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Animal disease 2 > Fractures > Flashcards

Fractures Flashcards

1
Q

Forces that can act on a fracture

A

Bending
Torsion
Compression
Shearing
Tension

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2
Q

Bending works by

A

Results in angulation of the bone
Breaks occurs opposite where force is applied
HBC, kicking, most common

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3
Q

Torsion works by

A

Rotation of the bone
Tends to cause a spiral fracture
Caught on something

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4
Q

Compression breaks bone by

A

Opposing forces acting on a bone
A fall

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5
Q

Tension breaks bone by

A

Results in distraction (pulling apart)
Called avulsion fractures
Most often occurs at tendon or ligament attachments on bone

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6
Q

Shearing breaks bone by

A

When a force is parallel to each other
Dragged by vehicle, an uncontrolled break

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7
Q

Are bones always broken by one or more forces

A

Bone fractures are often caused by multiple forces
Need to know which force caused the fracture
This force needs to be controlled to promote healing

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8
Q

How is Bone is viscoelastic

A

If a forces is applied slowly, bone has a greater ability to flex before breaking
If a force is applied quickly, less force is required to fracture the bone

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9
Q

Classification of fractures Based on

A

Whether or not the bone has penetrated the skin
Appearance of or geometry of fracture
Positioning of fractured bone with respect to each other
Where on the bone the fracture is occurring
Whether or not there is underlying bone pathology

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10
Q

Closed fracture

A

The fractured bone has not penetrated the skin

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11
Q

Open fracture

A

Previously called compound
The fractured bone has gone through the skin
Always considered infected- considered an emergency

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12
Q

Incomplete fractures are also known as

A

Cracks
Fissure fractures
Very good prognosis

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13
Q

Greenstick fractures is

A

A type of incomplete fracture
Only occur in young animals due to elasticity of bone
Young animals heal quickly

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14
Q

Comminuted fractures is

A

The bone has fractured into more than two pieces
Butterfly fragment
Comminuted fracture
A triangular or wedge shaped bone fragment

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15
Q

Physeal fractures are

A

Fractures along the physeal plat (growth plate)

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16
Q

Transverse fracture

A

The fracture occurs in a relatively straight line
Perpendicular to the (long axis) length of the bone

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17
Q

Oblique factures are

A

The fracture line is not perpendicular to the long axis of the bone
Classified as
Short oblique
Long oblique

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18
Q

Long oblique fracture is different form short by

A
  • the fracture line is at least twice the diameter of the bone at that point
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19
Q

Spiral fractures

A

Look like long obliques but hav a spiral patern

20
Q

Factors influencing how the bone fractures

A

How energy is applied
The type of force applied to the bone
The direction in which the force is applied to the bone
Which bone is affected
Bone maturity

21
Q

Why should you care how a bone breaks?

A

Knowing the type of fracture, what types of forces to avoid, and which forces work in your favour will matter to you when you are…
Assisting with bandage changes
Restraining an animals
Take radiographs
Providing nursing care

22
Q

Traumatic fractures occur because

A

These occur when too much force is applied to a healthy bone

23
Q

Pathological fractures occur when

A

These occur secondary to another disease process
Bone strength is impaired therefore less force is required to cause a fracture to occur

24
Q

Fracture repair needs formation of the bone by

A

Reduce fragments and immobilize the bone- need to understand how to minimize forces based on fracture types
Gap must be small enough for blood vessels to grow across- Blood vessels are required to bring other cells/healing factors to the repair site
Fibroblasts and chondrocytes enter gap and fill in with fibrocartilaginous tissue scaffold
Osteoblasts enter and fill with bone substance
Treat infection- INFECTED BONE DOES NOT HEAL

25
Q

Healing time for bone fractures and what needs to be done for it to work

A

Healthy adult: 8-12 weeks
Puppy, kitten: 4-6 weeks
The following conditions must be met
The fracture must be reduced
Immobilized- no motion or will cause sharing of newly formed blood vessels
The bone must be healthy

26
Q

Methods of fracture repair

A

External coaptation
Splints
Casts
Slings
Braces

Internal fixation
Intramedullary (IM) pins
Interlocking nails
Bone plates
Cerclage wire
External fixation
Fractures in certain bones present specific problems for repair

27
Q

External coaptation neutralizes what forces

A

Bending
Torsion
Shearing- maybe
If the splint or cast is applied too loosely, forces will not be neutralized and healing will be impaired

28
Q

External coaptation advantages

A

Non-invasive
Minimal disruption of the surrounding blood supply
Minimal effects on growth in young animals
Non Surgical placement- though may need to be sedated repeatedly during reassessments
Moderate expense (maybe…)
Can be performed in most clinics -specialized training is not required
Good temp measure
Before transporting the animal
Before surgical repair is performed

29
Q

Limitations of external coapitation

A

Poor control of tensile, compressive and in some cases shearing forces
Less rigid stabalization that with surgical repair
It may not be possible to get good fracture reduction and alignment with a closed repair
Especially true with fractures that have a lot of displacement or comminuted fractures

30
Q

Disadvantages of external coapitation

A

Rub sores and dermatitis are common
Bandages that are too tight can lead to swelling necrosis

31
Q

Rules for using external coapitation

A

Include the joints proximal and distal to the fracture
Don’t apply the bandage too tight
Ensure that the bandage is not too loose
Apply extra padding to pressure points to minimize the risk of pressure sores
Include the foot but leave the 2nd and 3rd digits exposed
The leg should be splinted with the joints in slight flexion- normal standing position
Splint changes will either require many people to help with restraint or sedation depending on the temperament/comfort level of the animal and staff support
Frequent rechecks are required
Take recheck radiographs with the splint on

32
Q

Follow up requirements with splinting

A

Recheck every 2-3 days initially, if things are going well, then increase to weekly rechecks
The animal needs to be brought in immediately if
The bandage has slipped
The bandage is soiled or wet
If the animal suddenly becomes more painful or starts trying to chew on the bandage where they had not previously
The toes are swollen

33
Q

Why don’t just put the splint on and see them back 6-8 weeks later

A

We need to evaluate the health of the tissues underneath the bandage and adjust management of the patient as necessary

34
Q

Internal fixation is and neutralizes what forces

A

Intramedullary pins
Forces neutralized
Bending
Shearing
IM pinning is often combined with some other form of fixation
Cerclage wire
Forces neutralized
Bending
Maybe torsion and shearing
Can be used on long obliques, not short oblique fractures
Also often combined with some other form of fixation

35
Q

External fixation is and neutralizes what forces

A

Can neutralize all forces
External skeletal fixation
This is hardware both inside and outside the body
Screws and bone plates
All forces are controlled by bone plates and screws

36
Q

Internal and external fixation advantages

A

Support of the fracture site
External fixation > internal fixation> external coaptation
Greater support means that the animal can use limb sooner
Bandaging is not required with an internal and external fixation
Don’t use the pressure sores and dermatitis associated with external coaptation
Wounds left uncovered if desired
With surgical repair, fracture and alignment are often better
Especially important with joint or growth plate involvement

37
Q

Disadvantages of external and internal fixations

A

The animal must have a general anesthetic
Higher cost?
Additional training and specialised equipment is required
Risk of iatrogenic fracture during hardware implantation
Disrupted blood supply- bone plates
ESF required second procedure for hardware removal
Hardware is often left in the animal when internal fixation is used
Discomfort in cold
Fracture at the ends of bone plates
Pins can shift
Infection risk

38
Q

Limitations of external and internal fixation

A

Need to monitor for infection
Can be very difficult to treat due to hardware
May require removal of hardware
Still need post op care
Recheck at 2 weeks, then q 2-4 weeks (earlier if concerns)
Wound care
Exercise restriction
Analgesia
PHYSICAL THERAPY

39
Q

Fracture complications

A

Tendon contracture
Quadriceps contracture or quadriceps muscle tie down
Osteomyelitis- an infection of the bone
Malunion- the fracture heals out of alignment
Non-union- the fracture does not heal

40
Q

Common Types of physical therapy

A

Warm packing
cold packing
passive range of motion
Active motion

41
Q

How does warm pack therapy work

A

Will help to relax tight muscles
Should be done before other exercise
Heat causes peripheral vessels to dilate- can increase tissue swelling
Avoid on joints, incisions and inflamed tissue
40-45oC for 15-20 min
Works well in combination with massage

42
Q

How does passive range of motion work

A

Benefits
Prevents contracture of tissues by maintaining mobility and flexibility of surrounding structures
Muscles, ligaments, tendons or scar tissue
Decrease muscle atrophy
Increases blood flow to the area
Strengthens innervation
Ensure to provide support both proximal and distal to the joint
20x, 1-3 reps, minimum 3x/day

43
Q

Active motion- recumbent animals works by

A

Helps to maintain muscle mass
Encourages nerve memory
Support the animal- can be done with slings, harnesses
Lifting the animal to a standing position and allowing them to support as much weight as they can
If the animal can support some weight- progress to rocking and balancing exercises
Recumbent patients must be flipped every 2-3 hours to prevent pressure sores

44
Q

Active motion- animals that are ambulatory can be done by

A

Slow walks
Underwater treadmill
Swimming
Start on flat, non-slippery surface for 2-4 weeks
Start with 5-10 minutes
Gradual increase in duration, frequency and incline
Must keep supported

45
Q

Cool packs for physical therapy help by

A

Decreases inflammation and swelling
10-15 minutes; 3x/day
Ensure that you don’t cause frostbite
After active motion and PROM

46
Q

Uncommon modes of physical therapy

A

Cold compression-works better than icing alone
Acupuncture
Transcutaneous nerve stimulation (TENS)- well tolerated by dogs and cats
Shockwave therapy
Underwater treadmills
Stem cell therapy
Therapeutic laser
Massage
Chiropractic
Assisi loop
Therapeutic ultrasound
Wobble boards, wobble balls, calvetti, underwater treadmills, etc

Animal disease 2 (6 decks)

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