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EXAM 3 FINAL > Long Bone Fractures 1: Cannon Bone And Ulnar Fractures > Flashcards

Long Bone Fractures 1: Cannon Bone And Ulnar Fractures Flashcards

1
Q

What is one of the biggest difference between orthopedic surgery in small animals and large animals (horse)?

A

A horse must be ambulatory and fully weight-bearing in the immdedate post op period after plating

-most fixation devices were not designed for horses

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2
Q

What are the challenges of Large animal fracture fixation?

A

1) large animals require large plates which need space —> Skin closure is challenging
2) implant failure—>cyclic fatigue

3) Post operative lameness
- contralateral limb lameness

4)orthopedic implants are not large animal specific

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3
Q

What are some post operative complications that can affect the contralateral lim?

A

1) Contralateral limb laminitis

2) angular limb/flexural limb deformities (due to consistent overloading of the limb)

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4
Q

What are the 5 types of Physeal fractures?

-what is important to know about these?

A

Salter Harris type 1-5

-decreased prognosis with articulate involvement

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5
Q

What does prognosis decrease with articulate involvement of Physeal fractures?

A

DJD subsequent to fracture.

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6
Q

Where do condylar fractures most often happen?

A

Metatarsus/metacarpus 3

Cannon bones

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7
Q

Condylar fractures can be lateral or medial, Which do we see most often?

A

Lateral

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8
Q

What special view needs to be taken to identify fractures in the articulate surface?

A

Tangential DP view

  • bend the horses fetlock
  • highlights palmer aspect of bone to fully evaluate the joint
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9
Q

Why is it important to see/assess comminution at the joint surface in an image (tangential view)
-Condylar fractures

A

To evaluate prognosis

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10
Q

What is the difference between TB and SB horses with condylar fractures?

A

TB: RACE HORSES
-forelimb (MC3) >2x more common than hind limb (MT3)

SB:
-Fore and hind limb Cannon bones are equally affected

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11
Q

What is the etiology of Lateral condylar fractures?

A
  • high compressive load
  • leads to Osseous adaption/sclerosis
  • Microtrauma/ microfracture

= Condylar fracture

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12
Q

What is the CS of a non displaced incomplete condylar fracture

A

History of lameness with acute exacerbation

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13
Q

What are the CS of an Acute displaced fracture?

A

1) Acute onset of severe lameness after intense exercise
2) effusion of MCP/MTP joint (FETLOCK)
3) Pain on palpation

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14
Q

What will you do (in the field) if you suspect a lateral condylar fracture?

A

First aid:

1) compression bandage (stabilize, possible Robert Jones)
2) NSAIDs And SEDATIVE (xylazine) and OPIOID (butorphanol)

3)ABSOLUTE stall rest until definitive treatment undertaken

Possible Kimsey Splint

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15
Q

When would you use Phenylbutazone over flunixin Meglumine?

A

Bute:
-orthopedic pain

Banamine:

  • visceral pain
  • ocular pain
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16
Q

How would you surgically treat Lateral Condylar Fractures?

A

Internal Fixation with transcortical screws in LAG fashion

-compress across the joint

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17
Q

What does LAG screw repair involve?

A
  • 4.5mm or 5.5mm cortical bone screws
  • Place in lag fashion
  • 2cm apart
  • most only require 2 screws
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18
Q

Where do you place the first LAG screw during lateral condylar fracture fixation?

A
  • CLOSE to the joint

- in the Epicondylar fossa of the cannon bone

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19
Q

When performing surgery for condylar fractures, What diagnostic tool should be used to aid placement of LAG screws?

A
  • Fluoroscopy
  • Radiographs
  • arthroscopy

intraoperatively

Dont forget your bone reduction forceps! Know what these look like

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20
Q

How can you make sure you have realigned the articulations surface properly during internal fixation of a condylar fracture?

A

Arthroscopy

articulate alignment = no cartilage gap

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21
Q

What is the prognosis for RETURN to RACE for :

A) Non displaced and incomplete condylar fracture

B) Displaced condylar fracture

C) Joint comminution

A

A) 70-80%

B) 50%

C) <50% Not looking good bro

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22
Q

How are lateral condylar fractures different from Diaphyseal fractures of the Cannon bone?

A

??????

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23
Q

What is the MOST common LONG Bone fracture in horses?

A

Diaphyseal fractures of MC3 and MT3

Cannon bone

24
Q

What is the prognosis of Diaphyseal fractures of MC3 and MT3?

A

Depends on:

  • immediate 1st aid
  • external coaptation
25
Q

What is the optimal treatment for Cannon bone fracture repair?

A
  • Double plate fixation
  • *plates on the tension side of the bone**
  • Staggered
  • span entire length of long bone

Forelimb: dorsomedial and dorsolateral

Hindlimb:

26
Q

How would you treat a comminuted Cannon bone fracture?

A

-Transform into 2 fragments

27
Q

WHy is interfragmentary compression IMPORTANT?

A
  • compress across fracture line

- Minimize the amount the body has to heal

28
Q

What is the Maximum compression that can be applied using plate holes?

A

4mm

-using a load drill guide to compress a fracture with a broad DCP/LC-DCP

29
Q

What is the difference between DCP and LC-DCP?

A

LC-DCP has:

  • Continuity of bending stiffness
  • Improved blood supply under plate

Limited contact-Dynamic compression Plate

30
Q

What is the LCP?

A

Locking compression plate**
-5.5mm LCP specifically designed for equine fracture repair

Known for Strength and rigidity we can achieve

31
Q

What are the 4 main plate functions?

A

1) compression
2) Neutralization
3) Tension band
4) Buttressing

32
Q

When would you use a plate in Butress?

A

Buttressing—> placed to bridge area of bone defect (even after reconstruction)

NOT a VIABLE option in HORSES/Large animal

33
Q

When would you use compression?

A

Maximum 2 screws on either side of FX are placed under load**

-4mm max compression when using plates and screws

34
Q

What does a tension band do?

A

Transforms tensile forces into compressive forces

35
Q

When do you use neutralization?

A

Already reconstructed the site, we just need it to stay ridgidly immobilized

36
Q

T/F: LC-DCP can use locking screw and cortex screw

A

True

  • combo-holes permit the combination of conventional or locking screw
  • treaded and smooth

Locking goes in threaded holes

37
Q

T/F: locking compression plates ((LCP) can be placed using standard screws or locking screws

A

True

-locking screws increase the stability and the fixation strength of the plate screw construct

38
Q

Are ulnar fractures common?

A

Yes

“They are not uncommon”-Dr. Little

39
Q

What muscle inserts on the olecranon/Apophysis?

A

Triceps

40
Q

What are the causes if Ulnar fractures?

A

1) direct trauma
- external trauma
- injury during halter training (rearing up)

41
Q

How do ulnar fractures usually present?

A

*usually closed fracture

  • Dropped elbow with carpus in flexion
  • no weight bearing
  • unable to fix carpus in extension
42
Q

Why are horses with ulnar fractures unable to keep the elbow in extension ?

A

Because they have disrupted the triceps apparatus!

43
Q

What are the differential diagnosis for a horses with a DROPPED elbow and Non weight bearing?

A

1) numeral fracture
2) Radial nerve paralysis
3) olecranon fracture
4) Neuro Disease (rare)

44
Q

How would you stabilize a horse with an Ulnar fracture ?

-i.e: non weight bearing, unable to fix carpus in extension

A

Splint to fix carpus in extension

-splint PALMARLY extending from the fetlock to the level of the elbow

ADEQUATE padding is a MUST!!!!!

45
Q

What is the exception to the rule of

“A joint above, a joint below”

A

Splinting an Ulnar fracture

46
Q

What is the mainstay of treatment for elbow fractures?

A

Open Reduction and Internal Fixation (ORIF)

47
Q

Why does Stall rest not work for elbow fractures in horses?

A

Even if it is not displaced the triceps apparatus will displace the fracture

48
Q

How do you surgically treat an Olecranon fracture ?

A

1) ORIF** treatment of choice!!!!
2) Use tension-band principle

3) plate applied to the caudal ulna
- or tension band wire/cable fixation

4) Narrow DCP, LC-DCP, LCP

49
Q

What is the treatment of choice for an olecranon fracture repair?

A

ORIF

50
Q

More often than not to fix a an olecranon fracture, surgeons will do what?

A

Bone plate contoured to fit of the the top of the olecranon tuberosity

51
Q

T/F: All olecranon fractures are articulate

A

FALSE

Not all olecranon fractures are articular

52
Q

You have a <250 Kg foal with a Salter Harris type 1 minimally displaced olecranon fracture….How would you repair it?

A

Tension band technique (screws and wires)

53
Q

You have a Heavy >250 Kg foal with a Salter Harris type 1 minimally displaced olecranon fracture….How would you repair it?

A

Must apply a plate!!!!!

54
Q

Over what weight must a olecranon fracture be corrected with a plate?

A

> 250kgs

55
Q

Why do we not want to engage the RADIUS in foals (<1year) corrected with olecranon fractures?

A

Engagement of the radius can cause elbow dysplasia
-elbow subluxation

If it has to be done, then it has to be removed

56
Q

What is the prognosis for Ulnar fracture repair?

A

GOOD (68-87%)

With ORIF!!!!!

EXAM 3 FINAL (19 decks)

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