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17- SA- Musculoskeletal Disease > Fracture Assessment and Post-Operative Complications > Flashcards

Fracture Assessment and Post-Operative Complications Flashcards

1
Q

What does a higher fracture score mean

A

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

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2
Q

Describe how to determine fracture types

A

two orthogonal radiographs
if complex fracture- CT may be needed

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3
Q

when should you give ABs post fracture repair

A

if surgery took >90mins
soft tissues are not healthy
original fracature open

generally thought to be unecessary

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4
Q

List 5 things the degree of post-op restriction’s after fracture repair depend upon

A
  1. Strength of repair
  2. nature of fracture
  3. age of patient
  4. temperament of patient
  5. degree to which owner can be relied upon to follow post-op instructions
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5
Q

how long to restrict exercise post fracture repair

A

in garden on lead for 3 weeks and on lead for another 8 weeks
cats restricted to house for 8 weeks

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6
Q

List some instructions to give owners if animal has robert jones bandage

A

keep dry
check toes and top of dressing twice daily
any smell bring in
if off-colour bring in

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7
Q

what % reduction do we aim for with a open repair of fracture

A

100%

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8
Q

what % reduction do we aim for with a closed repair of fracture

A

> 50%

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9
Q

List the things you should check after implant placement

A

check joints not entered
implants are adequate to fix the fracture
implants avoid entering the fracture site
check growth plates are not entered

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10
Q

What can happen if plate too large for fracture

A

risk of fracture at the stress riser (where the plate and bone meet)
can give rise to delayed fracture healing

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11
Q

what can happen if plate too small for fracture

A

may not be strong enough- then it will fail prior to the fracture healing

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12
Q

Lista possible post-op complication from using cerclage wires

A

the wires can loosen and result in fracture instability

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13
Q

What is a potential complication of using IM pin in the femur

A

can damage the sciatic nerve

an affected animal will show a great degree of episodic pain
it will also show a sciatic neuropathy

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14
Q

Describe what to do it IM pin migrates

A

the pin will continue to migrate
DO NOT push it back
movement of the pin suggest that the fracture site is unstable

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15
Q

what should you never pin

A

a radius

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16
Q

what can cyclic loading of a plate that has been used to repair fracture lead to

A

the plate fatigues and will either bend of break

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17
Q

What can a plate be used with to protect against bending

A

IM pin
OR
a very strong buttress plate

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18
Q

what force are plates not as good at resisting

A

bending

19
Q

If the trans cortex is not in tact what does the repair require

A

buttress fixation

20
Q

What can happen id external skeletal fixator is too weak/strong

A

weak- it may fail
strong- delayed union may occur

21
Q

List some potential complications of external fixators

A

pin tract sepsis
premature pin loosening
iatrogenic bone fractures
placing too close to skin can cause pressure necrosis

22
Q

List the aetiologies of osteomyelitis

A

introduction of infection at time of surgery
result of open fracture
uncommonly as a result of haematogenous spread

23
Q

List the clinical findings of osteomyelitis

A

lame
swelling, warmth and pain at fracture site
discharging sinus in more chronic cases
acute case- pyrexia

24
Q

List 5 radiographic findings of osteomyelitis

A
  1. proliferative changes to periosteum
  2. sclerotic margin to infected area
  3. bone lysis around implants
  4. Development of involucrum (a cavity in the bone) and sequestrum (a dense piece of necrotic bone within the involucrum)
  5. Soft tissue swelling
25
Q

Describe how to treat osteomyelitis

A

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)

26
Q

How can quadriceps contracture occur

A

as a result of an unstable femoral fracture repair- usually an IM pin
muscle contracture between the callus and quadriceps intermedius

27
Q

Describe how to treat quadriceps contracture

A

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

28
Q

why should we avoid IM pins in femoral fractures of young dogs

A

quadriceps contracture

29
Q

what is malunion

A

fracture heals but with incorrect alignment

30
Q

List possible causes of malunion

A

inaccurate reduction of the fracture
loss of initial reduction

31
Q

what type of malunion are well tolerated

A

craniocaudal plane well tolerated
lateromedial plane less well tolerated

32
Q

List the causes of non and delayed unions

A

instability due to nature of fracture or repair chosen
avascular bone or trauma to soft tissue
infection resulting in instability

33
Q

Describe how to treat delayed unions

A

patience
increase analgesia- to encourage weight bearing
stage down fixator to encourage bone loading
physio to encourage limb use

34
Q

List the 2 types of non-unions

A

atrophic non-union
hypertrophic non union

35
Q

describe atrophic non union

A

bone is atrophic and will not heal
can place a large bridging plate or amputate

36
Q

Describe hypertrophic non union

A

Elephant’s foot appearance
Debride and open the medullary cavity
Apply bone graft or equivalent such as cancellous bone chips
Rigidly fix and compress

37
Q

Decsribe how to manage open fractures

A

a wide clip
copious lavage with hartmanns
swab for bacteriology culture
IV broad spec ABs
sterile dressing

38
Q

where is contamination of open fractures most likely to come from

A

Us - bacteria on the animal and we accidentally put it in the wound

39
Q

List 3 management options for skin loss in open fractures

A
  1. delayed primary closure 3-5 days
  2. secondary closure 5-10 days - starting to granulate at this point
  3. second intention healing
40
Q

Describe open wound/ fracture dressings in the debridement stage

A

adherent dressing are used to hydrate and debride the wound

41
Q

Describe the open wound/fracture dressing in granulation stage

A

dry and non-adherent. These are used to dry the wound and allow it to epithelialise

42
Q

Describe ABs to use in open fractures/wounds

A

ABs not always indicated even for grossly contaminated
if using use narrow spec

43
Q

what are non traumatic bone infection

A

Occasional haematogenous infections are seen in the metaphyseal region of the juvenile animal but this is rare

17- SA- Musculoskeletal Disease (20 decks)

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