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Surgery 2 > Fractures > Flashcards

Fractures Flashcards

1
Q

what do compression fractures look like?

A
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2
Q

what do tension fractures look like?

A
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3
Q

what do shear fractures look like?

A
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4
Q

what do bending fractures look like?

A
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5
Q

what do torsion fractures look like?

A
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6
Q

what are simple vs complex forces?

A

simple:
-compression
-tension
-shear

complex:
-bending
-torsion

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7
Q

what, generally, causes a fracture to occur?

A
  • Occurs when load on bone exceeds the strength of the bone

Extrinsic forces:
* External forces acting on bone
> Cause the majority of fractures

Intrinsic forces
* Internal forces (tendon pull…)
> Less frequent, leads to specific fractures

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8
Q

how do we desribe a fracture (6 things)

A
  1. Bone involved
  2. Location within the bone
    * Epiphyseal, Physeal, Metaphyseal, Diaphyseal
    * Proximal, Middle, Distal
  3. Fracture type or complexity
    * Simple, Comminuted, Segmental
  4. Fracture configuration
    * Transverse
    * Oblique (Short, Long)
    * Spiral
    * Wedge
  5. Fracture characteristic
    * Open, Closed
  6. Displacement
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9
Q

simple vs comminuted fracture, and when does each occur

A

Simple:
-single fracture line
-Low energy trauma
-Minimal soft tissue trauma

Comminuted:
-multiple intersecting fracture lines
-High energy trauma
-High soft tissue damage

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10
Q

how do we desribe the segmental fracture configuration

A
  • Segmental: multiple, non intersecting fracture lines
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11
Q

what is a transverse fracture, when does it occur

A
  • Fracture line perpendicular to the long axis of bone
  • Tensile loading
  • Fracture angle 90° > x > 60° relative to long axis
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12
Q

what is an oblique fracture and what is short vs long? when do they occur?

A
  • Short oblique: Fracture angle 60° > x > 30° relative to long axis
  • Long Oblique: Fracture angle x <30° relative to long axis
  • Compression loading
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13
Q

what causes a spiral fracture

A
  • Torsional forces
  • “Figure-of-eight” fracture line
  • Very similar to a long oblique Fx
  • One of the easiest fractures to get
    > Playing…
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14
Q

when do we see a wedge fracture and what does its character depend on?

A
  • Result from bending forces
  • Size of wedge depends on loading
  • Biomechanically important
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15
Q

when should we fix a fracture

A

as early as possible

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16
Q

advantages to early, accurate fixation

A
  • Reduces pain
  • Allows early return to function
  • Reduces risk of non-union
  • Eliminates risk of mal-union
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17
Q

Goals of fracture fixation:

A

Early ambulation and complete return to function

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18
Q

what are the categories of primary bone healing?

A

-Contact Healing
-Gap Healing

19
Q

what are the properties of Primary Bone Healing – Contact Healing

A
  • Absolute stability (< 2% strain)
  • No or minimal gap (< 0.01mm)
  • Bone heals without the formation of callus
  • Weaker than 2* bone formation initially
  • Slow process…
20
Q

what are the properties of Primary Bone Healing – Gap Healing

A
  • Absolute stability (< 2% strain)
  • Small gap (< 1mm)
  • Initial fibrin matrix with angiogenesis
  • Within days-weeks lamellar bone fills gap
    > Initially oriented perpendicular to long axis – weak
    > 3-4 weeks > reoriented
21
Q

what are the properties of secondary (indirect) bone healing? what is the proccess?

A
  • Adequate stability
  • Some gap may be present
  • Formation of callus
  • Transformation of tissue into another until bone is repaired
    > Granulation
    > Fibrous tissue
    > Fibrocartilage
    > Bone
  • Clinical union is relatively fast
22
Q

5 steps of secondary bone healing

A
  • Inflammation
  • Intramembranous Ossification
  • Soft Callus (chondrogenesis)
  • Hard Callus (endochondral ossification)
  • Bone Remodeling
23
Q

fixation methods for broken bone

A
  • Splint/Cast (coaptation)
  • Intramedullary (IM) pin
  • Cerclage wire
  • Bone plate
  • External fixator
  • Interlocking nail
  • Often used in COMBINATIONS!
24
Q

how should casts be placed to help heal a fracture? when should they not be used?

A
  • Must immobilize joint above and (all) joints below
  • Cannot be used for upper extremities (femur, humerus)
  • Some bones should not be casted (radius in miniature breeds)
25
Q

disadvantages of using casts for fracture repair

A
  • Never provide full stability
    > Many fractures cannot be properly immobilized
    > Mal-unions are VERY frequent
  • High morbidity!
    > Morbidity quickly increases with duration
    > Cheaper initially but cost of maintenance is high
26
Q

when is it ok to use a cast to repair a fracture?

A
  • Closed, non-displaced fractures below elbow or stifle
    > Incomplete (Greenstick)
    > Transverse (non- displaced/reduced)
  • Fractures that can be reduced closed and will be stable once reduced
  • Good for small bones like toes and metacarpi
  • Fractures that are expected to heal quickly
    > Minimize fracture disease
    > Often young animals
27
Q

what type of fractures should never be casted?

A

MANY fractures should never be casted…
* Open
* Comminuted
* Non-reduced
* Unstable
* (Older dogs)
* Femurs
* Humerus
* Radius (miniature)
* etc

28
Q

what is an external fixator?

A

there are several types, but all work by the same principle

29
Q

Advantages of External Fixator

A
  • Versatility!
  • Minimally Invasive (reduced surgical approach)
    > Good for open or infected fractures!
  • Can be deconstructed easily
  • Reasonable cost
30
Q

Disadvantages of External Fixators

A
  • Technically demanding
    > (although less than some other techniques)
  • Requires significant aftercare
    > Daily cleaning
  • Pin tract infections/draining
  • Cumbersome for the patient
31
Q

Intramedullary Pins and Cerclage Wires advantages

A
  • Inexpensive
  • Minimal equipment
32
Q

disadvatages of Intramedullary Pins? why do we use them with other devices?

A
  • ONLY counteracts bending forces
  • Cannot be used for radius
  • Only for very specific fractures:
  • Simple Long oblique or spiral
  • Never used alone:
    -use with cerclage wires to make sure things cant twist out of position
  • Can be used with plates for complex Fx
33
Q

what is the interlocking nail and what are its advantages? what about disadvantages?

A
  • Very good stability
    > Counteract all forces
    > locking bolts
  • Minimally Invasive technique
    > Good for open fractures
    > Good for comminuted fractures
  • Not for the radius!
  • Technically difficult for small size bones
34
Q

what are bone plates and screws used for? what are the advantages?

A
  • Metal plates attached to the bone with bone screws.
  • Can be used for all bones
    > Probably the most used method for Fx
  • Very stable fixation
  • Can be combined with many other fixation methods
35
Q

disadvantages of bone plates and screws

A
  • More invasive (large approach)
  • Cause more bone trauma
  • Expensive
    > Large inventory and equipment
    > Technically demanding
36
Q

what are the 3 ways that a bone plate can be used?

A

A) Compression plate
* Transverse fractures only
* Bone supports most of the load

B) Neutralization plate
* Bone must be reconstructed
* Bone shares some of the load

C) Bridging plate
* Bone is NOT reconstructed
* NO load sharing

37
Q

what is plate-rod fixation?, what is the advantage?

A
  • Combination of plate and IM pin greatly increases the bending strength of the repair
  • IM pin 35-40% of medullary canal
38
Q

what is the ‘race’ for healing?

A
  • Most implants are designed to allow weight bearing …but NEVER running, jumping etc
  • Animals MUST ALWAYS be restricted until healing is confirmed
    > Short leash walks only
  • “Implant failure is always a time dependent certainty”
    > ie: if it does not heal in time, EVERY implant is going to eventually fail
39
Q

what does a bone need to heal? what determines the type of healing?

A
  • Bone needs blood supply and stability to heal
    > Stability determines the type of healing
40
Q

goal of fixation

A
  • The goal of fracture fixation is Return to Full Function
41
Q

Fixations should be designed to allow….

A

immediate use of the leg

42
Q

intramedulary pin and circlage wires can never be used for what bone?

A

radius

43
Q

intramedulary pin and circlage wires are only for what type of fractures?

A

simple long oblique, or spiral

44
Q

initerlocking nail good for what type of fractures? cant be used where?

A

good for comminuted, open
do not use on radius

Surgery 2 (7 decks)

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