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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
Q

Greenstick Fracture

A

Incomplete Fracture

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26
Q

Long Oblique

A

Length of fracture (mm) greater than 2.0 x diameter of diaphysis (mm)

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27
Q

What type of animal does a Physeal fracture occur in?

A

Young animals ONLY

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28
Q

Articular

A

Fracture runs through a joint surface

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29
Q

Displaced Fracture

A

If fracture ends do not line up then fracture is considered displaced

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30
Q

What are the goals of fracture fixation?

A

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

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31
Q

Wolff’s Law

A

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

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32
Q

What are the advantages of Internal/External Fixation?

A

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

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33
Q

What are the disadvantages of Internal/External Fixation?

A

Expense to clinic and owner
Requires training for appropriate application
May require second surgery for explanation

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34
Q

What are the advantages of External Coaptation?

A

Limited supplies necessary for placement
Need for highly specialized training is limited
Avoids prolonged surgical procedure

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35
Q

What are the disadvantages of External Coaptation?

A

Requires frequent rechecks ($$) and bandage changes
Limited effective applications
Risk of bandage morbidity preventing continued use
Immobilized joints

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36
Q

Indications for External Coaptation

A

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

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37
Q

What fractures should not be casted?

A

Comminuted fractures

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38
Q

What kind of bone healing takes place with Open anatomic reduction/reconstruction?

A

Primary bone healing with less than 1 mm gap

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39
Q

What is required for articular fractures?

A

Open Anatomic Reconstruction

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40
Q

What is most appropriate for repair of transverse, oblique, segmental, and non or minimally comminuted fractures?

A

Open Anatomic Reconstruction

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41
Q

What should you consider when selecting implants?

A

Fracture type and location
Bone affected
Patient factors
Surgeon preference and experience

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42
Q

Primary Implants

A

Bone Plates
Interlocking Nails
External Skeletal fixators (ESF)

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43
Q

Secondary Implants

A

Kirschner wires (K-wires)
Cerclage wire
Interfragmentary screws

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44
Q

What is the most common material used for Bone plates?

A

Stainless steel

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45
Q

What material is better fatigue resistant for bone plating?

A

Titanium

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46
Q

Dynamic Compression Plate (DCP)

A

Screw holes designed to allow screw placement that promotes compression of fracture ends
Tightening of the screws moves fracture ends closer together

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47
Q

Limited Contact DCP

A

Contoured underside that allows stress to be more evenly distributed across plate
Less contact with bone = less disruption of periosteal vascularity

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48
Q

Locking Plates (LCP)

A

Threaded locking screw head locks into threaded screw hole on plate

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49
Q

What plate type is commonly used for MIPO?

A

Locking Plates (LCP)

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50
Q

What kinds of bones are Locking Plates good to use in?

A

Osteoporotic bone
Soft bone
Comminuted fractures

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51
Q

What is the advantage of Locking Plates?

A

Greater force if required to cause implant failure

Pull out of screws only happens under significantly higher forces

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52
Q

What are cannulated screws used for?

A

Hollow for driving over pins

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53
Q

What is the goal of using screws?

A

Achieve as much contact with bone with a significantly stable implant of minimal size

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54
Q

What is the rule for measuring screws?

A

Screw diameter should not exceed 40% of bone diameter when used in diaphyseal bone

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55
Q

What are Cancellous screws best used for?

A

Metaphyseal and epiphyseal bone

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56
Q

Characteristics of Cancellous Screws

A

Increased outer diameter to core diameter ratio
Deeper thread
Larger pitch

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57
Q

Characteristics of Cortical Screws

A

Decreased outer diameter to core diameter
More shallow thread
Decreased pitch

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58
Q

Core diameter

A

does not include the threads

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59
Q

Outer diameter

A

does include the threads

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60
Q

When do you use Cortical Screws?

A

Dense cortical bone

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61
Q

What forces do Cortical screws overcome?

A

Bending forces

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62
Q

Self-tapping screws characteristics

A

Fluted tip

Does not require tapping

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63
Q

What screws are most resistant to bending forces than Cortical screws?

A

Locking screws

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64
Q

Locking plates

A

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

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65
Q

Lag Screws

A

Placed perpendicular across an oblique or sagittal fracture line to promote compression of the fracture ends

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66
Q

Lag Screw uses

A

certain articular fractures
oblique
causes compression across the fracture

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67
Q

Position Screws

A

Screw placed across a fracture line to hold fragments in place
No compression across the fracture is achieved

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68
Q

What is the application rule for conventional plates?

A

Stable repair requires screw purchase of at least 6 cortices above and below fracture

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69
Q

What is the application rule for locking plates?

A

Stable repair requires screw purchase of at least 4 cortices about and below fracture

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70
Q

Compression mode

A

Plate applied to achieve compression across the fracture

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71
Q

On what types of fractures do you use Compression mode?

A

Used for transverse or short oblique fractures

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72
Q

What type of bone healing is promoted with compression mode?

A

Primary bone healing

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73
Q

Neutralization Mode

A

Plates that are used in addition to primarily placed lag or positional screws
Plates act to protect/neutralize against shearing, bending, and rotational forces

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74
Q

Buttress Mode

A

Used in metaphyseal fractures to prevent collapse fractures to prevent collapse of the adjacent articular surface

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75
Q

Bridging Mode

A

Plate spans fractured area which cannot be anatomically reconstructed
Plate bears all load at level of fracture

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76
Q

What mode is used in biological osteosynthesis/MIPO?

A

Bridging Mode

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77
Q

Interlocking Nail

A

Internal fixation that combines benefits of a intermedullary rod and a plate

78
Q

Interlocking Nail uses

A

Used to treat diaphyseal comminuted fractures

79
Q

What can you not use an Interlocking Nail for?

A

fractures of the radius

80
Q

What can you not use for fractures of the radius?

A

IM pin

Interlocking pin

81
Q

What are the risks of internal fixation?

A 
Implant Failure
Osteomyelitis
Impingement of nerves
Osteopenia
Delayed or Non-union 
Malunion
82
Q

What is the rules for Orthopedic wire strength?

A

Thicker wire = increased tensile strength

Lower gauge = stronger wire

83
Q

What do you use Orthopedic Wire for?

A

Mandibular fractues used with IM Pins, external skeletal fixators and plates

84
Q

What type of fracture is a Tension Band used for?

A

Avulsion fractures

Some Osteotomies

85
Q

Cerclage Wire

A

Wire placed circumferentially around bone column causing compression across fracture line

86
Q

Rules for using Cerclage Wire

A

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
Q

What type of fracture do you use Cerclage and Skewer Pin

A

short oblique fractures

88
Q

How do you place K-wire?

A

perpedicular to the fracture line

89
Q

Tension Band Wire

A

Fixation used to neutralize the pull of muscles/tendons on the fracture fragment

90
Q

Interfragmentary Wire

A

Placed like “Sutures” holding bone fragments together

91
Q

Indications for Interfragmentary Wire

A

Simple Fractures of Flat, non-weight bearing bones that interdigitate
Mandibularly and maxillary fractures

92
Q

Common name for Steinmann Pins

A

Intramedullary pins

93
Q

Advantages of Steinmann Pins

A 
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
Q

Disadvantages of Steinmann Pins

A

Only resists bending forces
Pin migration
Limited application as a primary fixation implant

95
Q

Kirschner Wires

A

Small Steinmann Pins that are easily bent

96
Q

Intramedullary Pins

A

Placed in medullary cavity of bone to help restore length and maintain alignment

97
Q

What forces do Intramedullary Pins resist?

A

Bending Forces

98
Q

What fractures do you use Intramedullary Pins for?

A

Humerus, Femur, Tibia, Ulna, Metatarsals, and metacarpals

99
Q

What are Intramedullary Pins contraindicated in?

A

Fractures of the radius

100
Q

What must you avoid doing with Intramedullary Pins?

A

Avoid Penetrating the joint surface

101
Q

What percentage of the canal should be filled with the Intramedullary pins and cerclage wire?

102
Q

What percentage of the canal should be filled with the Intramedullary pins and a plate?

103
Q

What are the indications for Cross Pinning?

A

Simple Transverse fractures close to the joint

Salter Harris type 1 and 2 in young animals

104
Q

What are the rules for using Cross Pinning?

A

Pins cross above the fracture line

105
Q

Diverging Pin technique

A

Technique used to stabilize Salter Harris 1 fractures of Proximal Humerus or Femoral Head to promote normal physeal anatomy and bone growth

106
Q

External Skeletal Fixation

A

Uses percutaneous pins or wires attached to external construct external to stabilize fracture fragments

107
Q

What type of bone healing does External Skeletal Fixation promote?

A

Secondary Bone healing

108
Q

What are External Skeletal Fixations used for?

A 
Fractures of the appendicular skeleton 
Spinal fractures/luxation 
Mandibular fractures
Correction of angular limb deformities
Limb lengthening 
Arthrodesis
Joint Immobilization
109
Q

External Skeletal Fixator Components

A

Smooth or threaded pins or wires

Pins are secured with specialized clamps and connecting bars

110
Q

ESF Pin Types

A

Smooth Pins
Positive Profile
Negative Profile
Center vs. Threaded Pins

111
Q

Positive Profile Pins

A

The threads of the pin are increase the outer diameter of the pin

112
Q

Negative Profile Pins

A

The outer diameter is less than the core diameter due to the threads cutting into the core

113
Q

What is the strongest Pin type?

A

Positive Profile Pin

114
Q

What is the rule for the Pin diameter of the Tranfixation Pin Placement?

A

Pin diameter should be no more than 25% of the bone diameter

115
Q

What is the ideal number of pins used for Transfixation Pin Placement?

A

3 pins per segment

116
Q

What is the rule for Transfixation Pin Placement?

A

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
Q

What strain types can external skeletal fixators counteract?

A

Tension
Rotation
Bending
Axial Compression

118
Q

How do you increase the ESF rigidity?

A 
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
Q

How do you decrease ESF rigidity?

A

Frame type
Pin distribution
Decreased number of pins
Small diameter of pins and connecting bar

120
Q

Dynamization

A

Planned decrease of the stability to allow increased axial loading of the fracture to enhance callus hypertrophy and remodeling of the fracture

121
Q

Type 1A ESF

A

Unilateral-Uniplanar

122
Q

Type 1B ESF

A

Unilateral-Biplanar
Pins are placed 60-90 degrees from each other
Interconnecting bars increase rigidity

123
Q

What ESF types can be used on humerus and femur?

A

Type 1 A and 1B

124
Q

Type 2A ESF

A

Bilateral-Uniplanar

Stiffer than Type 1

125
Q

Type 2B ESF

A

Bilateral-Uniplanar with combination of full and half pins

126
Q

Type 3 ESF

A

Bilateral-Biplanar

Stiffer than Type 1 or 2

127
Q

Circular EFs

A

Wires connect to rings which are connected to rods

128
Q

What are circular ESFs used for?

A

increase rod length over time for bone lengthening
Complicated Fractures of the tibia and radius
Correction of angular limb deformities

129
Q

Hybrid Fixator

A

Utilizes components of linear and circular external skeletal fixators

130
Q

What are Hybrid Fixators used for?

A

Metaphyseal fractures

131
Q

ESF and Acrylic Frames Uses

A

Mandibular fractures

132
Q

What breeds and species are ESF and Acrylic Fixators used in?

A

Toy breed dogs
Cats
Exotics

133
Q

When do you recommend Dynamization?

A

6 weeks post repair

134
Q

Advantages of ESF

A

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
Q

Disadvantages of ESF

A

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
Q

ESF complications

A 
Pin tract drainage 
Loosening of Pins/Wires 
Osteomyelitis
Ring sequestrum 
Nerve vascular damage
137
Q

What is Scapular fractures associated with?

A

Blunt trauma

138
Q

Stable extraarticular fractures

A

fractures in the body that are protected and can be healed by themselves without surgical intervention

139
Q

Unstable extraarticular fractures

A

Might be distraction of the fracture fragments or comminution

140
Q

Intraarticular fractures

A

Fractures of the neck, acromion, and through the glenoid of the scapula

141
Q

What is the most common fracture of young large breed animals?

A

Fractures of the glenoid tubercle

142
Q

How do you repair a fracture of the glenoid tubercle?

A

lag screw or pin and tension band

143
Q

What must you avoid when repairing a Scapular neck fracture?

A

Suprascapular nerve entrapment

144
Q

What is Humeral condylar fracture associated with?

A

Incomplete ossification of Humeral Condyle

145
Q

What breeds are predisposed to Humeral Condylar Fractures?

146
Q

What portion is most commonly affected by Humeral Condylar Fracture?

A

Later Portion

147
Q

What is the primary means of fixation for Humeral Condylar Fractures?

A

Lag screw and anti-rotational wire

148
Q

What do you apply to Humeral Condylar T and Y fractures?

149
Q

Monteggia Fractures

A

Fracture of the ulna with dislocation of the radial head

150
Q

Type 1 Monteggia Fracture

A

Cranial displacement

151
Q

What type of Monteggia Fracture is most common?

152
Q

What fractures are most common in young small breed dogs?

A

Radius/Ulna fractures

153
Q

What is the differential diagnosis for Distal Diaphyseal Radius/Ulna Fractures in older large breed dogs?

A

Neoplastic disease

154
Q

What is a common fracture associated with trauma?

A

Metacarpal and Metatarsal fractures

155
Q

How do you manage Metacarpal and Metatarsal fractures?

A

Plantar/palmar splints

156
Q

What is the treatment rule if you have more than one metacarpal fracture?

157
Q

What is the treatment rule if you have fractures of Metacarpals 3 and 4?

158
Q

What is the treatment for fractures of all metacarpals?

159
Q

What fractures are seen with Hit By Car Trauma?

A

Pelvic Fractures

160
Q

What are important considerations for Pelvic Fractures?

A

Evaluate for life threatening injuries
Image thorax and abdomen
Perform thorough neuro exam

161
Q

What are some complications of Pelvic Fractures?

A

Malunion with pelvic canal narrowing
Entrapment of sciatic nerve in callus
Nonunion

162
Q

What is conservative management of Pelvic Fractures?

A

6-8 weeks cage rest

163
Q

What are the most common sites of Spinal Fractures and Luxation?

A

T3-L3 and L4-L7

164
Q

What is the Best modality for detecting bony lesions?

165
Q

What is the best modality for assessment of spinal cord changes within canal and spinal cord compression?

166
Q

What are the surgical goals for Spinal fractures and luxations?

A

Decompression of spinal cord

Stabilization of vertebral column

167
Q

Four A’s of Systematic Assessment?

A

Apposition
Alignment
Apparatus
Activity

168
Q

What is the average healing time of Fractures?

169
Q

Factors affecting bone healing include

A 
Fracture configuration/severity 
Soft tissue damage
Stability of repair 
Presence of infection 
Patient factors
Compliance
170
Q

Fracture Healing Complications

A

Delayed Union
Malunion
Nonunion

171
Q

Delayed Union

A

Healing is prolonged beyond normal expected time
Fracture line remains evident with feathery/wooly ends
Callus is visible
No sclerosis of bone ends

172
Q

Malunion

A

Failure to re-establish normal form and function in the face of healing

173
Q

Quadriceps Contracture

A

Complication associated with prolonged immobilization of the distal femur in young patients due to Muscle fibers being replaced by fibrous tissue

174
Q

What type of fracture is associated with Quadriceps Contracture?

A

Distal Femoral Fractures

175
Q

Disuse Osteoporosis

A

Decreased in stress application to the bone results in increased osteoclast activity
Can occur with casts and excessively strong implants/fixators

176
Q

What is Ligamentous Laxity associated with?

A

Muscle atrophy from disuse or immobilization causing loose ligaments and joint instability

177
Q

What is associated with improper casting/splinting of elbow/antebrachial fractures?

A

Digital Flexor Contracture

178
Q

Primary Bone Neoplasia

A

Osteosarcoma
Chondrosarcoma
Fibrosarcoma
Hemangiosarcoma

179
Q

Metastatic Bone Neoplasia

A

Multiple Myeloma

Lymphoma

180
Q

What breed are represented with Osteosarcoma?

A

Large and Giant Breed dogs

181
Q

What is the Bimodal age distribution of Osteosarcoma?

A

18-24 months

Greater than 7 years

182
Q

Where is the predilection site for Osteosarcoma?

A

Metaphyseal region of long bones

183
Q

What are the radiographic changes seen with Osteosarcoma?

A

Cortical lysis
Periosteal reaction
+/- Mineralization of surrounding soft tissues
Loss of trabecular pattern
Lack of distinct border between normal and abnormal bone

184
Q

What is common in young animals?

A

Bone cysts

185
Q

What is the gold standard for diagnosing Osteosarcoma?

186
Q

What is present in most patients with Osteosarcoma?

A

Micrometastases

187
Q

What is Palliative treatment for Osteosarcoma?

A

Pain Management
Bisphophonates
Radiation

188
Q

What Chemotherapy is used for treatment of Osteosarcoma?

A

Doxorubicin
Carboplatin
Cisplatin

189
Q

What is the first choice antibiotic treatment for open fractures?

190
Q

What is the most common complications associated with ESF?

A

Pin tract morbidity/ Drainage/ Infection

191
Q

When placing Cerclage wires how should they be positioned in reference to the long axis of the bone?

A

Perpendicular

192
Q

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?

A

Neutralization Plating

RUSVM Small Animal Surgery 2017 (17 decks)

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