Fracture Assessment and Repair Flashcards
what are the ABCs of triage and stabilization?
Airway
Breathing
Circulation and Consciousness
AKA rule out/address immediate life-threatening injuries; broken bones are pretty low on this list; don’t get distracted by bones!
how can you tell if pathology is related to one limb or not?
did the patient walk into the hospital?
if yes, probably limited to one limb
if no, stand the patient; if otherwise stable, animals with pathology of one limb should be willing to stand on the other 3 limbs
-this is important to keep you from missing less obvious problems!!
describe ortho and neuro exams of a traumatic patient
ortho: assess for SCRAPIE
Swelling
Crepitus
ROM
Alignment
Pain
Instability
Effusion
neuro: assess for
1. peripheral nerve injury: radial and sciatic nerve especially!
2. spinal cord injury
3. traumatic brain injury
-be systematic! can have problems in multiple limbs or at multiple levels in one limb
-try to perform exam (even limited) before analgesics, can affect interpretation, esp with neuro exam
describe radiographs to initially assess a fracture (2)
- provide analgesia (opioids, pure mew agonists)
- perform when stable, sedated when possible, collimated views for each region, and orthogonal views always!!
classify fractures based on their radiographic appearance (7)
- age (of fracture):
-acute (sharp edges, no remodeling) or
-chronic: evidence of remodeling (at least 2 weeks old) - etiology:
-traumatic: crisp lines at fx site, surrounding bone looks normal and healthy
-pathologic: lysis or mottled appearance to fx site, periosteal reaction - contamination:
-closed
-open (wounds near fracture site, gas in SQ tissue or around fx site) - configuration:
-severity: incomplete (only involves part of or one cortex)
-complete (all the way through)
-comminuted (more than one piece)
-segmental (type of comminuted fx)
-pattern: transverse, oblique, short/long, spiral
-often oblique and spiral go together - location: articular (in joint), physeal, epi-, meta-, diaphyseal
- bone: which bone was fractured
- displacement: position of distal segment in relation to proximal segment
describe the classification scheme of growth plate fractures
SALTER harris; know SALT!!
S: straight through physis
A: above/away from joint, through physis and extends to metaphysis
L: lower/towards the joint; trhrough physis to epiphysis (articular fracture)
T: through physis, epi, metaphysis (articular fracture)
E: erasure: complete physeal compression
R: restricted to one side: incomplete physeal compression
describe the goals of fracture management (2)
- complete healing; can accomplish without return to function
- return to function as soon as possible
both are equally important!!
how does every fracture repair become a race?
race between bone healing and implant failing (implants can only take so much force for so long; if bone never heals, implants will eventually bend or break; need bone to heal within appropriate time frame while implant able to take on force)
describe the different components that make up the fracture assessment score (FAS)
takes into account most factors affectting fracture outcome
score is from 1-10;
low = high risk, more stress on implants, longer time to heal, more prone to failure
high score = low risk
3 broad categories:
1. clinical: client compliance, patient compliance, low pain threshold (too painful = animal no move it and help healing)
-low clinical score = more stress on implants/delayed healing
- biological: factors that affect bone healing; animal age, health, soft tissue quality, energy (high = high risk, example gunshot wound), approach (extensive = high risk, closed = low risk)
-low biological score = longer time to healing - mechanical/stability:
-non-reducible (high risk), reducible (med risk), inherent stability (low risk)
-bridging (high risk), neutralization (mid), compression (low)
-multiple limb injury (high risk), pre-existing disease (med), single limb injury (low risk)
-giant dog (high risk), large dog, cat/small dog (low)
-obesity!!! high risk; overweight med risk, normal
-low mechanical score = more stress on implants
relate the FAS to decision-making in fracture management
clinical factors: surgeon comfort, pain, compliance
biological: surgical approach, timing
mechanical: stabilization method, timing
use all these to assign a score and determine plan
describe how FAS relates to surgical approach
if a fracture will take longer to heal, minimize your surgical footprint!
minimally invasive approach, maybe add a graft
if low risk/fast healing; can open approach and no graft
carpenter vs. gardener; sometimes it’s worth it to sacrifice biology to obtain a stronger fixation (carpenter); but other times is it crucial to preserve biology to speed up bone healing (gardener)
describe bone grafts
- many different types, but autogenous cancellous bone graft = gold standard
- proximal humerous most common location
- enhances bone healing
describe how FAS relates to plate choice
high risk:
-plate/rod combo
-interlocking nail
-type III ESF
med risk:
-IM pin/cerclage
-type II ESF
low risk:
-external coaptation
-IM pin
-type I ESF
ring/hybrid fixators span all levels of risk
what does fracture configuration help you decide? what are 3 important questions to ask?
implant type, size, and manner of application
important questions:
1. is it reducible? (can you achieve load sharing)
2. what forces will you need to counteract? will always have a combo
3. how much bone stock is there for your implant(s)?
describe the clinical, biological, and mechanical options for a low (1-3) FAS score (high risk) fracture
clinical: likely refer to a boarded surgeon
biological: choose a less invasive approach and a bone graft
mechanical: stronger fixation is required
