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SAS kban RUSVM > Intro to Ortho and Fracture Fixation Methods - Betance > Flashcards

Intro to Ortho and Fracture Fixation Methods - Betance Flashcards

1
Q

Definition of a Fracture

A

complete or incomplete break in the continuity of bone or cartilage

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2
Q

Goal of fracture repair

A

the early return of the patient to full funciton of the limb

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3
Q

How many methods of fracture classification are there?

A

six

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4
Q

Methods of Classification:

A
  1. direction of the fracture on the bone
  2. location of the fracture on the bone
  3. reducible or non-reducible
  4. displacement of fracture segments
  5. open or closed fracture
  6. specific types of factures
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5
Q

What is a comminuted fracture?

A

More than 2 pieces of bone

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6
Q

What is a long oblique fracture

A

if length of oblique fracture is >2x diameter of the bone

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7
Q

Who/where does Salter Harris fractures commonly occur?

A

Young animals at the growth plate

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8
Q

SH Type I

A

Straight Across

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9
Q

SH Type II

A

Above

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10
Q

SH Type III

A

Lower or beLow

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11
Q

SH Type IV

A

Two or Through

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12
Q

SH Type V

A

ERasure of growth plate or

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13
Q

Basic definition of Open fracture

A

at some point developed communication with external environment

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14
Q

Basic definition of Closed fracture

A

No communication with the external environment

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15
Q

Open Fracture Type I

A
  • bone penetrating thru skin
  • laceration < 1cm
  • Clean
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16
Q

Open Fracture Type II

A
  • External object penetrates soft tissue
  • laceration > 1cm
  • mild soft tissue trauma
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17
Q

Open Fracture Type IIIa

A
  • vast soft tissue laceration

- soft tissue available for closure

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18
Q

Open Fracture Type IIIb

A
  • extensive soft tissue injury and loss

- bone exposure and stripped periosteum

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19
Q

Open Fracture Type IIIc

A
  • arterial supply damaged

- requires arterial repair for limb salvage

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20
Q

What is the number one cause of direct insult fractures

A

Over 75% are HBC

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21
Q

What is an indirect insult?

A

Force transmitted through bone to distant point (like the femoral neck, tibial tuberosity)

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22
Q

What does reduction mean?

A

reestablishing normal alignment of fracture fragments

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23
Q

Closed reduction:

A

reducing a fracture without surgically exposing the fractured bones

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24
Q

What does performing a closed reduction accomplish?

A
  • preserves soft tissue and blood supply

- decreases risk of infection and OR time

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25
Q

What are some indications for performing a closed reduction?

A
  • closed fracture below elbow or stifle
  • bone will be stable after reduction
  • quickly healing fracture
  • small dogs/cats
  • greenstick, intact periosteal sleeve, impaction fxs
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26
Q

What is an open reduction?

A

surgical approach to expose fracture in order to reconstruct and stabilize

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27
Q

What does an open reduction accomplish?

A
  • direct visualization of fx to facilitate reconstruction

- allows direct placement of implant and load sharing

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28
Q

Indications for open reduction

A
  • unstable and displaced fractures
  • articular surfaces
  • delayed healing
  • bone grafts
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29
Q

What are the Rules for Open Reduction

A
  1. Halstead’s principles
  2. follow normal separations between muscles and fascial planes
  3. if muscles need to be severed, do it near origins or insertions
  4. preserve soft tissue and blood supply
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30
Q

Things about Transverse Fractures

A
  • stable in compression
  • unstable in bending
  • unstable in rotation
  • ideal for load sharing
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31
Q

Things about Oblique fractures

A
  • unstable in compression

- less unstable in bending and rotation when compared to a transverse fracture

32
Q

Things about Comminuted fractures

A
  • unstable in compression
  • unstable in bending
  • unstable in torsion
  • fracture will displace or collapse when forces are applied
  • no load sharing
33
Q

Fixator: Steinmann Pins aka IM pins resist what?

A

bending forces ONLY

34
Q

Indication for IM pins

A
  • fractures of the humerus, femur, tibia, ulna, metatarsal, and metacarpal
35
Q

Contraindication for IM pins

A

radius fractures, most fractures in medial and large dogs

36
Q

IM pinning RETROGRADE

A

pin is inserted at FRACTURE SITE

- humerus, femur

37
Q

IM pinning NORMOGRADE

A

pin is inserted at MOST PROXIMAL AREA OF BONE

- humerus, femur, tibia

38
Q

Where is the IM pin placed

A

medullary cavity of bone

39
Q

Does an IM pin require any adjunct fixation

A

Almost ALWAYS!!!

- cerclage wire, ESF, plate

40
Q

Is stack pinning common?

A

Nope, rarely used.

  • 2+ pins to fill the medullary cavity
  • higher incidence of pin migration
  • difficult cutting multiple pins
41
Q

When do you implement cross pinning?

A

with simple proximal/distal fractures

  • physeal fractures
  • smaller diameter smooth pins
42
Q

What forces does cross pinning counteract

A

rotational and bending forces

43
Q

What specific kind of fractures is cross pinning good for?

A

growth plate fractures, specifically Salter Harris II

44
Q

What is rush pinning used for?

A

simple proximal and distal fractures

45
Q

What kinds of forces does rush pinning resist?

A

bending and torsional forces

46
Q

How many points of contact do rush pins have?

A

THREE!

- the pin is forced to bend to provide dynamic forces on the bone

47
Q

What are diverging pins for?

A

stabilize Salter Harris I fractures of proximal humerus and femur

48
Q

What don’t you do with diverging pinning?

A

penetrate the joint surface

49
Q

What must you achieve with diverging pinning?

A

anatomical reduction!!!!

50
Q

What is orthopedic wire used for?

A

used with IM pins, ESFs, and plates

51
Q

Larger diameter of orthopedic wire means what in relation to strength?

A

Higher tensile strength

52
Q

When would you use full cerclage wire?

A

with long oblique or spiral fractures in which the fracture line is at least 2x the diameter of the bone

  • maximum of 3 fx segments
  • fx must be anatomically reduced
  • young/healthy patients combo w/ IM pin
53
Q

When would you never use full cerclage wire?

A

a fully comminuted fracture

54
Q

what would you use hemicerclage wire for?

A

short oblique diaphyseal fractures

55
Q

What would you use skewer pins for?

A

short oblique fractures

56
Q

What do skewer pins incorporate?

A

full cerclage wire and K-wire

57
Q

Tension band wires are used for a lot of things. What are they?

A
  • avulsion fractures or osteotomy of the greater trochanter
  • avulsion fracture of tibial tuberosity
  • fracture or osteotomy of the medial malleolus or olecranon
  • fracture of tuber calcanei or acromial process of scapula
58
Q

What’s the main theory behind tension band wires?

A

2 distractive forces become compressive forces

59
Q

What are interfragmentary wires used for?

A
  • simple fractures of flat, non-weight bearing bones that interdigitate well
  • certain mandibular and maxillary fractures
  • basically “suture” with wire
60
Q

What are external skeletal fixators for?

A
  • many open or closed fractures
  • limb deformities
  • when blood supply compromised
  • need stabilization and wound access
  • when bone purchase insufficient for plate
  • arthrodesis
61
Q

Are external skeletal fixators invasive or non invasive?

A

They offer less invasive fixation

62
Q

Which is more stable, external skeletal fixators or plate fixators?

A

Plate fixation is more stable!!

63
Q

which is more desirable, open or closed placement?

A

Closed!!! but only if fracture is reduced

64
Q

What type of fixator is a unilateral-uniplanar?

A

Type Ia

65
Q

What fractures is a unilateral-uniplanar fixator used on?

A
  • radial fractures
  • tibia-medial surface
  • femur and humerus - lateral surface
  • often used in combo with IM pin on femur and humerus
66
Q

What type if fixator is a unilateral-biplanar?

A

Type Ib

67
Q

What fractures is a unilateral-biplanar fixator used on?

A
  • radius: craniomedial or craniolateral

- tibia: craniomedial

68
Q

What kind of fixator is a bilateral-uniplanar?

A

Type II

69
Q

What fractures is a bilateral-uniplanar fixator used on?

A

radius and tibia

- CANNOT USE ON THE FEMUR AND HUMERUS

70
Q

What type of fixator is a bilateral-biplanar?

A

Type III

71
Q

What fractures is a bilateral-biplanar used on?

A

ONLY the radius and tibia

72
Q

What is the most common placement of a Type Ia fixator?

A

1 side of the bone in 1 plane

73
Q

What is the most common placement of a Type Ib fixator?

A

1 side of the bone on 2 planes

74
Q

What is the most common placement of a Type II fixator?

A

2 sides of the bone on 1 plane

75
Q

What is the most common placement of a Type III fixator?

A

2 sides of the bone on 2 planes

76
Q

Circular/Ring fixators are used when?

A
  • complex fractures with no other alternatives
  • limb shortening or lengthening procedures
  • angular deformities
  • transport of bone segements
77
Q

How does the circular/ring fixator place tension?

A

by weight

SAS kban RUSVM (2 decks)

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