Fracture Assessment and Post-Operative Complications Flashcards
What does a higher fracture score mean
Most scoring systems suggest that the higher the score the more prone to the fracture will be complications and hence the more robust the repair needs to be
Describe how to determine fracture types
two orthogonal radiographs
if complex fracture- CT may be needed
when should you give ABs post fracture repair
if surgery took >90mins
soft tissues are not healthy
original fracature open
generally thought to be unecessary
List 5 things the degree of post-op restriction’s after fracture repair depend upon
- Strength of repair
- nature of fracture
- age of patient
- temperament of patient
- degree to which owner can be relied upon to follow post-op instructions
how long to restrict exercise post fracture repair
in garden on lead for 3 weeks and on lead for another 8 weeks
cats restricted to house for 8 weeks
List some instructions to give owners if animal has robert jones bandage
keep dry
check toes and top of dressing twice daily
any smell bring in
if off-colour bring in
what % reduction do we aim for with a open repair of fracture
100%
what % reduction do we aim for with a closed repair of fracture
> 50%
List the things you should check after implant placement
check joints not entered
implants are adequate to fix the fracture
implants avoid entering the fracture site
check growth plates are not entered
What can happen if plate too large for fracture
risk of fracture at the stress riser (where the plate and bone meet)
can give rise to delayed fracture healing
what can happen if plate too small for fracture
may not be strong enough- then it will fail prior to the fracture healing
Lista possible post-op complication from using cerclage wires
the wires can loosen and result in fracture instability
What is a potential complication of using IM pin in the femur
can damage the sciatic nerve
an affected animal will show a great degree of episodic pain
it will also show a sciatic neuropathy
Describe what to do it IM pin migrates
the pin will continue to migrate
DO NOT push it back
movement of the pin suggest that the fracture site is unstable
what should you never pin
a radius
what can cyclic loading of a plate that has been used to repair fracture lead to
the plate fatigues and will either bend of break
What can a plate be used with to protect against bending
IM pin
OR
a very strong buttress plate
what force are plates not as good at resisting
bending
If the trans cortex is not in tact what does the repair require
buttress fixation
What can happen id external skeletal fixator is too weak/strong
weak- it may fail
strong- delayed union may occur
List some potential complications of external fixators
pin tract sepsis
premature pin loosening
iatrogenic bone fractures
placing too close to skin can cause pressure necrosis
List the aetiologies of osteomyelitis
introduction of infection at time of surgery
result of open fracture
uncommonly as a result of haematogenous spread
List the clinical findings of osteomyelitis
lame
swelling, warmth and pain at fracture site
discharging sinus in more chronic cases
acute case- pyrexia
List 5 radiographic findings of osteomyelitis
- proliferative changes to periosteum
- sclerotic margin to infected area
- bone lysis around implants
- Development of involucrum (a cavity in the bone) and sequestrum (a dense piece of necrotic bone within the involucrum)
- Soft tissue swelling
Describe how to treat osteomyelitis
acute- ABs (preferrably after culture)
chronic- remove necrotic bone and sequestrum, stabilise fracture with compression, open medulla to allow blood vessel access, give appropriate ABs (6-8 weeks)
How can quadriceps contracture occur
as a result of an unstable femoral fracture repair- usually an IM pin
muscle contracture between the callus and quadriceps intermedius
Describe how to treat quadriceps contracture
once process starts very hard to stop
surgical- section quads, remove adhesions, apply a rigid for of fixation such as a plate
recurrence is very common
why should we avoid IM pins in femoral fractures of young dogs
quadriceps contracture
what is malunion
fracture heals but with incorrect alignment
List possible causes of malunion
inaccurate reduction of the fracture
loss of initial reduction
what type of malunion are well tolerated
craniocaudal plane well tolerated
lateromedial plane less well tolerated
List the causes of non and delayed unions
instability due to nature of fracture or repair chosen
avascular bone or trauma to soft tissue
infection resulting in instability
Describe how to treat delayed unions
patience
increase analgesia- to encourage weight bearing
stage down fixator to encourage bone loading
physio to encourage limb use
List the 2 types of non-unions
atrophic non-union
hypertrophic non union
describe atrophic non union
bone is atrophic and will not heal
can place a large bridging plate or amputate
Describe hypertrophic non union
Elephant’s foot appearance
Debride and open the medullary cavity
Apply bone graft or equivalent such as cancellous bone chips
Rigidly fix and compress
Decsribe how to manage open fractures
a wide clip
copious lavage with hartmanns
swab for bacteriology culture
IV broad spec ABs
sterile dressing
where is contamination of open fractures most likely to come from
Us - bacteria on the animal and we accidentally put it in the wound
List 3 management options for skin loss in open fractures
- delayed primary closure 3-5 days
- secondary closure 5-10 days - starting to granulate at this point
- second intention healing
Describe open wound/ fracture dressings in the debridement stage
adherent dressing are used to hydrate and debride the wound
Describe the open wound/fracture dressing in granulation stage
dry and non-adherent. These are used to dry the wound and allow it to epithelialise
Describe ABs to use in open fractures/wounds
ABs not always indicated even for grossly contaminated
if using use narrow spec
what are non traumatic bone infection
Occasional haematogenous infections are seen in the metaphyseal region of the juvenile animal but this is rare
