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Surgery 3 > Lecture 18: Fractures of the thoracic Limb (Exam 3) > Flashcards

Lecture 18: Fractures of the thoracic Limb (Exam 3) Flashcards

1
Q
A
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2
Q

56-70% of scapular fractures have concurrent injuries because it requires substantial trauma, what are the most common

A
  • thoracic injuries
  • other fractures
  • neurologic
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3
Q

What are the 3 classifications of scapular fractures

A
  • anatomic location
  • articular surface involvement
  • stability
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4
Q

For minimally displaced scapular body and spine fractures should you use conservative treatment or surgical stabilization

A

conservative treatment

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5
Q

For unstable extra-articular and intraarticular fractures should you use conservative treatment or surgical stabilization?

A

**surgical stabilization: **
* Displaced scapular neck fractures
* Fractures of the acromion
* Unstable, overriding scapular body fractures
* +/-Scapular body fractures w/ severe angulation

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6
Q

What animals are predisposed to scapular fractures

A

young male dogs

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7
Q

Why might a patient with a scapular fracture have abnormal proprioception

A

pain

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8
Q

What are some common thoracic injuries that occur alongside scapular fractures that you should rule out

A
  • rib fractures
  • pulmonary contusion
  • pneumothorax
  • diaphragmatic hernia
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9
Q

In patients with scapular fractures you should evaluate for concurrent nerve damage to rule out involvement of: (3)

A
  • brachial plexus
  • suprascapular nerve
  • spinal cord trauma
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10
Q

Closed minimally displaced fractures like scapular body and spine can be treated with conservative management such as:

A

velpea sling (2-3 weeks & no longer)

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11
Q

Mechanical, biological, and clinical factors all contribute to a baseline score that you use to guide the type of implant you chose: what is this scale?

A

Fracture assessment score

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12
Q

Unstable extraarticular and intraarticular fractures with a high FAS can be repaired with

A
  • Orthopedic wire- pin
  • tension band with K wire
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13
Q

unstable extraarticular and intraarticular fractures with a low FAS can be fixated with what

A
  • plates and screws
  • lag screw
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14
Q

Scapular body fractures should be fixated with what

A

orthopedic wires or plates and screws

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15
Q

Scapular body fractures with a high FAS should be fixated with what

A

orthopedic wire

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16
Q

Scapular fractures at the supraglenoid tubercle should be fixated with what

A
  • orthopedic wire (pin and tension band)
  • lag screws
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17
Q

Scapular neck fractures should be fixated with what

A
  • Crossed K wires
  • angle plate
  • lag screw with plate
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18
Q

Scapular neck fractures with low FAS should be fixated with

A

lag screw and plate

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19
Q

In order to rule out neurological trauma associated with humeral fractures you pinch the dorsum of the paw, (rule out superficial pain first): what nerve are you checking?

A

radial n

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20
Q

FYI scapular and humeral PE finding can be the same: I listed them all out in answer

A
  • Usually non-wt. bearing
  • Varying degrees of limb swelling
  • Pain & crepitus elicited on palpation
  • Proprioception may appear abnormal
  • Animal may not lift paw when placed on its dorsum
  • Reluctance to move limb may be caused by pain
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21
Q

What thoracic trauma may be associated with humeral fractures

A
  • chest wall trauma
  • pulmonary contusion
  • pneumothorax
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22
Q

When radiographing a fractured humerus you should ALWAYS radiograph the contralateral limb, why?

A
  • assess normal bone length and shape
  • used to contour bone plate before surgery (reduces operative time)
  • used as a reference to select appropriate sized implants
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23
Q

What view of the contralateral humerus is necessary for accurate plate contouring

A

craniocaudal radiograph

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24
Q

Can you use external coaptation (cast or splints) on humeral fractures?

A

NO (contraindicated inadequate stabilization, not proper stabilization of scapulohumeral joint )

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25
Q

What can you do pre-operatively with patients with fractured humerus to reduce pain from bone fragments and protect soft tissue

A

Spica splint

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26
Q

Surgical treatment of humeral diaphyseal fracture includes fixation what can you use? (5)

A
  • intramedullary pins
  • interlocking nails
  • IM pins plus ESF
  • ESF alone (linear or hybrid)
  • bone plate and screws/plate-rod
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27
Q

Fill in the ?s

Simple fractures of the humeral diaphysis should be fixated with ? seated distally in the ? OR
? seated in the ?

A
  • intramedullary pin and cerclage wire seated distally in the medial condyle/epicondyle
  • interlocking nail seated in the medial epicondyle (comminuted fractures as well)
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28
Q

What type of external fixator can be used on simple fractures of the humerus

A

modified type Ia with intramedullary pins (seated distally in the medial condyle/epicondyle)

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29
Q

What type of external fixation can you use on comminuted fractures

A

modified type Ib with IM pin(medial condyle/epicondyle)

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30
Q

What fixation method is used for transverse diaphyseal fractures of the humerus

A

bone plates and screws (lateral, cranial, and medial)

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31
Q

What combination of fixation methods can work for stabilization of comminuted fracture, one part decreases the cyclic bending load of the other

A

Plate-rod (plate pin)

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32
Q

What should be used for correction/fixation

  • Transverse or short oblique humeral fractures are fixated based on their FAS Score of 0 to 3
A

compression plate external skeletal fixator plus IM pins or interlocking nails

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33
Q

What should be used for correction/fixation

Transverse or short oblique humeral fractures are fixated based on their FAS Score of a 4-7

A

interlocking nail ESF with IM pins

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34
Q

What should be used for correction/fixation

Transverse or short oblique humeral fractures are fixated based on their FAS Score of a
8-10

A

ESF with IM pins

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35
Q

What should be used for correction/fixation

long oblique or reducible comminuted humeral fractures are fixated based on their FAS Score of a 0-3

A
  • neutralization plate
  • interlocking nail
  • four pin ESF plus IM pins and cerclage wire
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36
Q

What should be used for correction/fixation

long oblique or reducible comminuted humeral fractures are fixated based on their FAS Score of a 4-7

A

two pin ESF with IM pin and cerclage wire

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37
Q

What should be used for correction/fixation

long oblique or reducible comminuted humeral fractures are fixated based on their FAS Score of a 8-10:

A

IM pin plus cerclage wire

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38
Q

What should be used for correction/fixation

nonreducible comminuted humeral fractures are fixated based on their FAS Score of a 0-3:

A
  • plate-rod combination
  • Interlocking nails
  • an ESF plus IM pin
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39
Q

What should be used for correction/fixation

nonreducible comminuted humeral fractures are fixated based on their FAS Score of a 4-7:

A

bridging plate or ESF with IM pins

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40
Q

What should be used for correction/fixation

nonreducible comminuted humeral fractures are fixated based on their FAS Score of a 8-10:

A

two pin ESF plus IM pin

41
Q

What fixation method was used here on this comminuted fracture

A

Plate and IM pin

42
Q

What should be used for correction/fixation

supracondylar humeral fractures are fixated based on their FAS Score of a 0-3:

A

two plates or a plate-rod combination

43
Q

What should be used for correction/fixation

supracondylar humeral fractures are fixated based on their FAS Score of a 4-7

A

medial compression plate or a two pin ESF plus IM pin

44
Q

What should be used for correction/fixation

supracondylar humeral fractures are fixated based on their FAS Score of a 8-10:

A

IM pin seated in medial condyle and a lateral placed crossed pin (stabilize transverse fracture)

45
Q

A Salter I fracture of the proximal humerus should be stabilized with what

A

two K wires or small Steinmann pins

46
Q

A Salter III fracture of the proximal humerus should be stabilized with what

A

multiple K wires or small Steinmann pins

47
Q

Type IV Satler harris fracture of distal humerus should be stabilized with what

A
  • lag screws and K wires
  • Older dogs = lag screws & plates
48
Q

What breed are predisposed to type IV Salter harris fractures of distal humerus

A

Spaniels (IOHC)

49
Q

T-Y fractures of the distal humerus should be surgical prepared with what

A
  • lag screw
  • IM pin though medial condyle and plate on lateral side (or plate medial side)
50
Q

What was used here to correct a type IV Salter harris fracture

A

lag screw and pin

51
Q

Radial-ulnar fractures have (less/more) of a risk of open fractures than others in the thoracic limb

52
Q

What dogs are susceptible to distal radial ulnar fractures

A

toy breeds (jump or falls)

53
Q

The diagnosis of all the limb fractures are the same, but what should you always make sure to do with any fracture

A

rule out underlying pathology

54
Q

closed non-displaced fractures of the radius and ulna and greenstick fractures of radius and ulna in young animals can be treated how?

A

splint or cast

55
Q

What is contraindicated in miniature and toy-breed dogs with radial and ulnar fractures

A

**splints and cast **
* high incidence of nonunion
* poor blood supply
* limited soft tissue
* biomechanical instability

56
Q

What should ALWAYS be done pre-operatively to Radial ulnar fracture repairs

A

temporarily bandage/splint

57
Q

simple or moderately comminuted open radial/ulnar fractures should be fixated with what

A

internal fixation or ESF

58
Q

Severely comminuted open radius/ulnar fractures should be fixated with what

A

bridging plates and cancellous bone graft

59
Q

Closed severely comminuted radial and ulnar fractures should be fixated with what

A

external skeletal fracture

60
Q

What fixation method is CONTRAINDICATED FOR THE RADIUS

A

IM PINNING AND INTERLOCKING NAIL (narrow medullary cavity and invasion of carpal joint)

61
Q

What can be used to fixate radial fractures

A

plate and screws or ESF

62
Q

What patients is fixation of the ulna indicated

A
  • added support to comminuted radial fractures
  • large dogs
  • athletic performance dogs
63
Q

What three fixator methods are used in ulnar fractures

A
  • IM pins
  • plates
  • ESF
64
Q

Radial fractures with high or moderate FAS can be fixated with what

A

type Ia and Ib external fixator(with cerclage wires)

65
Q

What type of fixation method is used on comminuted fractures

A

Type II external fixator (maximal or minimal bc of curve of radius)

66
Q

What can be used to stabilize transverse fractures of radial diaphysis

A

Compression plate

67
Q

What can be used to stabilize small distal diaphyseal radial bone segment

68
Q

What can be used to stabilize long oblique fractures of the radius

A

lag screws and neutralization plate

69
Q

comminuted nonreducible diaphyseal fractures of the radius can be stabilized with what

A

bridging with a plate (IM pin in ulna)

70
Q

Recommended methods of stabilizing transverse or short oblique radial fractures based on FAS.

A

STOPPED HERE

71
Q

0-3: bone plate and screw (esf can be used)

72
Q

Recommended methods of stabilizing transverse or short oblique radial fractures based on FAS.

73
Q

4-7: bone plate and screw (or esf)

74
Q

Recommended methods of stabilizing transverse or short oblique radial fractures based on FAS.

75
Q

8-10: ESF (if not displaced can cast)

76
Q

Recommended methods for stabilizing long oblique or reducible comminuted radial fractures based on FAS.

77
Q

0-3 neutralization plate

78
Q

Recommended methods for stabilizing long oblique or reducible comminuted radial fractures based on FAS.

79
Q

4-7 type II or Ib ESF and cerclage wire

80
Q

Recommended methods for stabilizing long oblique or reducible comminuted radial fractures based on FAS.

81
Q

8-10 type Ia ESF plus cerclage wire

82
Q

Recommended methods for stabilizing non reducible comminuted radial fractures based on FAS.

85
Q

8-10: bridging plate or maximal type II ESF

86
Q
  • bridging plate or minimal type II
87
Q
  • type Ib ESF
88
Q

Fractures of the olecranon should be fixated with pin and tension band wires

89
Q

Ulnar simple fractures should be fixated with plates(tension band plate) and screws

90
Q

Severely comminuted fractures of the ulna should be fixated with bridging plate (buttress plate)

91
Q

Styloid process fractures of the ulna should be treated with pin and tension band wires

92
Q

Intraarticular fractures of the ulna should be rigidly stabilized with lag screws and K wires

93
Q

Radial physeal fractures should be stabilized with K wires(cross pins)

94
Q

Nondisplaced ulnar fractures are treated how cast

95
Q

Physeal fractures can cause premature closure of a physis and lead to deformities: which physis fracture can cause Shortening

A

cranial bowing

96
Q

Physeal fractures can cause premature closure of a physis and lead to deformities: which physis fracture can cause shortening of radius and subluxation of radial and humeral joint distal or proximal radial physis

97
Q

Physeal fractures can cause premature closure of a physis and lead to deformities: which physis fracture can cause angular limb deformity of radius partial closure of distal radial physis

98
Q

Prognosis after surgical repair of radial and ulnar fractures good

Surgery 3 (20 decks)

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