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RUSVM Small Animal Surgery 1 > Fracture Disease And Complicaitons > Flashcards

Fracture Disease And Complicaitons Flashcards

1
Q

What are complications of fracture immobilization?

A 
Quadriceps contracture 
Disuse osteoporosis 
Muscle atrophy 
Ligamentous laxity 
Cartilage atrophy 
Fracture associated sarcoma
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2
Q

Most common complication after distal femor fractures that are improperly immobilized>

A

Quadraceps contracture

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3
Q

Predisposing factors to quadriceps contracture?

A

Young patient <6months

Poor use of limb during healing

Immobilization of limb

Extensive muscle trauma

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4
Q

Clinical presentation of quadriceps contracture?

A

Muscle replaced by fribrotic tissue
Forms adhesions between muscle and bone

Tight band at quadriceps 
Difficulty ambulatory 
Muscle atrophy 
Hock/stifle locked in extension 
Toe excoriation

Dorsally raised patella

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5
Q

Radiographs show..
patella drawn proximally

Genu recurvatum
Ankylosis and DJD

A

Quadripceps contracture

Genu recurvatumm = knee bent backwards

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6
Q

How do you prevent quadriceps contracture?

A 
Early return to function 
Physical therapy 
No immobilization 
Ice packs 
NSAIDS
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7
Q

Treatment of quadriceps contracture?

A

Salvage
-release of quadriceps
Arthrodesis (last ditch)
Amputation (toes abraded)

Dynamic flexor brace

Prognosis

  • poor for full fxn
  • guarded for partial fxn
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8
Q

What do you call loss of bone due to reduction of mechanical stress?

A

Disuse/secondary osteoporosis

Wolfs law - osteoclasts

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9
Q

If disuse osteoporosis is longer than ______ the damage can be permanent

A

12 weeks

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10
Q

If you have muscle atrophy due to immobilization after fracture, how much longer does recovery take?

A

2-4x longer

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11
Q

How is ligamentous laxity resolved?

A

Improved muscle tone

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12
Q

How does cartilage atrophy occur?

A

Joint use stimulates glycosaminoglycans

Immobilization decreased GAG —> cartilage erosion and ankylosis

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13
Q

Cartilage atrophy is reversible if under ____ weeks

A

4

Can be permanent over 7weeks

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14
Q

Digital flexor contracture is seen following what cases?

A

Small dogs with fracture of elbow/antebractum

Walks on 3 legs with carpus flexed

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15
Q

Prevention and treatment of digital flexor contracture?

A

Encourage limb use
Spoon splint
Passive range of motion

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16
Q

Fracture assoicated sarcoma is seen in what breeds more commonaly

A

Large

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17
Q

Fracture associated sarcoma is usually seen with what type of fracture?

A

Comminuted femoral fracture

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18
Q

etiologies of fracture assoicated sarcoma?

A

Implant corrosion at fracture site

  • Jonas pin
  • TPO plate

Dissimilar metals

Complicaitons( inflammation or infection)

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19
Q

What do you call a slower than expected healing

A

Delayed union fracture

20
Q

What do you call a fracture that the progression of healing has ceased?

A

Non union fractures

21
Q

What are the two types of non union fractures?

A

Viable — abundant callus formation (elephant foot)

Non viable — lack blood supply

22
Q

T/F: non union fractures are unlikely to heal without some form of intervention

A

True

23
Q

What are mechanical factors that can cause non union fracture/ delayed union?

A

Fracture segment proximity — avoid gaps larger than bone diameter

Motion at fracture site

  • some motion can trigger stem cell proliferation
  • too much motion damages cells and prevents callus formation
24
Q

What factors can alter the biological environment affecting bone healing?

A

Decreased blood supply of periosteum

Decreased surrounding soft tissue

Increased age

Open reduction/fixation method (extrinsic factors)

25
Q

What cells are found in the periosteum and medullary cavity, decrease in aging patients and will proliferate when exposed to growth factors ?

A

Cellular environment

26
Q

Causes of delayed and non union fractures?

A

Fracture instability

Damage to vascular supply

Bone affected

  • radius and ulna (blood)
  • femur (most commonly broken)
  • humerus
  • tibia

Local infection

Large fracture gaps
Fixation

Metabolic conditions

27
Q

How does local infection alter bone healing?

A

Alter pH and release enzyme that prevent neovascularization

28
Q

What metabolic conditions can impair bone healing?

A

Renal disease
Cushings
Hypothyroid
glucocorticoids

29
Q

What is the treatment for delayed union fractures?

A

Additional time to heal

Replace or add implant if failure

Infection - culture and treat

Reduce patient activity

30
Q

If you have treated a delayed union fracture and it has no improvement in 2-4weeks, it is then what kind of fracture?

A

Non union

31
Q

Treatment of non-infected viable non union fractures

A

Fracture stabilization
Bone graft

External fixator to preserve blood supply

32
Q

How do you treat a non infected, non viable, non union fracture?

A

Stabilized
Removed fibrous tissue from fracture site
Removed loose implants

Ream medullary cavity to reestablish blood supply
Bone graft

Roger bone ends until bleeding

33
Q

How do you manage open fractures?

A

Manage patient first
Limb viability?

Debridement

  • sterile lube over wound
  • cover wound
  • clip hair
  • clean surrounding with 4%CGS
  • debride non viable tissue

Vigorous irritation of would
-7-8psi sterile saline of 0.05% Chlorhexidine

Cover with sterile dressing
Stable bandage

34
Q

T/F: antibiotics are always indicated for open fractures

A

True

35
Q

What antibiotics do you give in case of open fractures?

A

Culture

Combo of gram pos and neg, anaerobic, aerobic

Most effective if <3 hours from injury
Change based on culture results

Cephalosporins and fluroroquinolones

36
Q

T/F: fractures can heal with coexisting infection

A

True

But they will not heal is there is also instability

37
Q

Why do most open fractures have increased healing times?

A

More necrotic tissue
Disruption of blood supply

Cancellous atuografts are indicated

38
Q

What is the best open fracture stabilization method that allows bone access to the wound and doesnt spread contamination ?

A

External fixator

Bone plate

39
Q

Etiologies of osteomyelitis?

A

Open fracture repair

Hematogenous

40
Q

Most common causative organisms of osteomyelitis ?

A

Staphylococcus intermedius
E.coli
Pseudomonas

41
Q

Pathophysiology of osteomyelitis?

A

Damage to bone
Vascular compromise and ischemia

Bacterial contamination

Necrotic tissue, instability
Lack of blood supply—> perpetuate infection

Surgical implants

  • biofilm, adherence, colonization
  • antimicrobal resistance
42
Q

Clinical signs of osteomyelitis ?

A

Excessive local pain
Excessive swelling
Fever
Lethargy

43
Q

Osteomyelitis appears how on radiographs?

A

Loose or broken implant

Lucency around implant

Periosteal proliferation

Sequestrum

Can confirm with biopsy and culture

44
Q

How do you manage osteomyelitis ?

A

If fracture healed - remove implant and give long term antibiotics

Not healed but implant is stable— leave in

Fracture not healed and not stable e— replace with stable fixation method

Large amount of discharge 
—> treat as open wound, direct culture 
Debride and lavage 
Pack 
IV abs for 3-5days then oral for 6-8wks 
When discharge stops, close or heal by second intention
45
Q

How do you manage a sequestrum ?

A

Dead bone from osteomyelitis

Involcrum — bone formed around sequestrum

Use rongeurs or bur to remove
Treat infection
If weakens bone — provide stabilization

RUSVM Small Animal Surgery 1 (39 decks)

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