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6th MELEAH Sur-Gur-RAYYY final lezzzz ace dis shit > Fracture Disease and Complications > Flashcards

Fracture Disease and Complications Flashcards

1
Q

Contracture of the ______ most often occurs after a distal femoral fracture

A

quadriceps

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2
Q

Predisposing factors of a quadripcepts contracture:

  • Age: ______
  • Poor use of limb during _____
  • _______ of limb
  • Extensive ______ ______
A
  • young patient <6 months
  • Poor use of limb during healing
  • immobilization of limb
  • Extensive muscle trauma
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3
Q

Quadriceps contracture often forms _____ between muscle and bone. Muscle is replaced by ______tissue.

Clinical signs:

(also state what we can do to prevent: ___)

  • _____ _____ at quadriceps
  • Difficulty _____
  • Muscle ______
  • Hock/stifle locked in _____
  • Toe _______
A
  • Quadriceps contracture often forms adhesions between muscle and bone. Muscle is replaced by fibrotic tissue.

Clinical signs: (rehab to prevent)

  • Tight band at quadriceps
  • Difficulty ambulating
  • Muscle atrophy
  • Hock/stifle locked in extension
  • Toe excoriation
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4
Q

What is key with quadricepts contracture in terms of avoidance or treatment?

  • ______
    • ______ therapy
    • No _______
    • _____ packs
    • ______(type of drug)
A

PREVENTION!!!!

  • Physical therapy
  • NO IMMOBILIATION (CREATES ADHESIONS)
  • Ice packs
  • Nsaids
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5
Q

What do you see upon looking on rads for quadriceps contracture with the patella?

A

Patella is drawn proximal

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6
Q

For treatment of quadriceps contracture theres:

  • Release of ______
  • _______ procedure
  • ________
    • TOES ABRADED
  • State the type of brace?
  • Poor or good prognosis to get back to full function
A
  • Release of quadriceps
  • Arthrodesis procedure
  • Amputation
    • TOES ABRADED
  • Dynamic flexor brace
  • POOR PROGNOSIS TO ACHIEVE FULL FUNCTION
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7
Q

Muscle Atrophy

  • Occurs with _____ or _____
  • Is it reversible or nonreversible
  • Recovery time takes 2-4x longer
A
  • disuse or immobilization
  • reversible
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8
Q

Muscle atrophy can lead to ______ _____. Muscle tightens ligaments. Which causes joint instability. Resolves with improved muscle _____

A
  • leads to Ligamentous laxity
  • muscle atrophy
  • resolves: tone
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9
Q

Cartilage Atrophy:

  • Joint use stimulates ______
  • Immobilization decreases _____
  • Is it reversible?
  • If it’s permanent?
A
  • Joint use stimulates glycoaminoglycans
  • Immobilization decreases GAG
  • Is it reversible?
    • REVERSIBLE IF < 4 WEEKS
  • If it’s permanent?
    • Can be permanent if > 7 weeks
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10
Q

This limb abnormality resulting in contracture is seen in small dogs with a fracture of the elbow or antibrachium?

A

Digital flexor contracture

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11
Q

When a dog has Digital flexor contracture what do they do with walking?

A

walk on 3 legs with carpus flexed

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12
Q

With Digital flexor contracture prevention and treatment what 3 things can you do?

  • Encourage ____ ____
  • Spoon _____
  • _____ range of _____
A
  • Encourage limb use
  • Spoon splint
  • Passive range of motion
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13
Q

Fracture associated _____

  • Develops over 5 years after fracture in _____ breeds dogs with _____ _____ fractures
A
  • Sarcomas
  • large breed
  • comminuted femoral
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14
Q

What 3 complications are there with fracture associated sarcomas?

  • _____ failure
  • _____ union
  • _____
A
  • Implant failure
  • Delayed union
  • Osteomyelitis
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15
Q

This type of fracture is slower than expected healing compared with similar fractures healing with similar fixation techniques, radiographs indicate progressive osteogenic activity and fracture healing its just “slower”

A

Delayed union fractures

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16
Q

When the progression of fracture healing has completely ceased (during a period of ___ months and fracture gap persists) and is not likely to heal without any sort of intervention we call it this type of fracture (___-____).

Intervention is feasible if it’s viable due to abundant _____ _____ formation

or

non viable due to lack of ______ _____

A

Non-union (3 months)

  • Viable
    • Abundant callus formation
  • Non viable
    • lack of blood supply
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17
Q

In terms of mechanical factors in fracture repair, the fracture segments must be close enough so development of healing _____ to bridge the fracture site

A

callus

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18
Q

In terms of mechanical factors in fracture repair, aoid gaps greater than _____ _____

A

greater than bone diameter

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19
Q

In terms of mechanical factors in fracture repair, appropriate motion is essential for ______ and triggers _____ _____ proliferation?

A
  • healing
  • stem cell
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20
Q

In terms of mechanical factors in fracture repair, too much motion damages _____ and prevents formation of the ______

A
  • cells
  • callus
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21
Q

Growth factors from the biological environment initiates ______and bone healing factors

A
  • angiogenesis
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22
Q

Compare and contrast intrinsic factors to extrinsic factors for growth factors (bio env.)

A
  • Intrinsic factors
    • Decreased
      • blood supply of periosteum
      • surrounding soft tissue
    • Increased age (longer to heal)
  • Extrinsic Factors
    • Open reduction
    • Fixation method
23
Q

In terms of biological factors in fracture repair, ______ stem cells are found in ______or _____ cavity. Aging patients have _____ numbers. The stem cells_____ when exposed to growth fators. Activity is LEAST in ______ bone

A

In terms of biological factors in fracture repair, Mesenchymal stem cells are found in periosteum and medullary cavity. Aging patients have decreased numbers. The stem cells proliferate when exposed to growth fators. Activity is LEAST in Diaphyseal bone

24
Q

What is the number one cause of delayed or non union fractures?

A
  • Fracture instability
25
Whats the most commonly fractured bone?
* femur
26
What 2 bones most commonly have delayed or non union healing issues and what is it due to?
* Radius and ulna * due to blood supply
27
Why do infections often cause delayed or non union fractures, what does it prevent?
Bacteria alter pH and release enzymes that prevent neovascularization
28
The #1 cause of osteomyelitis is _____ \_\_\_\_\_\_
* surgical repair
29
What 2 fixation devices often cause delayed or non union of fractures. * ______ \_\_\_\_\_\_ impede blood supply * Improperly placed ______ \_\_\_\_\_\_
* **_Bone plates_** impede blood supply * Improperly placed **_cerclage wire_**
30
What Metabolic conditions cause immunosupression leading to delayed or non union fractures? * ______ disease * ______ syndrome * \_\_\_\_\_\_ * \_\_\_\_\_\_(drugs)
* Renal disease * Cushings syndrome * Hypothyroid * Glucocorticosteroids
31
For treatment of Delayed Union fractures * Do they require sx? * May require additonal _____ to heal * If there's implant failure causing it you do this? * Infection (make sure you ____ and tx) * Reduce patient \_\_\_\_\_\_ * Re-evaluate in 2-4 weeks * if no improvement update status to \_\_\_\_\_\_\_?
* Do they require sx? * **Most don't** * May require additonal **time** to heal * If there's implant failure causing it you do this? * **replace or add implants** * Infection (make sure you **culture** and tx) * Reduce patient **activity** * Re-evaluate in 2-4 weeks * if no improvement update status to **Non-union**
32
For treatment of Non-infected VIABLE Non-Union fractures: * Provide adequate ____ \_\_\_\_\_ * Bone \_\_\_\_ * _____ \_\_\_\_\_ to preserve blood supply
* Provide adequate **_fracture stabilization_** * Bone **_grafts_** * **_External fixators_** to preserve blood supply
33
For treatment of Non-infected NON VIABLE Non-Union fractures: * Provide adequate stabilization * Remove this from the fracture site? * Remoove loose \_\_\_\_\_ * Re-establish blood supply by doing this? * Bone grafts * Rongeur bone ends until this?
* Provide adequate stabilization * Remove this from the fracture site? * **remove fribrous tissue** * Remoove loose **implants** * Re-establish blood supply by doing this? * **Ream medullary cavity** * Bone grafts * Rongeur bone ends until this? * **UNTIL BLEEDING OBSERVED (est good circulation)**
34
What are the keys to success for open fractures? * Prompt \_\_\_\_\_\_ * Vigorous \_\_\_\_\_ * \_\_\_\_\_\_(drug type) * ____ \_\_\_\_ restoration
* Prompt **debridement** * Vigorous **irrigation** * **Antibiotics** (drug type) * _**Soft tissue** restoration_
35
Antibiotics are ALWAYS indicated for this type of fracture
open fracuture
36
Antibiotics are most effective with open fractures if less than ____ hours from injury
3
37
What must you do as soon as possible with open fractures?
stabilize as soon as possible
38
Fractures cannot heal with _____ and \_\_\_\_\_
infection and instability
39
Fractures can heal with coexisting _____ if chosen a stable method of fixation?
infection
40
Describe the healing times associated with open fractures
* Increased healing times
41
Why do open fractures have Increased healing times? (3)
* More necrotic tissue * More disruption of blood supply * Cancellous autografts are indicated
42
With open fracture stabilization what do we worry about with IM pins and interlocking nails?
Spreads contamination within medullary cavity
43
What methods stabilization for open fractures are there? * For no wound access (\_\_\_\_\_\_ \_\_\_\_\_\_) * \_\_\_\_\_\_\_ * CAUSE CONTAMINATION * _____ \_\_\_\_\_ * preserves BS * No implant @ fracture site * Access to wound * _____ \_\_\_\_\_\_
* For no wound access (**_external coaptation_**) * **_IM pin/Interlocking_** * CAUSE CONTAMINATION * **_External fixator_** * preserves BS * No implant @ fracture site * Access to wound * **_Bone plate_**
44
In terms of infectious organisms (bacterial) the majority of osteomyelitis infections are caused by this organism?
Staphylococcus intermedius
45
Osteomyelitis due to fungal agents are spread by this route mostly: \_\_\_\_\_
hematogenous
46
SUrgical implants often produce _______ that is a huge cause of osteomyelitis. Other factors (common sense) include: * damage to bone * bascular compromise/ischemia * necrotic tissue perpetuate infection due to lack of stability * colonization,adherence, ab resistance of bacteria with implants
biofilm (slime) hides under bone plates!
47
What are the 4 main clinical signs of Osteomyelitis? * Excessive ____ \_\_\_\_ * Excessive \_\_\_\_\_\_ * \_\_\_\_\_\_ * \_\_\_\_\_\_
* Excessive **_local pain_** * Excessive **_swelling_** * **_fever_** * **_lethargy_**
48
Indications upon viewing radiographs of osteomyelitis: * Loose or broken \_\_\_\_\_ * \_\_\_\_\_\_around implant * ______ proliferation * \_\_\_\_\_\_ * Confirm with _____ and \_\_\_\_\_
* Loose or broken **implant** * **Lucency** around implant * **Periosteal** proliferation * **Sequestrum** * Confirm with **biopsy and culture**
49
* If the fracture is healed * Remove the \_\_\_\_\_and give long term AB * Fracture NOT HEALED but implant is providing stable fracture env * What do you do to the implant? * Fracture is not healed and not stable? * What do you do to the implant?
* If the fracture is healed * Remove the **IMPLANT** and give long term AB * Fracture NOT HEALED but implant is providing stable fracture env * What do you do to the implant? * **DO NOT REMOVE IMPLANT** * Fracture is not healed and not stable? * What do you do to the implant? * **Replace with stable fixation method**
50
\_\_\_\_\_\_\_\_\_\_: a piece of dead bone tissue occurring within a diseased or injured bone, typically in chronic osteomyelitis.
Sequestrum
51
\_\_\_\_\_\_: When bone forms around the sequestrum it's known as?
Involucrum
52
Can new bone grow through sequestrum?
No but it can form around the sequestrum?
53
Sequestrum contain _____ bone and form ____ \_\_\_\_\_ out to skin
* devitalized * draining tracts
54

6th MELEAH Sur-Gur-RAYYY final lezzzz ace dis shit (15 decks)

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