Long Bone Fractures III Complications, Prosthetics, Madibular Fractures Flashcards
What are open fractures at high risk of?
Infection
What are 3 clinical signs of infection?
Lameness
Heat
Fever
NOTE: You may also see drainage coming through a cast because the material is porous.
What are 3 treatment steps for an open/infected fracture?
Local debridement
Systemic and local Abx
Cancellous bone graft
If you have a long bone fracture in a heavier animal, what can you do to help create a stronger ex-fix?
Stick some tubing on the pins and fill with PMMA
NOTE: Leave 1/4 - 1/2” space between tube and skin to allow for swelling.
If you have a young animal come to you with a complete fracture of a long bone, what is a repair technique that you can use?
Stack pinning and cerclage wire
Note: Threaded-end pins are better because they are less likely to back out.
______ is unsuccessful for femoral fractures.
Stall rest. Because we see severe displacement of the fragments.
What is the difficulty with using plates and screws to repair long bone fractures in young ruminants?
Screws and plate loosen.
Why do you use stack pinning and cerclage wire to repair long bone fractures in young ruminants?
Because their cortical bone is thin and soft, so not great for plates and screws.
What is a downside to stack pinning and cerclage wire to repair long bone fractures in young ruminants?
You destroy the medullary vasculature so you slow healing.
What can intramedullary pinning not protect against?
Axial and compressive forces.
What are 3 possible complications with stacked pins in calves?
Seroma
Pin migration
Osteomyelitis
How would you repair a femoral fracture in a FOAL?
Double plating on the cranial and lateral aspect of the cortex.
NOTE: Stack pinning isn’t enough for foals.
How is a femoral fracture in an adult large animal repaired?
MUST use double plating.
What is the prognosis for an adult large animal fracture?
Poor. There is a significant risk of hemorrhage.
What 4 things does the overall prognosis of a long bone fracture depend on?
Age
Weight
Fracture configuration
Open or closed fracture
What part of the bone/fracture do you want to apply your plate when repairing a long bone fracture?
On the tension side.
What is a common cause of mandibular fracture?
Trauma
What sort of prognosis does a mandibular fracture have?
Good
What is so great about unilateral fractures of the madible and maxilla?
They are partially supported by the other side.
If you have loose teeth after a mandibular fracture, what should you do?
DO NOT extract them right away. Wait for them to declare themselves.
What are 4 surgical techniques you can use to treat a mandibular fracture.
Intraoral wiring
Tension band wiring
External fixators
Plates
When repairing maxillary fractures, what do you need to be careful to avoid?
The palatine artery.
Often, when an incisor fracture presents to you, it cannot be reduced, why is that?
There’s a ton of crap in there that you need to debride out of the fracture line.
What are 2 indications for plating a mandible?
Fx of the body and vertical ramus of the mandible
Fx of the caudal aspect of the horizontal ramus
What 3 types of plate might you use with a mandible?
LCPs
LC-DCP
Reconstruction plates
What are 4 major disadvantages of mandibular plating?
Can only place on the compression side of the bone (vs. the tension side)
Screw palcement is difficult
Exposure of the caudal ventrolateral mandible is difficult d/t parotid duct
Most mandibular fx are open (infection = implant removal)
What sort of diet modification do you see with an incisor fracture?
None
What must you do daily in aftercare with a mandibular fracture?
Lavage
When are the implants removed from a mandibular fracture?
Upon healing (~6-8 weeks)
What are 5 possible complications of mandibular fracture repairs?
Implant failure Breakage of plates Loosening/breakage of wires Drainage Sequestra
What is the most common reason for amputation in large animals?
Severe osteomyelitis
What does amputation require from the owners?
Extreme dedication for extensive aftercare.
Prosthesis should be removed daily and the soft tissue should be inspected for sores etc.
What are BIG risks with amputation in a large animal without a prosthesis?
Laminitis or angular limb deformity of the opposite limb
