) - Fractures stabilized by an adjacent bone (fibula, ulna, metatarsals/metacarpals)
3.fractures in young animals with intact periosteal sleeve (eg. greenstick, fissure fractures)
- Some joint injuries (eg. some collateral ligament tears, luxations that feel stable after reduction)
- temporary support before surgical repair and after surgical repairs
- Immobilization/protection of concurrent soft tissue injuries
Advantages of external coaptation
-minimal disruption of blood supply
-minimal interference with physeal growth
-nonsurgical placement
-moderate expense (rechecks and changes add up)
Limitations of external coaptation
-poor control of tensile and compressive forces
-less rigid stabilization than with internal fixation
-alignment and reduction can be difficult or impossible to attain close
-can be hard to get splint to stay on some patients
What bones are not appropriate for external coaptation?
femur, humerus, pelvis
*because need to immobilize joint above and below the fracture which is not possible with these bones
Complications from external coaptation
-stiffening
-muscle atrophy or contracture
-osteoarthritis
-congestion or necrosis of extremity with constrictive coaptation
-rub sores and dermatitis
Immobilization of joint
External coaptation should go from the foot to the proximal aspect of the bone above the affected joint
*the joint above the one you are treating should not be immobilized
Priniples of external coaptation
-Small animals= include toes in coaptation to prevent congestion
-external coaptation should conform close to limb and apply firmly enough to prevent motion
-coapt in normal walking position, and in neutral or slight varus tendency
