Long Bone Fractures 2

Question 1

What are the causes of Femoral Physeal fractures?

Answer 1

Most common in food animals (cattle)

1) Dystocia (over eager birthing aid)
2) Group housed juvenile Cattle

Question 2

How can you treat Femoral Physeal Fractures?

Answer 2

1) Stall rest

2) FHO (femoral head ostectomy)
- Not successful in Large animals

3) ORIF
- Pins and Screws

Question 3

What treatment for Femoral Physeal fractures is most commonly used?

Answer 3

ORIF

-Pins and Screws

Question 4

Why are FHOs not successful in Large animals?

Answer 4

They are too heavy bra!!!!

Question 5

Describe INTRAmedullary Pin repair for Femoral Physeal fracture in FOOD animals.

Answer 5

• two 3/16th inch pins
• insert through femoral neck from caudolateral femur
• Penetrating the femoral head with fracture reduction

Question 6

Why do you NOT want to go through the femoral head during INTRAmedullary pin replair for Femoral Physeal fracture, in food animals?

Answer 6

ITs an articular surface!!!!

Cause DJD

Question 7

What should be used to fix Femoral Physeal fracture in :

Horse

Food Animal:

Answer 7

Horses

• FOALS: dynamic hip screw (DHS system)
• Adults:???????

Food Animal:
-INTRAmedullary pin repair

Question 8

What are the clinical signs of Tibial fracture?

Answer 8

-walk in and it definitely doesn’t look right

• 3 month old calf ACUTELY lame
• SEvere lameness
• crepitus and pain at stifle

Question 9

How do you treat Tibial Physeal fracture in food animal?

Answer 9

1) external coaptation
- Thomas Schroeder splint/cast
* caution with straw in stall (slippery)

Question 10

How do you treat Tibial Physeal fracture in a foal?

Salter Harris type 2 fracture of the proximal tibial physis

Answer 10

Plate and screw fixation, with tension band wiring

Question 11

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???

Answer 11

Due to horse mentality

-also horse have better purchase (can handle implants)

Question 12

How would you treat a Heifer with a CLOSED comminuted Mid-Diaphyseal fracture of the humerus with displacement?

Answer 12

1) stall rest 2-3 months
2) nursing care
- no external support

Question 13

What are the potential complications of stall confinement?

Answer 13

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

Question 14

How would you treat a humeral fracture in a FOAL?

Answer 14

ORIF with plates

Question 15

What are the complications with ORIF with plate in horses when fixing a Femoral fracture?

Answer 15

• Challenging
• Surgical approach is difficult
• risk of injury to the radial nerve
• Irregular contour of the humerus
• economic concerns

Question 16

What treatment (other than ORIF with plates) can be used to fix a femoral fracture in a FOAL?

Answer 16

Interlocking nails

-inadequate in adult large animal**

Question 17

What type of splint do you put on a radial fracture in a horse?

Answer 17

2 splints:

• Lateral splint from foot to whither (minimize abilitity to abduct the limb)
• palmar from foot to elbow (prevents bending)

Question 18

What are transfixation pins supported by?

Answer 18

1) external frames
2) acrylic resins
3) cast material

Question 19

What are the three main things that need to be done when placing TPCs (transfixation pinning and casting)

Answer 19

1) systemic antibiotics
2) general anesthesia
3) dorsal recumbency

Question 20

When fixing tibial fractures (FA), how many pins per fragment is required?

Answer 20

Minimum of 2 pins per fragment

-as the animal get heavier you can have 3-5

Question 21

Describe Transfixation pin placement?

Answer 21

1) lateral incision
2) pins inserted between the muscles
3) 4.5drillbit-LAVAGE
4) Positive profile centrally threaded 1/4” steinman pin

Question 22

What is a type 2 external fixative?

Answer 22

Pins placed laterally to medially

Question 23

What is a type 3 external fixation?

Answer 23

-Cranially to causally directed half pins

In addition to type 2

Question 24

When should you remove pins?

Answer 24

6-8 weeks later

Question 25

Following pin removal from a tibial fracture, what should be done?

Answer 25

Additional stall rest for a minimum of 2 WEEKS

Question 26

What is the minimum stall rest required following pin removal from a tibial fracture repair?

Answer 26

2 weeks

Question 27

What are the advantages for TPC in farm animals?

Answer 27

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

Question 28

What are the disadvantages of TPC in farm animals?

Answer 28

1) no adjustment after application
2) restricted access to soft tissue
3) requires GA (expensive in Farm animals)

Question 29

What do we use TPC for in Horses?

Answer 29

Comminuted phalange always fractures!!!

Question 30

TPC in Equine patients?

Answer 30

• 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

Question 31

What is the prognosis for tibial fracture in adult horse?

Answer 31

POOR
-its done

• weight and spiral nature of the tibia make it bad prognosis
• but in a mini it is possible to fix

Question 32

How do you treat a tibial fracture in a miniature horse?

Answer 32

• Double plate fixation with 4.5 mm broad DCP

- Lute the plate to increase stability

Question 33

What is plate luting?

Answer 33

• Bone cement (PMMA)
• applied between the plate and bone (after plate/screw placement)
• Creates 100% plate bone contact (increasing strength of repair