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LaSx Final > Long bone fractures/head and neck fractures > Flashcards

Long bone fractures/head and neck fractures Flashcards

1
Q

What is the difference of fracture repair in domestic animals vs. large animals?

A

Large animals must be ambulatory & fully weight-bearing immediately post-op

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2
Q

What are the challenges of fracture fixation in equine?

A

Large plates make skin closure difficult
Implant failure (excessive movement)
Post-op lameness (contralateral limb laminitis)

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3
Q

How many Salter Harris fracture types are there and what are they?

A

Five

1: through the physis (S-straight)
2: through metaphysis (A-above)
3: through epiphysis (L-Lower)
4: through all (T-through)
5: compression (ER-CRush)

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4
Q

What causes the prognosis to decrease when dealing with Salter Harris fractures?

A

Articular involvement

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5
Q

What is a common fracture in young racehorses?

A

Lateral condylar fractures (vertical fractures of distal cannon bone)

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6
Q

Where are the condylar fractures commonly found in thoroughbreds vs. standard bred horses?

A

TB: Forelimb
SB: equally found on fore/hindlimb

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7
Q

What is the typical series of events leading to a condylar fracture?

A

High compressive load –> sclerosis –> microtrauma –> fracture

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8
Q

What type of condylar fractures have the best prognosis?

A

Non-displaced incomplete fracture

Hx of lameness with acute exacerbation

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9
Q

What signs are noticed with acute displaced fractures?

A

Pain on palpation
Joint effusion
Severe lameness after intense exercise

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10
Q

What radiographic view highlights palmar aspect of bone to fully evaluate the joint?

A

Tangential view

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11
Q

What is the sx treatment for a condylar fracture?

A

Internal fixation with transcortical lag screws

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12
Q

How many screws are needed in the internal fixation of a condylar fracture?

A

2 screws

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13
Q

What is the most common long bone fracture in horses?

A

Cannon bone diaphyseal fractures

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14
Q

What is the prognosis dependent upon for cannon bone diaphyseal fractures?

A

First aid in the field and external coaptation

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15
Q

What is the tx for cannon bone diaphyseal fractures?

A

Double plate fixation

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16
Q

What side are the plates placed on for cannon bone fractures?

A

Tension side, 90 degrees from each other

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17
Q

Why are plates offset when treating cannon bone diaphyseal fractures?

A

To reduce the fulcrum effect

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18
Q

What is the maximum amount of compression that is used when using plate holes?

A

4mm compression

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19
Q

What are the four functions of plates and which of these functions is not applied to LA?

A
  1. Compression
  2. Neutralization
  3. Tension band
  4. Buttress- not for LA (not strong enough)
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20
Q

What are two advantages of limited contact-dynamic compression plate?

A

Continuity of bending stiffness

Improved blood supply under plate (can place at 40 degree angle)

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21
Q

Which orthopedic plate is specifically made for equine?

A

Locking compression plate

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22
Q

What are ulnar fractures caused by?

A

Direct trauma

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23
Q

What muscle attaches to the olecranon?

A

Triceps m.

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24
Q

What is the characteristic sign of ulnar fractures?

A

Dropped elbow and carpus in flexion

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25
Q

What is disrupted during an ulnar fracture?

A

Stay apparatus disrupted

Important to splint the carpus in extension before transport so they are weight bearing

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26
Q

Where is the splint for transport applied with ulnar fractures?

A

Palmar splint from fetlock to elbow

**exclusion of the joint above/below rule

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27
Q

What do young patients have present that can be confused with an olecranon fracture?

A

Apophysis

28
Q

What is the tx of choice for ulnar fractures?

A

Open reduction & Internal fixation using tension band principle

29
Q

Where is the ORIF plate applied in ulnar fractures?

A

Caudal ulna

30
Q

What is the difference in treatment for patients +/- 250 kg?

A

> 250 kg: plate required

< 250 kg: tension band wire/cable fixation or hook plates

31
Q

If the horse is not done growing, what should you make sure is not involved in the plate?

A

Don’t involve the radius, can lead to elbow subluxation

*Adult horses you can place distal screws in caudal cortex of radius for more rigid fixation

32
Q

What are the four ddx for ulnar fractures?

A

Humeral fracture
Radial n. paralysis
Olecranon fracture
Neuro dz (rare)

33
Q

What are femoral physeal fractures caused by?

A

Dystocia or group housed juvenile cattle mounting each other

34
Q

What is the tx for femoral physeal fractures?

A

Stall rest & ORIF w/ pins/screws

Foals: dynamic hip screw system

35
Q

What are the tx for tibial fractures in calves vs. foals?

A

Calves: Thomas Schroeder splint/cast
Foal: plate & screw fixation w/ tension band wiring (cancellous screws)

36
Q

How are radial fractures treated?

A

Double plate fixation

37
Q

What is the minimum amount of pins needed per fragment?

A

2 pins per fragment

3-5 in heavier animals

38
Q

When can pins be removed post application?

A

6-8 weeks then additional stall rest for 2 more weeks

39
Q

What is the difference in type 2 vs. type 3 pin placement?

A

Type 2: lateral –> medial

Type 3: cranial –> caudal

40
Q

What is bone cement called?

A

PMMA (plate luting)- creates 100% bone-plate contact increasing strength of repair

41
Q

T/F: You can attempt stall rest for a patient with a femoral fracture

A

FALSE- this is inappropriate tx for femoral fractures

Leads to severe fragment displacement

42
Q

What is the tx of a femoral fracture for a neonatal calf?

A

stack pinning & cerclage wire

43
Q

What is the tx of a femoral fracture for young ruminants?

A

IM pins & cerclage wire w/ active drain

No plates/screws in ruminants <4 mo. because cortical bone is thin/soft

44
Q

What is the tx of a femoral fracture for older/heavier calf?

A

Stack pinning & type 1 external fixator

45
Q

What is the tx of a femoral fracture for foals?

A

Double plate application

46
Q

What is the tx of a femoral fracture for adult large animals?

A

double plate application

47
Q

What type of force do IM pins protect against?

A

Bending (not axial/compressive)

Slow return to weight bearing

48
Q

T/F: Avulsion fractures of incisors, mandible or premaxilla are common?

A

TRUE

49
Q

T/F: mandibula region has great vascular supply

A

TRUE

good functional and cosmetic prognosis

50
Q

T/F: You can remove loose teeth upon discovery of fracture

A

FALSE-wait for them to declare themselves

51
Q

T/F: No diet modification needed for incisor fractures

A

TRUE

52
Q

What do you need to watch for when treating a mandibular fracture

A

Buccal branches of facial n. with maxillary wiring

53
Q

What are the compression surfaces of the mandible?

A

Ventral/lateral surface

54
Q

What are head/neck fractures caused by?

A

Trauma

55
Q

What drug should be avoided when a patient has head trauma and increased intracranial pressure?

A

Ketamine

56
Q

What procedure should be performed if the patient is unable to breathe?

A

Tracheostomy

  • Midline of upper 1/3 of neck
  • Blunt dissection of sternothyrohyoid m.
  • Remove tracheal ring
  • Place tube
57
Q

What are problems associated with calvaria fractures?

A

Subdural hemorrhage and hyphema

58
Q

What is a common head fracture from young horses being halter trained?

A

Basilar fracture

59
Q

What is a radiographic contrast evaluation of the nasolacrimal duct called?

A

Dacryocysto-rhinography

60
Q

What catheter is placed in the maxillary sinus if a fracture is present?

A

Foley catheter (balloon catheter)

61
Q

What type of facial fracture can lead to chemosis?

A

Zygomatic process fracture

62
Q

Why is sx not commonly required for vertical ramus fractures?

A

The large masseter m. keeps fragments in place allowing healing

63
Q

What are two causes of neck fractures?

A

Trauma or electrocution

64
Q

When is static compressive spinal cord lesions clinically relevant?

A

If both dorsal & ventral contrast columns narrow at the same time

65
Q

What is the tx for static compressive spinal cord lesions?

A

Dorsal laminectomy or cervical ventral interbody fusion

LaSx Final (5 decks)

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