fracture fixation Flashcards

1
Q

Causes of Fracture

A

External forces
* Relatively minor to Violent
* Repetitive stresses (fatigue fracture)…rare
<><><><>
Internal forces
* Less frequent
* Avulsion of tendons…

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2
Q

Fracture Care

A
  • Address life threatening injuries
    <><>
    Airway/Breathing
  • Chest injuries = 50%
    > Lung contusions 66%
    > Pneumothorax 30%
    > Diaphragmatic hernia 3%
    <><>
    Cardiovascular
  • Cardiovascular shock
  • VPC
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3
Q

Minimum Database

A

PCV, TP, BUN (QAT’s)
* CBC/Chemistry to follow
<><>
CHEST RADIOGRAPHS
* All violent trauma
* All unknown trauma
* May need to be repeated >24h
<><>
Abdominal Radiographs / Ultrasound
* Suspicion of abdominal organ injury
* Bladder…

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4
Q

Pre-operative Fracture Care

A
  • Analgesia
  • NSAID (if no contraindications)
  • Morphinic
    > Methadone, hydromorphone, oxymorphone, buprenorphine,…
    > Continue until post op
    > May (should) require hospitalization
    <><>
  • Antibiotics: Not needed unless open!
    <><>
    Stabilize the fracture if applicable
  • Splint (Distal fractures)
  • (Robert Jones)
  • Cage rest until repair (All fractures)
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5
Q

Fracture Care
- timing of repair
- delays?

A
  • As soon as the animal is stable
  • Generally within 1 to 3 days
    > Decreases morbidity
    > Decreases mortality
    > Decreases cost
    > Improves well being
    <><><><>
    Longer delays increases complications
  • Increased difficulty of procedure
  • Particularly young animals
  • Do not let the client unnecessarily delay!
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6
Q

Open Fractures - what we need to do ASAP

A
  • 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
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7
Q

Fracture Classification
- what info do we need

A
  1. Bone involved
  2. location within the bone
  3. Complexity of the fracture
  4. configuration
  5. Closed / Open
  6. Displacement
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8
Q

simple vs comminuted fracture

A

Simple
* 1 Fracture line
* Low energy trauma
<><>
Comminuted
* multiple fracture lines (several fragments)
* high energy trauma

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9
Q

possible fracture configurations

A
  • Applies to simple fractures
  • Does not apply to comminuted Fracture
    <><>
    1. Transverse
    2. Oblique
  • Short (< 2X diameter)
  • Long (> 2X diameter)
    3. Spiral
    4. With butterfly fragment
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10
Q

transverse fracture
- what is it, good repair method
- healing properties

A

Roughly perpendicular
* Good for a bone plate
> Compression
* Bone able to provide support when healing

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11
Q

Oblique Fracture
- short vs long categorization
- how we treat

A

Short Oblique
* Approximately 30 deg
* Treated like transverse
<><>
Long Oblique
* Approximately 60 deg
* Fx >2x bone Ø
* Maybe treated with pin and wire

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12
Q

spiral fracture
- common? how it arises
- how to treat

A

Easiest fracture to get
* Often dog playing… low energy
* Result from torsion of bone
* Treated like long oblique fractures

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13
Q

Butterfly Fragment
- what is this
- fixation must do what
- how to fix

A
  • Results from bending forces
  • Technically a comminuted fracture
    > Fracture fixation must resist bending forces > Plate/rod, Interlocking nail…
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14
Q

Closed / Open
- what do we look for?

A

Closed / Open
* Skin damage
* Presence of gas in soft tissues…
* Cannot always tell on radiographs
> Always examine the leg!

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15
Q

Displacement of a fracture
- how do we describe it?

A
  • Describe the position of the distal fragment relative to parent bone
  • Always described in terms of the distal fragment
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16
Q

Salter Harris Classification
- for what?
- prognosis for different areas?

A

Fractures of the growth plate have a different classification
* Loosely linked to prognosis
* Based on
> Likelihood damage to specific zones
> Articular damage
* But! Not as accurate as hoped
<><><>
- Damage of the epiphysis is likely articular
- Proliferative zone: Damage in this zone leads to irreversible damage
- hypertrophic zone: This zone is the most fragile but can recover
- trabecular bone: Damage in this zone is easily recoverable

17
Q

Salter Harris Classification
- prognosis for growth?
- articular Fx outcomes
- what type will definitely cease growth

A

Naturally occurring fractures involved all the zones
* Prognosis for growth is always guarded
* Articular Fx lead to additional DJD
* Type V Fx leads to complete/partial cessation of growth

18
Q

Goals of fracture fixation:

A

Return to full function
* Bone reconstruction
* Preservation of the blood supply
* Stable fixation
* Early active, pain free movement and full weight bearing
> (Activity must ALWAYS be restricted to avoid failure)