Internal Fracture Repair- Moving 3

Question 1

What factors affect the decision made for fracture repair?

Answer 1

• Information about the patient (size, weight, activity, etc)
• Information about the fracture (bone, configuration, location, comminution, etc)
• Knowledge of fracture biomechanics and healing
• Knowledge of fixation devices (function & availability)

Question 2

What forces must be neutralized for a fracture to heal?

Answer 2

Bending, torsional forces (rotation) and weight bearing (axial load)

Question 3

How do you properly evaluate a postoperative radiograph following fracture repair?

Answer 3

Assess fracture reduction, alignment and proper use and technique (correct implant application)

alignment is most important

Question 4

Where should bone graft be harvested from?

Answer 4

The metaphaseal region of long bones

The four main bones include:
- head of humerus
- wing of ileum
- proximal tibia
- distal femur

Question 5

How does bone graft expedite healing?

Answer 5

Osteogenesis, osteoinduction, osteoconduction, osteopromotion

Question 6

Describe how the principle of osteogenesis helps with bone graft expediting healing of bone.

Answer 6

Cells surviving the transplant

Question 7

Describe how the principle of osteoinduction helps with bone graft expediting healing of bone.

Answer 7

Uses products such as BMP 2,4 and 7 as well as TGF-B to stimulate bone formation

Question 8

Describe how the principle of osteoconduction helps with bone graft expediting healing of bone.

Answer 8

Scaffolding of bone: the 3D matrix that allows and stimulates the attachment and proliferation of osteoinducible cells on its surfaces

Question 9

Describe how the principle of osteopromotion helps with bone graft expediting healing of bone.

Answer 9

It is based on platelet cells. It enhances without cells or scaffold and it utilizes platelet-rich-plasma.

Question 10

What are the principles of bone plating?

Answer 10

IM pin placed prior to plating

Question 11

What are some advantages of a plate rod fixation?

Answer 11

• Establishes proper alignment and length
• Maintains alignment while plate is applied
• Reduces plate strain and increases fatigue
  life
• Allows microstrain at fracture (stimulate healing) if pin occupies 35-40% of medullary cavity
• Less manipulation of fragments

Question 12

A patient comes in with a tibial fracture. You decide to fix the bone. What method of fracture repair are you using? What are some advantages to using this method of fracture repair?

Answer 12

External Skeletal Fixation.
It is versatile, adjustable, can be used for open or closed application and preserves extraosseus blood supply.

Question 13

What are major types of external skeletal fixator configurations?

Answer 13

Type 1A
Type 1B
Type 2
Type 3

Question 14

You decide to use a Hybrid ESF on a dog with a radial fracture. What is an advantage of this?

Answer 14

It can stabilize short juxta-articular fracture segments and utilize the principles of biologic fixation.

It can minimize morbidity by avoiding placement of wires through prominent muscle masses

Question 15

What are components of a hybrid ESF?

Answer 15

• Ring (complete or partial) component(s)
• Wire or pin fixation elements secured to ring(s)
• Linear components
• SK clamps
• Fixation pins
• Hybrid connecting rod(s) links linear & circular components