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Surgery > Fracture Complications > Flashcards

Fracture Complications Flashcards

1
Q

list potential fx complications

A
  1. Delayed unions
  2. Nonunion
  3. Malunion
  4. Osteomyelitis
  5. Implant Failure
  6. Fracture Disease
  7. Implant/Fracture associated neoplasia
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2
Q

Local factors of fx healing

A
  1. Instability
  2. Vascular impairment
  3. Infection
  4. Open fractures
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3
Q

Systemic factors of fx healing

A
  1. Old age
  2. Significant concurrent disease/injury
  3. Poor nutrition
  4. Delayed return to function
  5. Unrestricted exercise
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4
Q

when is vascular supply deemed poor

A
  • poor pre-existing muscle (distal tibia/radius)
  • high energy comminuted/open fxs
  • sx trauma/approach high
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5
Q

define strain

A

% of how much a fx fragment moves on weight-bearing compared to the size of the fx gap

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6
Q

amount of strain tolerated by bone tissue

A

<2%

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7
Q

a highly unstable fx w/ good blood supply =

A

large callus formation

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8
Q

tx of a well aligned and stable delayed union

A

give time and monitor w/ q4wkly rads

if suspect osteomyelitis –> C&S –> infected but stable = tx w/ ABs from C&S

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9
Q

tx of unstable delayed union

A
  • remove implants - realign and stabilise
  • C&S of implants
    +/- cancellous bone graft
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10
Q

tx of unstable and infected delayed union

A
  • remove implants –> C&S –> longterm ABs
  • 1-5L warm saline lavage
  • realign + stabilise
    + cancellous bone graft
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11
Q

two types of non-unions

A
  1. Viable (hypervasc) non-union

2. Non-viable (avasc.) non-union

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12
Q

rad appearance of hypervasc. non-union

A

abundant mineralised non-bridging callus w/ a radiolucent line separating the proximal and distal parts

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13
Q

tx of hypervasc non-union

A

caused by fx instability

–> remove implants (C&S) –> replace w/ rigid fixation (plates) + lavage like hell

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14
Q

rad appearance of non-viable non-union

A

Significant bone resorption @ fragment ends and no evidence of bone xn.
The bone ends are sclerotic and there is typically complete closure of the medullary canal w/ cortical bone.
Osteoporosis of the bone usu. apparent
+/- sequestra

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15
Q

tx of non-viable non-union

A
  1. Aggressive resection of the fibrous tissue and debridement of the fragment ends to open the medullary canal.
  2. Any necrotic bone or bone w/ no soft tissue attachment should be removed and submitted for C&S in addition to implants that are removed.
  3. Rigid stabilisation w/ bone plate
  4. Cancellous bone graft!!! (after 1-5L lavage) *can delay if site obviously infected
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16
Q

5 types of malunion

A
  • overriding
  • angular
  • rotational
  • distracted
  • intra-articular
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17
Q

indications to tx malunion

A

if signif. functional impairment exists/will exist

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18
Q

tx of malunion

A
  1. Osteotomy
  2. Debridement
  3. Realignment
  4. Stable fixation
  5. Cancellous bone graft
19
Q

2 main causes of osteomyelitis

A

endogenous (haematogenous) or exogenous

20
Q

polyostotic, metaphyseal osteomyelitis in a 9month old collie is most likely…

A

haematogenous origin

21
Q

define sequestrum

A

a piece of avascular bone separated from the surrounding living tissue. The sequestrum serves as a nidus for chronic infection - ideal for anaerobes.

22
Q

define involucrum

A

highly vascular new bone which walls off a sequestrum. the involucrum isolates infection but limits ABs and immune system access

23
Q

tx of osteomyelitis

A

empirical amoxicillin/clav whilst waiting for C&S –> ABs for 4wks (acute)/ 6-8wks (chronic) and reassess

24
Q

rad signs of osteomyelitis

A

only obvious 3wks after infection –> lysis + new bone production at the metaphysis

25
Q

methods of obtaining a sample to C&S with suspect osteomyelitis

A
  • remove implants
  • FNA
  • swab of infect bone
  • Jamshidi biopsy needle
26
Q

approach to suspect acute exogenous osteomyelitis

A
  1. If animal initially improves w/ respect to weight-bearing after sx and then lameness increases after 5-7days
  2. –> take rads to rule out early implant failure
  3. –> deep tissue C&S + empirical ABs (amoxicillin/clav)
  4. –> implant replacement if unstable + analgesia
  5. Monitor for resolution of pyrexia and inc. weight-bearing on C&S ABs
27
Q

a draining sinus tract that temporarily heals (spont/ABs) and then breaks out again is a hallmark of…..

A

chronic osteomyelitis

28
Q

why is it useless to culture a draining sinus tract?

A

full of opportunistic polymicrobes and the causative agent is rarely IDed

29
Q

if suspect chronic osteomyelitis you send a deep tissue sample for what cultures?

A
  • aerobic
  • anaerobic
  • fungal
30
Q

3 factors to result in a sequstrum

A

Bacterial contam + avasc. fx fragment + high strain environment

31
Q

rule of thumb = if there are more than 3 fragments use…

A

biologic/bridging osteosynthesis approach w/ open but do not touch sx repair approach

32
Q

most common pathogen of osteomyelitis

A

B-lactamase producing Staph. intermedius and aureus

33
Q

other pathogens of osteomyelitis

A

E.coli, Pseudomonas, Strep, Proteus

34
Q

anticipated healing time of infected non-unions =

A

3-6months

35
Q

suitable options to stabilise an infected non-union fx

A
  • plate

- interlocking nail

36
Q

chronic osteomyelitis req. AB for what time frame?

A

6-8wks minimum

37
Q

4 factors involved in exogenous osteomyelitis development

A
  1. bacteria: number/type
  2. Extent of soft tissue damage + impaired blood supply
  3. Stability of fx repair
  4. Formation of a biofilm (glycocalyx) over implants
38
Q

biofilms do what for bacteria

A
  • facilitate bacterial adhesions to implants

- protects bacteria from phagocytes, antibodies and ABs

39
Q

how do you avoid chronic fatigue implant failure?

A

always use fracture assessment + planning

40
Q

Why does femoral fx repair by retrograde IM pin placement cause disuse atrophy?

A

the pin cannot be cut level w/ greater trochanter thus irritates the gluteal muscles/forms a fibrous seroma –> dog uses leg less

41
Q

3 types of fracture dz

A
  1. Disuse atrophy
  2. Adhesions/contractions
  3. Joint disease
42
Q

how do you prevent fracture dz?

A
  • physio
  • analgesia
  • minimising surgical trauma (Halsted’s principles)
  • rigidly stable fixation of fxs
43
Q

when should you recommend removal of implants following fx healing?

A
  1. Grade 2-3 open fxs

2. Osteomyelitis

Surgery (22 decks)

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