Long Bone Fractures 3: Stacking,complications, Mandibular Fractures

Question 1

Are femoral fracture in cattle common?

Answer 1

Not really

Question 2

Why is stall rest alone, unsuccessful to treat FEMORAL fractures?

Answer 2

Diaphyseal fracture, different place

-this is different to the femoral head fracture (in which stall rest is indicated)

Question 3

Why is the age of note in Young ruminant fracture repair?

Answer 3

1) difficulties with plate and screw repair
2) screw and plat loosening
3) Ruminants <4 months old have thin and soft cortical bone BUTTER BONES

Question 4

T/F : When Ruminants are young (<4months old) they have very few options for fracture repair because they have soft bones

Answer 4

TRUE

Question 5

How would you treat your young ruminant femur fracture?

Answer 5

• Cerclage wire
• IM pins (threaded)
• Drain (radio-opaque)

Question 6

How would you treat Older/Heavier calf femur fracture?

Answer 6

Stack Pinning and type 1 external fixation

Question 7

T/F: INTRAmedullary pinning (IM) Does NOT protect against axial and compressive forces at the fracture site

Answer 7

TRUE

Question 8

T/F: IM pinning can cause a slow return to weight bearing.

Answer 8

TRUE

Question 9

What is the prognosis for Neonatal calf femoral fracture repair with stacked pin fixation
-Complications?

Answer 9

75% Pretty good

-Seroma, pin migration, osteomyelitis

Question 10

In order of commonality: what are the complications of Calf femoral fracture repair with stacked pin fixatures?

Answer 10

SEROMA>pin migration>osteomyelitis

Question 11

How you you treat a femoral fracture in a FOAL?

-prognosis?

Answer 11

• Double plate application
• cranial and lateral aspects of the bone

Prognosis: 50%

Question 12

How would you treat a femoral fracture in an adult LArge animal?
-prognosis?

Answer 12

MUST place DOULBE plates

Prognosis: POOR

Question 13

What does the prognosis of Long Bone Fractures Repair depend on?

Answer 13

1) age
2) weight
3) Fracture configuration
4) open/closed

Etc…

Question 14

What are the complications of fracture repair?

Answer 14

1) implant failure
2) infection
3) sequestration
4) delayed /non- union
5) Contralateral limb laminitis (equine)
6) contralateral angular limb deformity
- immature animals

Question 15

What is more likely to occur in an open fracture compared to closed?

Answer 15

Closed:

• > 4x more likely to remain uninflected
• > 4.5x more likely to be discharged

Open :
-HIGH risk of infection

Question 16

What are the clinical signs of infection Due to open fracture?

Answer 16

Lameness
Heat Fever (even mild-often on NSAIDs)

Question 17

How would you treat an OPEN/ INFECTED fracture?

Answer 17

1) local debridement

2) systemic and local antibiotics
- RLP
- Ab-impregnated PMMA beads

3) Cancellous Bone graft

Question 18

Are tubing with acrylic (PMMA) and external frames strong enough for fixing OPEN fractures in Heavier patients?

Answer 18

NOOOOOO

Question 19

Cause and prognosis of Mandibular fractures.

Answer 19

Commonly Trauma
GOOd prognosis (cosmetic and functional)
-excellent vascular supply
-non-weight bearing 
-equipment cheap and readily available

Question 20

T/F: loose teeth of a horse with a mandibular fracture should NEVER be removed until the fracture has healed.

Answer 20

TRUE

1) they will often do well and become solid later in the mouth
2) good anchor and space occupior

Question 21

What are the surgical techniques for mandibular treatment?

Answer 21

1) intraoral wiring
2) tension band wiring to heel teeth
3) external fixators
4) plates

Question 22

WHAT are the indications for mandibular plate application?

Answer 22

• Fx body and vertical ramus of mandible
• Fx of caudal aspect of horizontal ramus
• LCP, 3,5mm LC-DCP or reconstruction plates

Question 23

What is the problem with plate fixation in mandibular fracture cases?

Answer 23

When plating, plate should be placed on the tension side of the fracture….but in mandibular fractures you can only place them on the ventrolateral edge (not tension)

Question 24

What are the disadvantages of mandibular plate application?

Answer 24

• can only place on the compression surface of the bone (ventral, ventrolateral, lateral)
• screw placement tricky (due not engage tooth roots)
• exposure of caudal ventrolateral mandible difficult (parotid duct)
• most mandibular fractions are open

Question 25

Why do you not want to modify the diet for incisor fractures?**

Answer 25

COLIC

Question 26

What after care should be considered following mandibular fracture repair?

Answer 26

• no diet modification
• lavage mouth daily
• Bute 2.2mg/kg PO BID
  4. 4mg/kg POD SID x 7 days
• +/- antibiotics
• implant removal 6-8 weeks