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Orthopedic Surgery > Midterm > Flashcards

Midterm Flashcards

1
Q

Bone strength factors

A

Material, structural, rate of load, orientation of load

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2
Q

Rate of load applied=

A

Viscoelastic properties

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3
Q

Direction of load=

A

anisotropic (identical properties in all directions?)

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4
Q

Heirarchy of strength in response to forces

A

Compression > tension > shear

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5
Q

Name Fx mechanisms

A

Tension, compression, torsion, shear, bending

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6
Q

Compression: aka, type of Fx, where

A

Axial load; short oblique; vertebral bodies.

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7
Q

Tension causes what type of Fx and where

A

Avulsion at apophyses (traction physes- lig/tend attchmt)

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8
Q

Shear- type of Fx

A

SH4

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9
Q

Bending- type of Fx

A

transverse or short oblique starting on tension surface (+/- Y with butterfly segment)

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10
Q

Torsion- Fx type

A

Spiral

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11
Q

Configuration of Fx classification

A

Incomplete (greenstick vs fissure), complete (transverse, oblique, spiral, comminuted, segmental)

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12
Q

Greenstick Fx- describe, produced by, Fx types

A

by bending/torsion, still weight bearing- both cortices involved- oblique/spiral

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13
Q

Transverse Fx- force type

A

Bending

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14
Q

Transverse- reduction withstands what forces

A

axial/compression

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15
Q

Oblique vs spiral

A

Oblique: cortices on same plane

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16
Q

Oblique- causes

A

compression and bending together

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17
Q

Comminution- define

A

three segments with connected Fx lines, multiple forces, higher energy trauma

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18
Q

Segmental- define

A

Three pieces but no interconnection- intact cylinder between fxs, +/- avascular segment from disrupted medullary vascular supply

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19
Q

Open Fx classifications

A

I- clean, laceration 1cm

III- extensive damage, worse prognosis, wont ever be perfect

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20
Q

Type of bone in diaphysis, healing speed

A

Mainly cortical, haversian system (mostly mineral, some osteoblasts) slow turnover/healing

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21
Q

Type of bone in metaphysis, healing speed

A

cancellous with mantle of cortex, muscle attachments, less mechanical forces applied, good blood supply, fast turnover

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22
Q

Long term effect of SH fx

A

physeal fracture- impeded growth, poor long term fxn

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23
Q

When joint involved in a fracture, treatment MUST have

A

Anatomic reduction and rigid fixation!

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24
Q

SH scheme

A

SALTR - straight (physis), above (thru meta/phys), lower (thr phys/epi, through (epi/meta/phys), compressive cRush

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25
Q

Effect of all SH fx on all dogs and cats

A

growth plate closes

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26
Q

Where do SH fx occur? (Boards)

A

Zone of hypertrophy (where cells get large before mineralizing)`

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27
Q

Describe Fx

A

open/closed, configuration, location, R/L, bone, displacement

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28
Q

Describe displacement of fx

A

Distal to prox

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29
Q

Fracture assessment score

A

Fx, owner, patient- high (10) good- less plates, fast heal; low (1) slow heal, need plates

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30
Q

Primary goal of fracture management

A

Early and complete return to fxn (small incisions, anatomic reduction, rigid fixation, direct bone healing, good rads)

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31
Q

Outcomes of anatomic reduction

A

Load sharing, weight bearing, fracture healing, alignment

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32
Q

Biologic fixation- describe

A

The gardener approach, preserve environment, use bridging osteosynthesis- align ends of bones in functional position, let nature heal

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33
Q

What has greatest impact on limb function

A

alignment >reduction

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34
Q

Define fixation

A

implant physically engaging bone

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35
Q

Define stabilization

A

dont touch bone- cast/splint

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36
Q

What does union depend on in bone healing

A

Mechanical and biologic env- haversian systems laid down along lines of stress

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37
Q

Secondary healing- define

A

Body’s natural healing, inflammatory–> reparative –> remodeling

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38
Q

Define reparative phase

A

extra/periosseous blod supplu revascularizes, bringing fibrous tissue for support (–>fibrocart –> cart –>woven)

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39
Q

Describe remodeling phase

A

Woven to lamellar bone

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40
Q

Primary healing- define, requirements

A

Sx intervention with plates/screws (not ExFix), anatomic reduction and rigid stabilization (minimal callus formation)

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41
Q

Two forms of primary healing

A

Contact (direct apposition. MNGC osteoclast chewing, osteoblast laying haversian) or gap healing (

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42
Q

Difference between primary healing types

A

Contact- endochondral ossification; Gap- woven bone (no fibrous/cartilage- just bone)

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43
Q

Faster healing: meta or diaph? why?

A

Meta- less bending, more blood, cancellous

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44
Q

When will callus be evident on rads

A

2-4 weeks (young faster than old)

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45
Q

Segment vs fragment

A

seg- big pieces at end; frag- little pieces in middle

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46
Q

Primary site of bone graft- dog/cat

A

Greater tubercle of humerus (also use iliac crest, prox tibia) (diaphysis is yella marrra)

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47
Q

Indications for graft

A

Enhance unions, replace bone loss, stimulate fusion in arthrodesis

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48
Q

Dog/cat histo graft type

A

Cancellous (vs cortical, corticocancellous)

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49
Q

Osteogenesis- def, histo type

A

Direct placement of osteoblasts (and osteoprogenitors) from cancellous

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50
Q

Osteoinduction- def, histo type

A

Causing mesenchymal cells to differentiate into osteoblasts via cytokines like BMP (corticocancellous)

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51
Q

Osteoconduction- def

A

Trabeculae of bone transfered to act as scaffold for capillaries and incoming osteoblasts, evenutally resorbed

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52
Q

Structural support- graft type, describe

A

Cortical only- usually allograft; never complete remodel- creeping substitution

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53
Q

Define “coapt”

A

To approximate

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54
Q

Toggling- define, goal

A

leverage pieces against each other, 50-100% apposition and functional alignment

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55
Q

What forces does coaption reduce best

A

Bending

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56
Q

Copation indications

A

Temp immob, young fx, distal fx, simple/stable fx, lig/tend inj

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57
Q

Effect of coaption post surgery

A

No increased stability, higher risk of fracture disease

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58
Q

Cardinal rule of coaption

A

Immob prox and distal joints

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59
Q

Schanz bandage

A

Soft, padded, like MRJB

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60
Q

What position must p be in for lateral coaption splints

A

Functional standing- not extension

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61
Q

Spica- describe

A

Splint or cast (hard material), goes proximally over midline then wrapped around body

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62
Q

Spica indications

A

Proximal to elbow

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63
Q

RJB- indications, rule of thumb

A

distal to humeral and femoral condyles; 1 lb cotton/20lb dog

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64
Q

RJB- fxn

A

Decrease swelling, prevent closed going to opened

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65
Q

Mason-meta- describe

A

Spoon splint

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66
Q

Mason meta- indications

A

distal to carpus or tarsus/hock

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67
Q

Mason-meta- dont use on what?

A

Radius/ulna fx- cant immobilize prox joint

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68
Q

Velpeau sling- describe

A

hold forelimb against body, non=weight bearing

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69
Q

Velpeau sling- indication

A

Shoulder injuries

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70
Q

Figure of 8- bandage with similar effects

A

Ehmer sling

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71
Q

Figure of 8 and Ehmer function, differences

A

Non-weight bearing, Prevent abduction, flex hip, internally rotate- Ehmer comes around waist

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72
Q

What do Ehmer bandages prevent

A

Quadriceps tie down- stifle lock from quad fibrosis due to hyperextension- young cats/dogs

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73
Q

ExFix best for- Fx type

A

Comminuted, open, infected, non-union, arthodeses

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74
Q

What function does ExFix provide to fx

A

Stable, but NOT rigid fixation

75
Q

ExFix- forces counteracted

A

Compression, bending, rotational

76
Q

ExFix- advantages

A

Open or closed application, stable, post-op adjustments, early weight bearing mitigating fracture dz, economical

77
Q

Types of Ex Fix

A

I- half pin splintage, uniplanar, unilateral; II- full pin splintage- uniplanar, bilateral (through two skin); III- biplanar, bilateral half and full splintage

78
Q

Which type of exfix cant be used above elbow/stifle

A

Type II (and type iii)

79
Q

Most used ExFix types in gen prac

A

Linear

80
Q

What is the weakest link in the exFix

A

Bone-pin interface

81
Q

Maleffects of smooth pins- exfix

A

loose so caused periosteal rxn and resorption, had to angle for surface area

82
Q

Threaded pins in exfix, describe

A

Positive profile- threaded above core diameter, harder to extract- faster healing

83
Q

Type of drill, ExFix

A

low speed, high torque

84
Q

Pin stiffness in ExFix

A

Inversely proportional to distance between cis and clamp^3

85
Q

Pins per segment

A

3-4 per major segment

86
Q

Fixation pin diameter rules

A

no more than 30% diameter of bone

87
Q

KE vs SK

A

KE- no threaded pins, one diameter, cant add/subtract clamps, not radiolucent, rod weaker; SK- PPP, allows pre-drilling, bigger/stronger connecting rod, more stability

88
Q

Bone healing in SK system

A

Secondary! NOT rigid - only plates and screws give primary

89
Q

Most common form of intFix in gen prac, goal

A

IM fixation- three point fixation

90
Q

IM implants (and describe)

A

Steinmann (large diameter, less bend), kirschner wire (smallest diameter steinmann, flex), in the manner of Rush, interlocking nails

91
Q

Three point fixation- points

A

1) prox epi/meta cancellous 2) endosteal diaph 3) distal epi/meta cancellous

92
Q

IM resistance to bend

A

Proportional to diameter^4th

93
Q

IM points

A

Trochar (three sided, sharp); threaded (bounce off), chisel (spaded- trocar goes through bone better!)

94
Q

IM approaches

A

Normograde (in end of bone, across fx, into far segment); Retrograde (in fx site, drive prox, then back down to distal)

95
Q

Easiest to retrieve end of bone config

A

Tied in (pin through skin, tied to exFix) (vs end cut flush, end cut and countersunk)

96
Q

Which type of pin are used in the manner of Rush in IM

A

K wires with chisel tip to deflect

97
Q

K wire positioning

A

Less than 15 degrees or less than parallel with medullary cavity

98
Q

Describe Rush manner

A

Into cavity, against endosteal cortex, providing dynamic flexion with three point fixation

99
Q

What IM technique is used in SH fractures

A

Dynamic pinning- in the manner of Rush, cross proximal to Fx line

100
Q

Interlocking nails prevent what , due to

A

Bending, rotational, axial forces due to screw prox and dist to fx line

101
Q

Femur- preferred IM approach

A

USUALLY Normo with over=reduction for better distal positioning

102
Q

Tibia- preferred IM approach

A

MUST be normo (retro comes out in stifle)

103
Q

Radius- preferred IM approach

A

JUST SAY NO (stress pinning of physeal ok)

104
Q

Ulna- preferred IM approach

A

either

105
Q

Humerus

A

Retro>normo, easier

106
Q

Requirements for circlage 10 command

A

Perfect 360 reduction/reconstruction; oblique fx 2-2.5x diameter of bone at Fx level, wire sufficient diameter, more than 1 wire, approp distance (1/5), no soft tissue inside (wire contact bone), perp to long axis (except K), must be tight, prevent slip with hemi or K

107
Q

Function of cerclage

A

fragment apposition, not enough stability alone for weight bearing- Always used with plate, pin or exFix

108
Q

Cerclage forces resisted

A

dependent on friction of interdigitation

109
Q

Cerclage wire placement

A

1cm apart, 5mm from end of segments, evenly spaced

110
Q

Cerclage- prevent slip at diameter change

A

Hemi-cerclage (thread through hole in bone); K wire perpendicular to fx, cerclage prox and distal to K wire protrusions

111
Q

Twist knot- adv/disadv

A

More resistant to distractive forces, simpler, retighten, cheaper; not as tense as loop, twist protrudes into soft tissue

112
Q

Loop knot- adv/disadv

A

Tighter, less trauma from loop, perp to long axis of bone; Less resistant to distractive forces, can’t re-tighten, more $

113
Q

Biomechanics of loops and twists- 4 studies

A

Loop greater tension before and after bend; twist lose tension when bent; twist greater distractive resistance, resistance to dist. forces increase with greater wire diameter

114
Q

Pin and tension band best for

A

Apophyseal protuberances

115
Q

Pin and tension band function

A

Turn tension forces to compressive in osteotomy

116
Q

Equine limb toe up

A

P3 (coffin) P2 (pastern) P1 (MCP/fetlock) MC3 (carpus/tarsus-hock) R/U (elbow) Humerus

117
Q

Primary goal of eq fx

A

Stabilize limb for transport

118
Q

Eq- sedation, avoid

A

Xylazine or detomidine +/- torb (avoid ataxia and acepromzine for a1 antag)

119
Q

Eq- Section 1 goal

A

Immob fetlock, align dorsal cortices

120
Q

Eq- Sec 2 goal

A

Immob distal to Fx

121
Q

Eq- Sec 3 goal

A

Prevent abd

122
Q

Eq- Sec 4 goal

A

Carpal extension

123
Q

Eq- Section 1 bandage and splint

A

thin nonRJB, dorsal/plantar

124
Q

Eq- Sec 2 bandage and splint

A

Thick RJB, Ca/lat (calc to ground)

125
Q

Eq- Sec 3 bandage and splint

A

Thick RJB, Ca/lat (elbow/withers or tub cox to ground with wide board)

126
Q

Eq- Sec 4 bandage and splint

A

Thin nonRJB, Ca gr to elb; none on hind limb

127
Q

Eq- Best NSAID for MSkel

A

Phenybutazone

128
Q

Eq- transport

A

Gooseneck or large van - no box or stock

129
Q

Eq- hindlimb fx face

A

Front

130
Q

Eq- forelimb fx face

A

Back

131
Q

Eq- Fx Px

A

type, number, location, open/closed, soft tissue/vasc injury, age/breed/weight/nature, time between injury and intervention, first aid efficacy

132
Q

Biggest factor for horse prognosis

A

Type and location

133
Q

Stall rest indications

A

non displaced/incomplete stress fx, MC/T 2/4, patella, pelvis

134
Q

Thomas Schroeder bandage

A

cast with donut ring- used as a crutch to stabilize

135
Q

Eq- exFix indication

A

Distal limb only (fetlock down)

136
Q

Describe transfixation-pin casts

A

Spiral around eq leg to dec rotational stress and give axial suppt., 2-3 cross pins prox to Fx in cast to the ground

137
Q

transfixation-pin casts indications

A

distal limb

138
Q

EFSD- describe

A

U shaped transosseus exFix for distal comminuted

139
Q

Adv/disadv of eq exFix

A

Immediate weight bearing, wound/open fx access; only under 90kg or non-weight bearing

140
Q

4 Principles of Eq intFix

A

rigid stabilization, anatomic reduction, preserve blood supply, early mobilization (Via screws and plates)

141
Q

Eq- cortical screws, most common size

A

Thick with thin thread = strong, rigid; as position, implant, lag fashion; 4.5

142
Q

Eq- cancellous screw

A

Thin diameter with thick thread, replace stripped cortical

143
Q

Eq screw in lag fashion- order

A

drill (glide) drill (thread) countersink, measure, tap, screw

144
Q

Eq drill specs

A

1mm/sec with saline flush to prevent swath overheating/necrosis of bone

145
Q

Tapping

A

Creates threaded holes in drilled holes

146
Q

Plate fixation- eq minimums

A

4 screws per side of Fx

147
Q

Eq- DCP- features

A

Slanted holes, interfrag compression, neutral or compression positions

148
Q

Eq- LC-DCP- features

A

same as DCP with scallops and sturdier due to even distribution of mass

149
Q

Eq- LCP features

A

more rigid, bigger core, smaller threads, perpendicular only needed, LCP or cortical screws both work, less bone-plate contact bc heads of screws lock in plate= rigid fixation

150
Q

Eq fx complications

A

infection, breakdown, osteoarthritis, angular limb deformity, supporting limb laminitis (life threatening)

151
Q

Princ of intFix

A

Anatomic reduction, stable int fixation, atrauma, early return to fxn

152
Q

IntFix screws

A

self tap- big core, sturdy, creates groove; cancelous- less study but better in cancellous

153
Q

Locking screws (strength vs cortical)

A

diam bigger, so stronger

154
Q

Screw function classification (3)

A

Implant, lag, position

155
Q

Implant screw

A

Most common fxn, hold plate to bone, both cortices preferred

156
Q

lag screw indications

A

very oblique fx

157
Q

position screw

A

holds in place, no compression, both cortices

158
Q

Plate classification by function (3)

A

Compression, neutralization, buttress (bridging)

159
Q

Compression plate- indication, function, goal

A

transverse and short oblique; reduce and compress, primary healing

160
Q

Neutralization plate- indication, function

A

comminuted, no compression

161
Q

Buttress plate - indication, function

A

not reconstructing the column, bridges fx gap and takes on entire load

162
Q

What plate is the internal external fixator

A

Locking plates

163
Q

Minimum cortices in SA plates

A

4, 6 preferred (3 bicortical or 4 uni+2bi)

164
Q

Fx fixation specs

A

Screws 4-5mm from fx line

165
Q

What fx should not get RJB in SA

A

femoral and hmeral- fulcrum creation, vessel/tissue tears

166
Q

When fx takes longer to heal than expected; main causes

A

Delayed union (>3-4m); bio and mechanical

167
Q

Bio causes of delayed union

A

poor blood, infxn, systemic dz, drugs

168
Q

Mechanical causes of delayed union

A

inadequate fx fixation causing motion and no callus maturation, poor reduction, excessive post op activity

169
Q

Dx delayed union-

A

Rads- distinct fx margins (not rounded), arrest/regression of healing from serial rads

170
Q

Tx delayed union

A

Autograft of cancellous, vascularized graft, bone forage, remove implants

171
Q

Two types of non-union

A

Viable and non

172
Q

Dx non-union

A

palpable instability, mm atrophy, limb deformity

173
Q

Viable non-unions

A

hypertrophic callus (lots of blood supply but no healing in middle); slightly hypertrophic, oligitrophic (no callus)

174
Q

Non-viable unions

A

dystrophic, necrotic, defect non-union, atrophic non-union

175
Q

Tx non-union

A

Just like delayed- Sx- debride, open med canal, rigid fixation, autograft, tx according to type

176
Q

What type of plate is best for ulna

A

NONE- too small

177
Q

Types of mal-union; causes

A

fxn and non-fxn’l; GP injury, non-anatomic position, poor reduc/stab

178
Q

Tx mal-union

A

Corrective osteotomy- realign, rigid rfix

179
Q

Most common dog infection of implant

A

Staph

180
Q

Rad findings in osteomyelitis

A

Long zone of transition, swelling, sequsterum, avascular/nonviable, involucrum, cloaca

181
Q

Involucrum

A

(periosteal rxn around sequestrum, forms membrane

182
Q

Bandages- change q?

A

5-7 (can stretch 10 with good compliance)

183
Q

Prophylactic Abx- schedule

A

Cefazolon 30-60 min pre-sx; q 1.5-3 h; no more than 24 unless contaminated

Orthopedic Surgery (2 decks)

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