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RUSVM Small Animal Surgery 2017 > Fractures > Flashcards

Fractures Flashcards

1
Q

Stress

A

External force applied to any cross sectional area

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2
Q

Stiffness

A

Ability of a material’s ability to resist an applied force

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3
Q

Strain

A

Deformation of a loaded material as compared to its original form.
Typically measured in length

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4
Q

Tensile Strain

A

a change in length longwise

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5
Q

Compressive Strain

A

shortening of the length

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6
Q

Shear

A

a stress is applied that results in a change from side to side

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7
Q

Bending

A

Combination of tensile and compressive loading forces

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8
Q

Torsion

A

Combination of compressive, tensile, and shear loading forces

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9
Q

Deformation

A

change in shape due to application of a force (stress)

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10
Q

Elastic Deformation

A

a reversible change in shape

Material returns to original shape when load is removed

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11
Q

Plastic Deformation

A

a permanent change in shape

Material does not return to original shape when load is removed

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12
Q

Yield Point

A

point when material begins to deform plastically
Strain exceeds the material ability to recover rendering it permanently deformed
Occurs between elastic and plastic deformation

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13
Q

Ultimate failure point

A

material cannot withstand anymore strain and fails

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14
Q

Porosity

A

ratio of volume of open space to volume of total bone

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15
Q

High Porosity

A

Long elastic phase

Lower yield point

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16
Q

Low Porosity

A

Steep and short plastic phase (brittle)

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17
Q

Viscoelastic

A

Increased speed of loading (stress application) increases material stiffness

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18
Q

Anisotropic

A

Elastic modulus is dependent upon the direction of loading (stress application)
Bone is stronger and stiffer in compression
Bone is weakest when shear stress is applied

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19
Q

Type 1 open fracture

A

Wound smaller than 1 cm
Typically created by bone fragment from inside that retracts back through skin
Mild/Moderate soft tissue contusion

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20
Q

Type 2 Open Fracture

A

Open wound greater than 1 cm in size
Mild soft tissue trauma without extensive soft tissue damage
No flaps or avulsion

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21
Q

Type IIIA Open Fracture

A

Adequate soft tissue for wound coverage

Large ST laceration/flap

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22
Q

Type IIIB Open Fracture

A

Extensive ST loss
Bone exposure
Stripped periosteum

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23
Q

Type IIIC Open Fracture

A

Arterial +/- nerve supply to distal limb compromised

Requires microvascular anastomosis or amputation

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24
Q

What is the first priority of Open Fracture Management?

A

Systemic Stabilization: Cover the wound and stabilize patient

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25
Greenstick Fracture
Incomplete Fracture
26
Long Oblique
Length of fracture (mm) greater than 2.0 x diameter of diaphysis (mm)
27
What type of animal does a Physeal fracture occur in?
Young animals ONLY
28
Articular
Fracture runs through a joint surface
29
Displaced Fracture
If fracture ends do not line up then fracture is considered displaced
30
What are the goals of fracture fixation?
Restore length and alignment to promote healing and limb function Minimize motion at fracture ends Permit early ambulation with use of as many joints as possible during healing period Balance the forces that promote bone healing versus those that promote bone resorption
31
Wolff's Law
Bone remodels based on the forces that are applied Bone remodels and thickens in response to increased sustained forces Bone resorbs and weakens in response to decreased sustained forces
32
What are the advantages of Internal/External Fixation?
Variety of fixation options to promote stable repair Can promote normal muscle/joint function during bone healing Typically fewer rechecks than with external coaptation Nothing external to monitor
33
What are the disadvantages of Internal/External Fixation?
Expense to clinic and owner Requires training for appropriate application May require second surgery for explanation
34
What are the advantages of External Coaptation?
Limited supplies necessary for placement Need for highly specialized training is limited Avoids prolonged surgical procedure
35
What are the disadvantages of External Coaptation?
Requires frequent rechecks ($$) and bandage changes Limited effective applications Risk of bandage morbidity preventing continued use Immobilized joints
36
Indications for External Coaptation
Fractures below the know or the elbow: Minimally displaced fractures and those amenable to reduction Non-articular fractures Fractures expected to heal rapidly: Greenstick fractures
37
What fractures should not be casted?
Comminuted fractures
38
What kind of bone healing takes place with Open anatomic reduction/reconstruction?
Primary bone healing with less than 1 mm gap
39
What is required for articular fractures?
Open Anatomic Reconstruction
40
What is most appropriate for repair of transverse, oblique, segmental, and non or minimally comminuted fractures?
Open Anatomic Reconstruction
41
What should you consider when selecting implants?
Fracture type and location Bone affected Patient factors Surgeon preference and experience
42
Primary Implants
Bone Plates Interlocking Nails External Skeletal fixators (ESF)
43
Secondary Implants
Kirschner wires (K-wires) Cerclage wire Interfragmentary screws
44
What is the most common material used for Bone plates?
Stainless steel
45
What material is better fatigue resistant for bone plating?
Titanium
46
Dynamic Compression Plate (DCP)
Screw holes designed to allow screw placement that promotes compression of fracture ends Tightening of the screws moves fracture ends closer together
47
Limited Contact DCP
Contoured underside that allows stress to be more evenly distributed across plate Less contact with bone = less disruption of periosteal vascularity
48
Locking Plates (LCP)
Threaded locking screw head locks into threaded screw hole on plate
49
What plate type is commonly used for MIPO?
Locking Plates (LCP)
50
What kinds of bones are Locking Plates good to use in?
Osteoporotic bone Soft bone Comminuted fractures
51
What is the advantage of Locking Plates?
Greater force if required to cause implant failure | Pull out of screws only happens under significantly higher forces
52
What are cannulated screws used for?
Hollow for driving over pins
53
What is the goal of using screws?
Achieve as much contact with bone with a significantly stable implant of minimal size
54
What is the rule for measuring screws?
Screw diameter should not exceed 40% of bone diameter when used in diaphyseal bone
55
What are Cancellous screws best used for?
Metaphyseal and epiphyseal bone
56
Characteristics of Cancellous Screws
Increased outer diameter to core diameter ratio Deeper thread Larger pitch
57
Characteristics of Cortical Screws
Decreased outer diameter to core diameter More shallow thread Decreased pitch
58
Core diameter
does not include the threads
59
Outer diameter
does include the threads
60
When do you use Cortical Screws?
Dense cortical bone
61
What forces do Cortical screws overcome?
Bending forces
62
Self-tapping screws characteristics
Fluted tip | Does not require tapping
63
What screws are most resistant to bending forces than Cortical screws?
Locking screws
64
Locking plates
Tightening of the screws "locks" the screw into the plate creating a construct that converts shear and bending stress into compressive forces at bone-screw interface
65
Lag Screws
Placed perpendicular across an oblique or sagittal fracture line to promote compression of the fracture ends
66
Lag Screw uses
certain articular fractures oblique causes compression across the fracture
67
Position Screws
Screw placed across a fracture line to hold fragments in place No compression across the fracture is achieved
68
What is the application rule for conventional plates?
Stable repair requires screw purchase of at least 6 cortices above and below fracture
69
What is the application rule for locking plates?
Stable repair requires screw purchase of at least 4 cortices about and below fracture
70
Compression mode
Plate applied to achieve compression across the fracture
71
On what types of fractures do you use Compression mode?
Used for transverse or short oblique fractures
72
What type of bone healing is promoted with compression mode?
Primary bone healing
73
Neutralization Mode
Plates that are used in addition to primarily placed lag or positional screws Plates act to protect/neutralize against shearing, bending, and rotational forces
74
Buttress Mode
Used in metaphyseal fractures to prevent collapse fractures to prevent collapse of the adjacent articular surface
75
Bridging Mode
Plate spans fractured area which cannot be anatomically reconstructed Plate bears all load at level of fracture
76
What mode is used in biological osteosynthesis/MIPO?
Bridging Mode
77
Interlocking Nail
Internal fixation that combines benefits of a intermedullary rod and a plate
78
Interlocking Nail uses
Used to treat diaphyseal comminuted fractures
79
What can you not use an Interlocking Nail for?
fractures of the radius
80
What can you not use for fractures of the radius?
IM pin | Interlocking pin
81
What are the risks of internal fixation?
``` Implant Failure Osteomyelitis Impingement of nerves Osteopenia Delayed or Non-union Malunion ```
82
What is the rules for Orthopedic wire strength?
Thicker wire = increased tensile strength | Lower gauge = stronger wire
83
What do you use Orthopedic Wire for?
Mandibular fractues used with IM Pins, external skeletal fixators and plates
84
What type of fracture is a Tension Band used for?
Avulsion fractures | Some Osteotomies
85
Cerclage Wire
Wire placed circumferentially around bone column causing compression across fracture line
86
Rules for using Cerclage Wire
Use only on long oblique or spiral fractures Fracture line greater than 2x the diameter of the bone Place at least 2 cerclage wires Place at least 0.5cm from fracture ends spaced 0.5-1x bone diameter apart Place perpendicular to the bone Leave 2-3 twists
87
What type of fracture do you use Cerclage and Skewer Pin
short oblique fractures
88
How do you place K-wire?
perpedicular to the fracture line
89
Tension Band Wire
Fixation used to neutralize the pull of muscles/tendons on the fracture fragment
90
Interfragmentary Wire
Placed like "Sutures" holding bone fragments together
91
Indications for Interfragmentary Wire
Simple Fractures of Flat, non-weight bearing bones that interdigitate Mandibularly and maxillary fractures
92
Common name for Steinmann Pins
Intramedullary pins
93
Advantages of Steinmann Pins
``` Less expensive than plates/screws Less inventory +/- Smaller surgical approach +/- less surgical time Easy to remove if necessary Ideal for fractures that require less rigid fixation ```
94
Disadvantages of Steinmann Pins
Only resists bending forces Pin migration Limited application as a primary fixation implant
95
Kirschner Wires
Small Steinmann Pins that are easily bent
96
Intramedullary Pins
Placed in medullary cavity of bone to help restore length and maintain alignment
97
What forces do Intramedullary Pins resist?
Bending Forces
98
What fractures do you use Intramedullary Pins for?
Humerus, Femur, Tibia, Ulna, Metatarsals, and metacarpals
99
What are Intramedullary Pins contraindicated in?
Fractures of the radius
100
What must you avoid doing with Intramedullary Pins?
Avoid Penetrating the joint surface
101
What percentage of the canal should be filled with the Intramedullary pins and cerclage wire?
70%
102
What percentage of the canal should be filled with the Intramedullary pins and a plate?
35-40%
103
What are the indications for Cross Pinning?
Simple Transverse fractures close to the joint | Salter Harris type 1 and 2 in young animals
104
What are the rules for using Cross Pinning?
Pins cross above the fracture line
105
Diverging Pin technique
Technique used to stabilize Salter Harris 1 fractures of Proximal Humerus or Femoral Head to promote normal physeal anatomy and bone growth
106
External Skeletal Fixation
Uses percutaneous pins or wires attached to external construct external to stabilize fracture fragments
107
What type of bone healing does External Skeletal Fixation promote?
Secondary Bone healing
108
What are External Skeletal Fixations used for?
``` Fractures of the appendicular skeleton Spinal fractures/luxation Mandibular fractures Correction of angular limb deformities Limb lengthening Arthrodesis Joint Immobilization ```
109
External Skeletal Fixator Components
Smooth or threaded pins or wires | Pins are secured with specialized clamps and connecting bars
110
ESF Pin Types
Smooth Pins Positive Profile Negative Profile Center vs. Threaded Pins
111
Positive Profile Pins
The threads of the pin are increase the outer diameter of the pin
112
Negative Profile Pins
The outer diameter is less than the core diameter due to the threads cutting into the core
113
What is the strongest Pin type?
Positive Profile Pin
114
What is the rule for the Pin diameter of the Tranfixation Pin Placement?
Pin diameter should be no more than 25% of the bone diameter
115
What is the ideal number of pins used for Transfixation Pin Placement?
3 pins per segment
116
What is the rule for Transfixation Pin Placement?
Pins should be placed 1/2 bone diameter away from fracture and each other Clamps connecting the pins and rods should be at least 1 cm away from skin Connecting rod should be as close to bone as possible
117
What strain types can external skeletal fixators counteract?
Tension Rotation Bending Axial Compression
118
How do you increase the ESF rigidity?
``` Frame type (I-III) Double bar Interconnecting bar Reduce bone-connecting bar distance Pin distribution Increased number of pins Larger diameter of pins and connecting bar ```
119
How do you decrease ESF rigidity?
Frame type Pin distribution Decreased number of pins Small diameter of pins and connecting bar
120
Dynamization
Planned decrease of the stability to allow increased axial loading of the fracture to enhance callus hypertrophy and remodeling of the fracture
121
Type 1A ESF
Unilateral-Uniplanar
122
Type 1B ESF
Unilateral-Biplanar Pins are placed 60-90 degrees from each other Interconnecting bars increase rigidity
123
What ESF types can be used on humerus and femur?
Type 1 A and 1B
124
Type 2A ESF
Bilateral-Uniplanar | Stiffer than Type 1
125
Type 2B ESF
Bilateral-Uniplanar with combination of full and half pins
126
Type 3 ESF
Bilateral-Biplanar | Stiffer than Type 1 or 2
127
Circular EFs
Wires connect to rings which are connected to rods
128
What are circular ESFs used for?
increase rod length over time for bone lengthening Complicated Fractures of the tibia and radius Correction of angular limb deformities
129
Hybrid Fixator
Utilizes components of linear and circular external skeletal fixators
130
What are Hybrid Fixators used for?
Metaphyseal fractures
131
ESF and Acrylic Frames Uses
Mandibular fractures
132
What breeds and species are ESF and Acrylic Fixators used in?
Toy breed dogs Cats Exotics
133
When do you recommend Dynamization?
6 weeks post repair
134
Advantages of ESF
Can be placed with minimal disruption of the fracture fragments All implants removed once fracture has healed Useful for grade II and III open fractures Can be removed in stages to slowly increase the loading on bone Cost associated is low compared to some devices
135
Disadvantages of ESF
Frequent rechecks required Morbidity associated with skin-pin interface Pin loosening implant failure External hardware poses risk to people/objects Additional procedure for removal
136
ESF complications
``` Pin tract drainage Loosening of Pins/Wires Osteomyelitis Ring sequestrum Nerve vascular damage ```
137
What is Scapular fractures associated with?
Blunt trauma
138
Stable extraarticular fractures
fractures in the body that are protected and can be healed by themselves without surgical intervention
139
Unstable extraarticular fractures
Might be distraction of the fracture fragments or comminution
140
Intraarticular fractures
Fractures of the neck, acromion, and through the glenoid of the scapula
141
What is the most common fracture of young large breed animals?
Fractures of the glenoid tubercle
142
How do you repair a fracture of the glenoid tubercle?
lag screw or pin and tension band
143
What must you avoid when repairing a Scapular neck fracture?
Suprascapular nerve entrapment
144
What is Humeral condylar fracture associated with?
Incomplete ossification of Humeral Condyle
145
What breeds are predisposed to Humeral Condylar Fractures?
Spaniels
146
What portion is most commonly affected by Humeral Condylar Fracture?
Later Portion
147
What is the primary means of fixation for Humeral Condylar Fractures?
Lag screw and anti-rotational wire
148
What do you apply to Humeral Condylar T and Y fractures?
Plates
149
Monteggia Fractures
Fracture of the ulna with dislocation of the radial head
150
Type 1 Monteggia Fracture
Cranial displacement
151
What type of Monteggia Fracture is most common?
Type 1
152
What fractures are most common in young small breed dogs?
Radius/Ulna fractures
153
What is the differential diagnosis for Distal Diaphyseal Radius/Ulna Fractures in older large breed dogs?
Neoplastic disease
154
What is a common fracture associated with trauma?
Metacarpal and Metatarsal fractures
155
How do you manage Metacarpal and Metatarsal fractures?
Plantar/palmar splints
156
What is the treatment rule if you have more than one metacarpal fracture?
Surgery
157
What is the treatment rule if you have fractures of Metacarpals 3 and 4?
Surgery
158
What is the treatment for fractures of all metacarpals?
Surgery
159
What fractures are seen with Hit By Car Trauma?
Pelvic Fractures
160
What are important considerations for Pelvic Fractures?
Evaluate for life threatening injuries Image thorax and abdomen Perform thorough neuro exam
161
What are some complications of Pelvic Fractures?
Malunion with pelvic canal narrowing Entrapment of sciatic nerve in callus Nonunion
162
What is conservative management of Pelvic Fractures?
6-8 weeks cage rest
163
What are the most common sites of Spinal Fractures and Luxation?
T3-L3 and L4-L7
164
What is the Best modality for detecting bony lesions?
CT
165
What is the best modality for assessment of spinal cord changes within canal and spinal cord compression?
MRI
166
What are the surgical goals for Spinal fractures and luxations?
Decompression of spinal cord | Stabilization of vertebral column
167
Four A's of Systematic Assessment?
Apposition Alignment Apparatus Activity
168
What is the average healing time of Fractures?
6-8 weeks
169
Factors affecting bone healing include
``` Fracture configuration/severity Soft tissue damage Stability of repair Presence of infection Patient factors Compliance ```
170
Fracture Healing Complications
Delayed Union Malunion Nonunion
171
Delayed Union
Healing is prolonged beyond normal expected time Fracture line remains evident with feathery/wooly ends Callus is visible No sclerosis of bone ends
172
Malunion
Failure to re-establish normal form and function in the face of healing
173
Quadriceps Contracture
Complication associated with prolonged immobilization of the distal femur in young patients due to Muscle fibers being replaced by fibrous tissue
174
What type of fracture is associated with Quadriceps Contracture?
Distal Femoral Fractures
175
Disuse Osteoporosis
Decreased in stress application to the bone results in increased osteoclast activity Can occur with casts and excessively strong implants/fixators
176
What is Ligamentous Laxity associated with?
Muscle atrophy from disuse or immobilization causing loose ligaments and joint instability
177
What is associated with improper casting/splinting of elbow/antebrachial fractures?
Digital Flexor Contracture
178
Primary Bone Neoplasia
Osteosarcoma Chondrosarcoma Fibrosarcoma Hemangiosarcoma
179
Metastatic Bone Neoplasia
Multiple Myeloma | Lymphoma
180
What breed are represented with Osteosarcoma?
Large and Giant Breed dogs
181
What is the Bimodal age distribution of Osteosarcoma?
18-24 months | Greater than 7 years
182
Where is the predilection site for Osteosarcoma?
Metaphyseal region of long bones
183
What are the radiographic changes seen with Osteosarcoma?
Cortical lysis Periosteal reaction +/- Mineralization of surrounding soft tissues Loss of trabecular pattern Lack of distinct border between normal and abnormal bone
184
What is common in young animals?
Bone cysts
185
What is the gold standard for diagnosing Osteosarcoma?
Biopsy
186
What is present in most patients with Osteosarcoma?
Micrometastases
187
What is Palliative treatment for Osteosarcoma?
Pain Management Bisphophonates Radiation
188
What Chemotherapy is used for treatment of Osteosarcoma?
Doxorubicin Carboplatin Cisplatin
189
What is the first choice antibiotic treatment for open fractures?
Cefazolin
190
What is the most common complications associated with ESF?
Pin tract morbidity/ Drainage/ Infection
191
When placing Cerclage wires how should they be positioned in reference to the long axis of the bone?
Perpendicular
192
After achieving compression of a short oblique fraction using a lag screw. you also place a plate to protect the compression and apposition achieved lag screw. What plating mode is demonstrated in this example?
Neutralization Plating

RUSVM Small Animal Surgery 2017 (17 decks)

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