Final: Fractures Flashcards
8-month old M boxer 30kg. Hit by baseball 2 hours ago.
Classify and assess fracture, and give repair options
Salter Harris Type 2
Fracture assesment score: 8-10
Repair: Diverging pin technique (K-wires)
4 month old canine, 10kg
HBC 24 hours ago
Classify and assess fracture, and give repair options
Long oblique fracture of the proximal femoral diaphysis
Fx score= 8-10
Repair: IM pin+ cerclage wire, ESF, bone plate
4 month old mixed breed canine
Acute lameness RHL
Classify and assess fracture, and give repair options
Transverse fracture of the diaphysis of the tibia
Fx score= 8-10
Repair: ESF, Interlocking nail, External coaptation
Bone plate may be overkill (young patient)
14 year old M mixed breed dog, 22kg
HBC yesterday
Classify and assess fracture, and give repair options
Spiral fracture of the distal to mid diaphyseal femur
Fx score= 0 (AGE!)
Repair: Type 2 ESF spanning the articular surface place in a CLOSED fashion
1 year old DSH, 4.5kg
HBC 24 hours ago.
Classify and assess fracture, and give repair options
Severely comminuted femoral fracture
and
Short oblique tibial fracture
Fx score= 5
Repair: 2 ESFs (Type 1A), on femur + cerclage wire and IM pin
How can you prevent quadriceps contracture?
Early return to function
Physical therapy
No immobilization
Ice packs
NSAIDs
4 year old spayed female Dalmatian, 26kg
HBC 4 days ago
Concurrent ipsilateral tibial-tarsal luxation
Classify and assess fracture, and give repair options
Olecranon avulsion
Fx score WITHOUT luxation = 7-9
Fx score = 5-7
Repair: Tension band
4 year old NM Burmese, 5kg
Unknown trauma yesterday
Classify and assess fracture, and give repair options
Luxation of the radial head
and
Montaggia fracture of the ulna
Repair: ASAP - IM pin in ulna + Cerclage wire around radius
What does excessive local pain, fever, lethargy, lucency around the bone impant and a loose implant imply?
Osteomyelitis
4 year old F St.Bernard, 50kg
HBC 1 week ago
Classify and assess fracture, and give repair options
Transverse fractures of the radius and ulna
Fx score= 5
Repair: 2 plates- one on radius and one on ulna (because of size, if had been smaller would not need ulnar plate)
What would you use to allow a scapular fracture to heal?
Velpau sling
What causes ligamentous laxity when referring to fractures?
Disuse or immoilization, muscle atrophy, loose ligaments (due to atrophy), joint instability (due to muscle atrophy)
How deep does the first screw hole have to be when placing a lag screw into the long sacral body?
60% of the sarcal body width
2 year old GSD, 45kg
HBC 1 hour ago
Classify and assess fracture, and give repair options
Comminuted fracture of the mid-diaphysis of the femur
Fx score= 5 (large patient and comminuted, but young)
Repair: Bone plate + IM pin, Interlocking nails
What causes osteoporosis when referring to fractures? When can it be permanent?
Disuse (reduction of mechanical stress)
Will cause bone loss especially distally
Can be permanent if >12 weeks
2 year old M Pharaoh hound, 18kg
HBC yesterday
Classify and assess fracture, and give repair options
Comminuted T or Y fracture
Fx score= 3-5
Repair: Osteotomy of olecranon, bilateral plates or pins
4 year old mixed breed canine, 25kg
Found on side of road, NWB LHL with wound at level of the fracture
Classify and assess fracture, and give repair options
Open mid-diaphyseal tibial oblique fracture (possibly comminuted)
Fx score= 3-4 (open)
Repair: ESF, bone plate (Perl plate), interlocking nail
What are the 3 classifications of scapular fractures? When is surgery indicated?
SEA- Stable extra-articular
USEA- Unstable extra-articular
IA- Intraarticular
Sx if IA and some USEA
When does quadriceps contracture occur most often and in what type of patient?
After distal femoral fracture
Young (<6mo) with poor limb use during healing and extensive muscle trauma
9 month old Mastiff, 75lbs
Ran over by owner
Classify and assess fracture, and give repair options
Comminuted fracture of the distal humerus
Fx score= 3-5 (large patient, comminuted)
Repair: Bone plate (Perl) + IM pin
6 month old M mixed breed dog, 15kg
Playing w/larger dog, yelped and started running on 3 legs 2 hours ago
Classify and assess fracture, and give repair options
Avulsion fracture of the tibial tuberocity
Fx score = 10
Repair: Tension band
7 month old mixed breed dog, 13kg
Weight-baring lameness for 2 days, unknown cause
Classify and assess fracture, and give repair options
Single cortex greenstick fracture of the radius
Fx score= 10 (Potential problem= stunted growth/ limb shortening if physis closes prematurely)
Repair IF GROWTH AFFECTED: Radial osteotomy + Ulnar ostectomy (plus fat graft) and Ring fixator and Distraction Osteogenesis
What are the suggested implants in a situation where you have a small sized dog, with a simple greenstick fracture, and highly complant owner? What score range is this?
Type 1 ESF
IM pin + cerclage wire
External coaptation
Score: 8-10 (high)
18 month old M pitbull, 22kg
HBC 18 hous ago
Simple transverse fracture of the distal diaphysis of the femur
Fx score= 10
Repair= ESF + IM pin
IM pin + cerclage wire C/O’d on transverse fx
What are some proposed etiologies for fracture associated sarcomas?
Implant corrosion at fx site (Jonas pins, TPO plates)
Dissimilar metals
Hx of complications (inflammation, infection)
What are the options for repairing fractures of the ischial body?
2 or more IM pins (to resist forces of hamstrings) +lag or K-wires
Reconstruction plate
What are they keys for success for open fracture repairs?
Prompt debridement
BIgorous irrigation
Antibiotics
Soft tissue repair
When does fracture associated sarcoma occur?
In large breed dogs with comminuted/complicated femoral fractures >5 years after the facture has occured
What causes muscle atrophy when referring to fractures?
“Use it or lose it” (disuse, immobilization)
If occurs recovery takes 2-4 times longer to recover
What is the best approach when surgically repairing a sacroiliac fracture or luxation?
Dorsal
- Allows visualization of sacral wing*
- Use Ventral when have ipsilateral ilial fracture*
What are the 3 options for reparing a bilateral sarcoiliac luxation?
Lag both sides
One long screw
Transilial pin (dorsal to L7)
5 month old M Saluki, 13kg.
Unknown trauma 12 hours ago
Classify and assess fracture, and give repair options
Note top arrow= physis, bottom=fx
Transverse articular fracture of the proximal ulna
Fx score= 7-9
Repair: Tension band
8 month old F Dobermann, 30kg
HBC yesterday, presented in full-limb cast
Classify and assess fracture, and give repair options
Transverse fracture of radius
and
Comminuted fracture of the ulna
Fx score= 5-6
Repair: Plate on cranial aspect of radius + plate or in in ulna
Which pelvic fractures can be managed conservatively?
Ischium and pubic fractures
When there is no compromised neuro function
If there is no severe pain or displacement
20 month old bearded collie, 20kg
Radial fx at 8 months of age treated w/cast
Assess pathology and give repair options
Distal ulnar and radial physis closure - Procurvatum
Repair: Corrective osteotomy then stabilize w/plate + ESF
What is seen in small dogs with elbow or antebrachial fractures because they walk on 3 legs?
Digital flexor cantracture
Can use spoon split and physical therapy
6 month old border collie, 14kg
Acutely lame after running across field 1 hour ago.
Classify and assess fracture, and give repair options
Medial malleolar fracture
Fx score: 7
Repair: Tension band, Lag screws (if reducible and stable then cast)
What causes cartilage atrophy when referring to fractures? When can it be reversed and when can it be permanent?
Immobilization dreases GAG (glycosaminoglycans) which lubricates the joints and stimulates joint fluid production
Reversible if <4 weeks
Permanent if >7 weeks
14 month old toy poodle, 4kg
Acute lameness after jumping off stable
Classify and assess fracture, and give repair options
Transverse fractures of the mid to distal diaphyses of the radius and ulna
Fx score= 3ish (LOW BLOOD SUPPLY in this location in toy breeds)
Repair: Bone plate, ESF (less blood supply compromise)
Remember Can’t put nails or IM pins in the radius!!!!
A(n) ________ is a dead section of bone from osteomyelitis and a(n) ___________ is new bone formed around that.
Sequestrum
Involucrum
What plates can you use for a fracture of the scapular neck?
VPL
L plate
T plate
In small dogs use cross pins
What is/are the most common bone(s) affected by delayed healing or non union? For what reason?
Radius and ulna
Insufficient blood supply
What potential result of diaphyseal trauma results in a fusion of paired bones?
Synostosis
Can cause ulnar subluxation and elbow pain
What are the 3 A’s of fracture assessment?
Alignment
Aparatus
Activity
What are the suggested implants in a situation where you have a medium sized dog, with a reducible comminuted fracture, and complant owner? What score range is this?
Bone plate
Type 1 or 2 ESF
ESF + IM pin
Interlocking nail
IM pin + cerlage wire
Score: 4-7 (moderate)
What factors are used to obtain a fracture assesment score?
Mechanical (Type of fracture, number of fragments, number of injuries)
Biological (Age, health, type of bone)
Clinical (Client/patient compliance, wimp vs stoic)
What does an ‘elephant foot’ callus indicate?
Viable non-union
2 year old Great Dane, 110 lbs. HBC 3 hrs ago.
Classify and assess fracture, and give repair options
Simple transverse mid-diaphyseal fracture of the humerus
Fx score: 5-7 (patient size + simple fx)
Repair: Bone plate, Interlocking nails
How are ilial fractures reduced and repaired?
Bone forceps on cranial and caudal fracture segements to reduce
Option 1: Place DCP on lateral surface 1/3 from dorsum (at least 1 screw engagaes ilial body
Option 2: Use 2-3 lag screws placed frm ventral aspect (more rigid than plate)
2 year old F mixed breed dog, 30kg.
HBC 4 hours ago.
Classify and assess fracture, and give repair options
Comminuted fracture of distal diaphysis of the femur
Fx score: 6
Repair: ESF, Plate
- IM pin + wire wont work*
- Make sure you look for concurrent injuries (e.g. if hip luxated would also need Ehmers sling)*
How do you treat quadriceps contracture?
Salvage procedures: arthrodesis of stifle (will have poor limb function), amputation, quadriceps release (doesn’t work well)
Dynamic flexor brace (if early, helps break down some of the fibrosis by aallowing flexion of the stifle joint)
What are the suggested implants for a situation in which you have an old patient with a comminuted fracture and a non-compliant owner? What score range is this?
Lengthening plate (+/- rod)
Type 2 or 3 ESF +/- tie-in
Interlocking nail
Plate + ESF
Score: 0-3 (low)
6 month old mixed canine
Owner came home and notices pet not using RH leg.
Classify and assess fracture, and give repair options
Salter Harris type 2 fracture of the distal femur
Reduce ASAP
Fx score= 7-10 (non-articular, young)
Repair: Cross pins, Rush pins, or single IM pin + cross pin
If the patient was younger you could do only a single IM pin to help the dog reach full frowth potential
What is the non-surgical approach to acetabular fractures? In what patients can this sometimes be used?
Ehmers sling q10-14 days
Young patients with stable fractures involving the NWB aspect of the acetabulum
An osteotomy of the ______ is requried when you need to make an approach to the neck of the scapula, while an osteotomy of the _________ is required when trying to get to the supragenoid tubercle?
Acromion (using tension band fixation)
Greater tubercle (using lag screw or tension band)
6 month old F mini Dachshund, 8kg
Jumped off steps 4 hours ago.
Classify and assess fracture, and give repair options
Salter Harris type 4 of the lateral condyle of the humerus
Fx score= 6-8
Repair: Lag screw + anti-rotational K-wire
What type of fracture are ilial fractures most often?
Oblique
What do you often have to do if there is osteomyelitits in a bone where you have placed a plate?
Remove plate
What are the options for repairing fractures of the pubis?
For pubic bone fx: K-wires or lag screws
For pubic symphysis fx: Orthopedic wire
Repair herniation of soft tissue first
What is the surgical procedure for repairing acetabular fractures?
Osteotomy of greater trochanter (for appropriate visualization)
Expose joint w/longitudinal incision (to enable visualization, preserve blood supply to neck femur, and allow better joint closure to prevent luxation)
Place IM pin into ischial wing OR use Kern bone forceps on ischeum and provide caudal traction to reduce
Place plate on sursal surface
T/F: Surgical repair is the #1 cause of osteomyelitis.
True
11 month old F irish setting, 28kg
HBC yesterday
Classify and assess fracture, and give repair options
Salter Harris Type 1 (Slip fracture of the femoral head)
Fx score= 10
Repair: Diverging pins
