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MSK2 > Fracture management 2 > Flashcards

Fracture management 2 Flashcards

1
Q

Explain non-locking plate contouring

A
  • Required to create bone-plate friction
  • Contour plate to the shape of the bone
  • Use bending iron or press
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2
Q

Explain the use of dynamic compression plates

A
  • Apply axial compression to transverse fracture

- Aim for primary bone union (contact healing)

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3
Q

Explain the use of compression screws in plates

A
  • Screw either side of fracture fixed
  • Screw inserted eccentrically
  • As tightened, head shift down towards centre, pulls bone with it towards the fracture therefore compressing the fracture site
  • Compression screws placed first, then neutralisation screws placed (place one positional first to hold plate in place
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4
Q

Explain the use of neutral screws in plates

A
  • As tightened pull plate onto bone

- Do not move in plate hole and do not move bone

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5
Q

How many screw head movements and how many compression screws can be use in plates?

A
  • Maximum of 2 screw head movements per plate hole

- Maximum of 2 compression screws, rest all neutral screws

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6
Q

Explain the function of neutralisation plates

A
  • Used where other implants are used to reconstruct the fracture e.g. K wire, cerclage wire
  • Used to stabilise against (neutralise) some forces and allow weight bearing on bone
  • Bone takes some load
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7
Q

Explain the function of bridging plates

A
  • Used where fracture is not reconstructed and bone unable to take any load, unstable to all forces
  • Plate must take load, spans the fracture gap
  • Use larger plate and auxillary fixation device e.g. IM pin
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8
Q

What is the main risk with bridging plates?

A

Plate failure in particular in mid section

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9
Q

What are the advantages and disadvantages of plate application for fracture repair?

A
  • Good for fracture reduction/internal fixation
  • But requires dissection and high biological cost: trauma to bone, disruption to soft tissue attachment and blood supply
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10
Q

Explain the use of locking plates

A
  • Screw head locks into plate, have thread on head of screw and plate
  • Implant stability provided by locking mechanism
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11
Q

Outline the advantages of locking plates

A
  • Implant stability not dependent on bone quality
  • Good purchase in poor quality bone
  • Does not compress plate onto bone so no periosteal vascular disturbance
  • Exact contouring not necessary
  • Able to resist higher loads
  • No chance of screw/thread stripping
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12
Q

Explain how plate failure most common occurs

A
  • Exposure to cyclical bending due to trans cortex not being in tact (trans cortex must resist bending)
  • Non-reconstructed fractures higher chance of bending
  • Most common fail through screw hole
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13
Q

What is an external skeletal fixator device?

A

A device that fixes bone using pins inserted into the bone, external to skin and bone

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14
Q

Name the different frame times for ESFs

A
  • Linear (most common)
  • Circular
  • Free form (putty/epoxy)
  • Hybrid
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15
Q

Describe linear ESFs

A
  • Longitudinal connecting bars
  • Clamps attaching to pins inserted into bone
  • Versatile
  • Limited surgical incision so low biological cost
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16
Q

Name the different types of linear ESFs (5) in order from weakest to strongest

A
  • Type IA
  • Type IB
  • Type II modified (IIB)
  • Type II (IIA)
  • Type III
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17
Q

Describe type IA linear ESFs (structure, insertion, pins, risks)

A
  • Uniplanar and unilateral
  • Safe corridor insertion through clean skin site
  • Do not exceed 30% of bone diameter
  • Plain and threaded pins used
  • Tip threads and positive threads prevent breakage due to bending
  • Pin tract infection risk
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18
Q

Describe type IB linear ESFs (structure, insertion, pins, risks)

A
  • Biplanar (craniocaudal and mediolateral plane) and unilateral (one side of each plane)
  • SAfe corridor insertion through clean skin site
  • Do not exceed 30% of bone diameter
  • Plain and threaded pins used, tip threads and positive threads prevent breakage due to bending
  • Consideration of pin tract infection
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19
Q

Describe type IIB linear ESFs (structure, pins)

A
  • Uniplanar, bilateral (2 sides of bone)

- Full pins top and bottom, half pins in between

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20
Q

Describe type IIA linear ESFs (structure, pins, risks)

A
  • Bilateral and uniplanar
  • Full pins throughout
  • Technically difficult
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21
Q

Describe type III linear ESFs (structure, disadvantages)

A
  • Biplanar, bilateral

- Excessively complicated, large, rarely used

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22
Q

Describe the structure of circular ESFs

A

Thin wires suspended by rings surrounding the limb

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23
Q

Outline the advantages and disadvatages of circular ESFs

A
  • More versatile
  • More applications
  • Good for complex fracture applications
  • More complex
  • More demanding
24
Q

Outline the advantages and disadvantages of free form/epoxy putty ESFs

A
  • Very adaptable, bespoke frame
  • Clamps and bars replaced by resin or epoxy putty
  • Messy, cannot adjust post-op, tricky to de-stage
25
Q

Describe hybrid ESFs and give a common example

A
  • Combination of various fixator types

- Typically circular ESF distally + linear ESF proximally

26
Q

Compare the healing achieved with ESFs and bone plates

A
  • Bone plates have slower healing, primary bone union

- ESFs use secondary bone healing and heal twice as quickly, used for non-reconstructable/comminuted fracture

27
Q

Describe the basic application of ESFs

A
  • Pins designed for purpose, can have negative and positive profile
  • 2 placed at either end of bone, external connecting bar placed
  • Pins clamped in position whilst examining limb for length and orientation of the two joints
  • Further pins placed to strengthen the construct with 2 close to the fracture
  • Some limited ability to alter alignment after pins placed
28
Q

Outline the main disadvantages of ESFs

A
  • Do not get accurate fracture reduction
  • Pins loosen
  • Pin tract discharge common
  • Complications almost guaranteed due to catching of structure
  • Frequently have problems with bone healing due to technique or pin loosening
  • Avoid ESF where possible as internal more reliable
29
Q

In what conditions are splints required?

A
  • Unstable fractures

- Unstable tendon injuries

30
Q

When an injury is in region 1 of an equine limb, describe the correct splint placement

A
  • Need to align the dorsal cortices
  • Place splint dorsally
  • Use commercial splints
31
Q

When an injury is in region 2 of an equine limb, describe the correct splint placement

A

Splint placed laterally and caudally

32
Q

When an injury is in region 3 of an equine limb, describe the correct splint placement

A

Splint should be placed laterally (and medially if possible)

33
Q

When in injury is in region 4 of an equine limb, describe the correct splint placement

A

Only possible in the forelimb, need to stabilise the carpus, some may be better without splints as the joint above cannot be stabilised

34
Q

Outline the main uses of coaptation

A
  • Temporary support or first aid before definitive procedure is performed
  • Reduce post operative swelling
  • Provide additional support following surgical intervention
  • To help protect wounds
35
Q

What factors must be taken into consideration to determine if external coaptation is appropriate?

A
  • Location
  • Type of fracture
  • Fracture reduction
  • Breed and age
36
Q

What is the basic principle of external coaptation?

A

To immobilise the joint above and below the site of fracture

37
Q

What location of fractures are most suited to external coaptation? What is the exception?

A
  • Fractures distal to the elbow and stifle
  • Fractures proximal to these sights have high risk of bandage slippage which may increase stress on fracture site
  • Articular and growth plate fractures: best managed with open reduction and internal fixation
38
Q

What forces is external coaptation resistant to?

A

Bending and some resistance to rotation

39
Q

Which types fractures are well suited to external coaptation?

A
  • Transverse fractures best suited

- Simple oblique or spiral fractures that are stable after reduction

40
Q

Outline the fracture reduction requirements when using external coaptation

A
  • Minimally displced best
  • Ends of fracture need to overlap by at least 50% in both orthogonal views to achieve healing
  • Goal must always be perfect reduction
41
Q

Compare and explain the suitability of juveniles vs adults to external coaptation

A
  • Juvenile better than adults

- Good healing potential, able to form bridging callus in short period of time

42
Q

In which location should external coaptation be avoided and why?

A
  • Fractures of distal radius and ulna (esp. toy breeds)

- High incidence of delayed union due to poor blood supply to the area

43
Q

Outline the complications that may occur with external coaptation

A
  • Poor application
  • Non-union due to poor stabilisation
  • Excessive pressure on limb
  • Excessive movement of bandage (rub, sores, swelling)
44
Q

Briefly outline the application of a cast in small animals

A
  • Rigid material completely surrounding limb
  • Use Robert-Jones bandage for temporary support
  • Only apply case once swelling subsided
  • Use synthetic casting tapes
  • Can make bivalving casts
  • Any prominent areas should have additional padding surrounding it (i.e. doughnut shape) in order to make the area level
  • Radiograph following application to ensure adequate fracture reduction
45
Q

When might a modified Robert Jones bandage be used and what is meant by this?

A
  • Replace cotton wool layer with light cast padding
  • Does not provide fracture support, but can be benneficial following internal fixation to reduce swelling of soft tissues
46
Q

Outline the method for applying a Robert Jones bandage

A
  • Tape stirrups from above carpus/tarsus to beyond the toes
  • Cotton wool layer to level of the mid-humerus/femur, leave nails of 2 middle toes visible
  • Wrap conforming gauze over cotton wool, even pressure
  • Repeat cotton wool and gauze layers twice, each time compress cotton wool
  • Invert tape stirrups, adhere to outside of gauze
  • Apply cohesive bandage layer
47
Q

When would a Robert Jones bandage be appropriate?

A
  • Temporary support to injured limb
48
Q

When is the use of splints indicated in small animals?

A

Only for distal limb injuries, should not be used to stabilise more proximal fractures of the radius and tibia

49
Q

Outline the application of a splint and explain why this is done

A
  • Less padding to reduce motion between splint and skin
  • Splint positioned over secondary layer and held in place with additional layer of gauze
  • Final layer of adhesive tape/cohesive bandage
50
Q

What are velpaeu slings used for?

A

Thoracic limbs, immobilise fractures and joints more proximally

51
Q

What are Ehmer slings used for?

A

Pelvic limbs, immobilise fractures and joints more proximally

52
Q

What are the disadvantages of slings?

A
  • Difficult to place and maintain without slipping

- Potential to cause skin necrosis over feet if not carefully monitored

53
Q

Outline the monitoring and treatment of a cast or splint for fracture and post-op support

A
  • For fracture support: check weekly, change padding and inspect limb every 2 weeks
  • For post-surgical support: change padding and inspect weekly
54
Q

When should a Robert Jones bandage be changed for fracture support and general limb support?

A
  • Fracture: change every 2-3 days

- General limb support: change weekly

55
Q

Outline what checks should be performed for cast/bandages by the owner and how often?

A
  • Check twice daily
  • Check toes carefully for heat, swelling, pain
  • Check pads and nails to ensure normal colour
  • Check top of dressing for pain swelling
  • Check skin above cast/bandage for increased redness, sores, swelling
  • Check cast/bandage for bad smell

MSK2 (29 decks)

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