fracture fixation Flashcards
Causes of Fracture
External forces
* Relatively minor to Violent
* Repetitive stresses (fatigue fracture)…rare
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Internal forces
* Less frequent
* Avulsion of tendons…
Fracture Care
- Address life threatening injuries
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Airway/Breathing - Chest injuries = 50%
> Lung contusions 66%
> Pneumothorax 30%
> Diaphragmatic hernia 3%
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Cardiovascular - Cardiovascular shock
- VPC
Minimum Database
PCV, TP, BUN (QAT’s)
* CBC/Chemistry to follow
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CHEST RADIOGRAPHS
* All violent trauma
* All unknown trauma
* May need to be repeated >24h
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Abdominal Radiographs / Ultrasound
* Suspicion of abdominal organ injury
* Bladder…
Pre-operative Fracture Care
- Analgesia
- NSAID (if no contraindications)
- Morphinic
> Methadone, hydromorphone, oxymorphone, buprenorphine,…
> Continue until post op
> May (should) require hospitalization
<><> - Antibiotics: Not needed unless open!
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Stabilize the fracture if applicable - Splint (Distal fractures)
- (Robert Jones)
- Cage rest until repair (All fractures)
Fracture Care
- timing of repair
- delays?
- As soon as the animal is stable
- Generally within 1 to 3 days
> Decreases morbidity
> Decreases mortality
> Decreases cost
> Improves well being
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Longer delays increases complications - Increased difficulty of procedure
- Particularly young animals
- Do not let the client unnecessarily delay!
Open Fractures - what we need to do ASAP
- Prevent further contamination
- Provide antibiotic coverage ASAP
> Broad spectrum IV (cefazolin or ampi/baytril)
> Continue until definitive closure - Wound management ASAP
> Same as other wounds
<><><><> - Provide temporary stabilization
- Repair sooner than later
Fracture Classification
- what info do we need
- Bone involved
- location within the bone
- Complexity of the fracture
- configuration
- Closed / Open
- Displacement
simple vs comminuted fracture
Simple
* 1 Fracture line
* Low energy trauma
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Comminuted
* multiple fracture lines (several fragments)
* high energy trauma
possible fracture configurations
- Applies to simple fractures
- Does not apply to comminuted Fracture
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1. Transverse
2. Oblique - Short (< 2X diameter)
- Long (> 2X diameter)
3. Spiral
4. With butterfly fragment
transverse fracture
- what is it, good repair method
- healing properties
Roughly perpendicular
* Good for a bone plate
> Compression
* Bone able to provide support when healing
Oblique Fracture
- short vs long categorization
- how we treat
Short Oblique
* Approximately 30 deg
* Treated like transverse
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Long Oblique
* Approximately 60 deg
* Fx >2x bone Ø
* Maybe treated with pin and wire
spiral fracture
- common? how it arises
- how to treat
Easiest fracture to get
* Often dog playing… low energy
* Result from torsion of bone
* Treated like long oblique fractures
Butterfly Fragment
- what is this
- fixation must do what
- how to fix
- Results from bending forces
- Technically a comminuted fracture
> Fracture fixation must resist bending forces > Plate/rod, Interlocking nail…
Closed / Open
- what do we look for?
Closed / Open
* Skin damage
* Presence of gas in soft tissues…
* Cannot always tell on radiographs
> Always examine the leg!
Displacement of a fracture
- how do we describe it?
- Describe the position of the distal fragment relative to parent bone
- Always described in terms of the distal fragment