Long Bone Fractures 2 Flashcards
What are the causes of Femoral Physeal fractures?
Most common in food animals (cattle)
1) Dystocia (over eager birthing aid)
2) Group housed juvenile Cattle
How can you treat Femoral Physeal Fractures?
1) Stall rest
2) FHO (femoral head ostectomy)
- Not successful in Large animals
3) ORIF
- Pins and Screws
What treatment for Femoral Physeal fractures is most commonly used?
ORIF
-Pins and Screws
Why are FHOs not successful in Large animals?
They are too heavy bra!!!!
Describe INTRAmedullary Pin repair for Femoral Physeal fracture in FOOD animals.
- two 3/16th inch pins
- insert through femoral neck from caudolateral femur
- Penetrating the femoral head with fracture reduction
Why do you NOT want to go through the femoral head during INTRAmedullary pin replair for Femoral Physeal fracture, in food animals?
ITs an articular surface!!!!
Cause DJD
What should be used to fix Femoral Physeal fracture in :
Horse
Food Animal:
Horses
- FOALS: dynamic hip screw (DHS system)
- Adults:???????
Food Animal:
-INTRAmedullary pin repair
What are the clinical signs of Tibial fracture?
-walk in and it definitely doesn’t look right
- 3 month old calf ACUTELY lame
- SEvere lameness
- crepitus and pain at stifle
How do you treat Tibial Physeal fracture in food animal?
1) external coaptation
- Thomas Schroeder splint/cast
* caution with straw in stall (slippery)
How do you treat Tibial Physeal fracture in a foal?
Salter Harris type 2 fracture of the proximal tibial physis
Plate and screw fixation, with tension band wiring
Why can you not put a Thomas Schroeder split/cast on a FOAL with a proximal tibial Physeal fracture like you would with a Calf???
Due to horse mentality
-also horse have better purchase (can handle implants)
How would you treat a Heifer with a CLOSED comminuted Mid-Diaphyseal fracture of the humerus with displacement?
1) stall rest 2-3 months
2) nursing care
- no external support
What are the potential complications of stall confinement?
1) non union and mal union
2) breakdown or laminitis of the opposite limb
3) negative effect of the age and weight of the patient
How would you treat a humeral fracture in a FOAL?
ORIF with plates
What are the complications with ORIF with plate in horses when fixing a Femoral fracture?
- Challenging
- Surgical approach is difficult
- risk of injury to the radial nerve
- Irregular contour of the humerus
- economic concerns
What treatment (other than ORIF with plates) can be used to fix a femoral fracture in a FOAL?
Interlocking nails
-inadequate in adult large animal**
What type of splint do you put on a radial fracture in a horse?
2 splints:
- Lateral splint from foot to whither (minimize abilitity to abduct the limb)
- palmar from foot to elbow (prevents bending)
What are transfixation pins supported by?
1) external frames
2) acrylic resins
3) cast material
What are the three main things that need to be done when placing TPCs (transfixation pinning and casting)
1) systemic antibiotics
2) general anesthesia
3) dorsal recumbency
When fixing tibial fractures (FA), how many pins per fragment is required?
Minimum of 2 pins per fragment
-as the animal get heavier you can have 3-5
Describe Transfixation pin placement?
1) lateral incision
2) pins inserted between the muscles
3) 4.5drillbit-LAVAGE
4) Positive profile centrally threaded 1/4” steinman pin
What is a type 2 external fixative?
Pins placed laterally to medially
What is a type 3 external fixation?
-Cranially to causally directed half pins
In addition to type 2
When should you remove pins?
6-8 weeks later
Following pin removal from a tibial fracture, what should be done?
Additional stall rest for a minimum of 2 WEEKS
What is the minimum stall rest required following pin removal from a tibial fracture repair?
2 weeks
What are the advantages for TPC in farm animals?
1)immobilization (less motion than T-S cast)
2) early weight bearing
- +/- joint mobility
3) flexibility in pin positioning
4) availability of pins and casting material
5) comparable to side bar/clamp and plate/screws
6) less expensive than plates and screws
What are the disadvantages of TPC in farm animals?
1) no adjustment after application
2) restricted access to soft tissue
3) requires GA (expensive in Farm animals)
What do we use TPC for in Horses?
Comminuted phalange always fractures!!!
TPC in Equine patients?
- comminuted phalangeal fractures
- 2-3 pins 4-6mm diameter
- separated by 2-4cm
- placed in metaPhyseal bone
- 30 decree divergence of the pins in the FRONTAL plane
- use centrally threaded, positive profile pins
What is the prognosis for tibial fracture in adult horse?
POOR
-its done
- weight and spiral nature of the tibia make it bad prognosis
- but in a mini it is possible to fix
How do you treat a tibial fracture in a miniature horse?
- Double plate fixation with 4.5 mm broad DCP
- Lute the plate to increase stability
What is plate luting?
- Bone cement (PMMA)
- applied between the plate and bone (after plate/screw placement)
- Creates 100% plate bone contact (increasing strength of repair
