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Orthopedic Surgery > Midterm > Flashcards

Midterm Flashcards

1
Q

What is the strength of bone dependent on?

A

Material properties

Structural properties

Rate of load applied (viscoelastic)

Orientation of applied load (anisotropic)

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2
Q

What are the different types of forces you can put on a bone?

A 
Tension
Compression
Shear
Bending 
Torsion
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3
Q

Which force produces elongation, creates avulsion fractures, and occurs at apophyses?

A

Tension

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4
Q

Which force is the opposite of tension and tends to create short oblique fractures? This is the force in which bone strongest.

A

Compression

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5
Q

Which force is eccentric loading of a bone’s surface? This is the force in which bone is weakest.

A

Shear

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6
Q

Which force results in compressive and tensile forces and causes transverse or short oblique fractures?

A

Bending

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7
Q

Which force includes rotational forces applied along the long axis of a bone and results in spiral fractures?

A

Torsion

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8
Q

*What forces cause oblique fractures?

A

Axial compression and bending forces

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9
Q

Which fracture type has limited inherent stability?

A

Oblique

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10
Q

Which fracture type is inherently stable is anatomically reduced?

A

Spiral

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11
Q

What are the classifications for open fractures?

A

I: Clean soft tissue laceration <1 cm

II: Soft tissue laceration >1 cm; mild trauma, no flaps or avulsion

IIIa: Soft tissue available for wound coverage despite vast laceration, flaps, or high energy trauma

IIIb: Extensive, soft tissue injury loss periosteum stripped and bone exposed

IIIc: Arterial supply to the distal limb damaged; arterial repair indicated

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12
Q

What are the different Salter-Harris classifications of fractures?

A

I: Physis (separation)

II: Metaphysis/physis

III: Epiphysis/physis

IV: Metaphysis/physis/epiphysis

V: Physis (compression)

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13
Q

What do articular fractures demand?

A

Anatomic reduction and rigid stabilization!

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14
Q

What do you always need to include in radiographs of a fracture?

A

Always include the joint proximal and distal to the fracture

Always obtain two orthogonal views of the bone

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15
Q

What is a fracture assessment score?

A

Score that assess the risks associated with a fracture repair

1-10, (1 being high risk, 10 being little risk)

Depends on clinical assessment (owner compliance, patient compliance, comfort level), mechanical assessment (type of fracture, pre-existing conditions, type of dog), and biological assessment (old patient, soft tissue envelope, velocity of injury)

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16
Q

What is the primary objective of fracture management?

A

Promote an early and complete return to function

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17
Q

What is the difference between anatomic reconstruction and biological fixation? Which is more common?

A

“The Carpenter”: Anatomic reconstruction is anatomic reduction and rigid fixation to promote weight-bearing and fracture healing

“The Gardner”: Biological fixation aims to preserve the vascular supply to the bone using bridging osteo-synthesis (ex fix, IM pins)

Biological is becoming more commonly used

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18
Q

What is the difference between reduction and alignment?

A

Anatomic reduction is putting everything back in its normal, anatomical position

Alignment refers to the orientation of joints proximal and distal to the fracture and has a greater impact on function

Anatomic reduction is not necessary to achieve anatomic or at least functional alignment

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19
Q

What is secondary bone healing?

A

Includes inflammatory, reparative, and remodeling phases of bone healing and is dependent on callus formation to heal

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20
Q

What is primary bone healing?

A

Requires anatomic reduction and rigid fixation

Associated with minimal callus formation

Contact healing or gap (<1mm) healing

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21
Q

When would a callus be evident on radiographs in a fracture healing by secondary bone healing?

A

2-4 weeks

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22
Q

What is bone grafting?

A

The transfer of bone from one site or source to another to facilitate and promote bone healing (osseous union)

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23
Q

What are the indications for bone grafting?

A

To enhance union in acute, nonunion or delayed union fractures

Replace areas of bone loss

Stimulate fusion of arthrodeses

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24
Q

What are the types of bone grafts?

A

Immunologic (auto, allo, xeno)

Histologic (cancellous, cortical, corticocancellous)

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25
Q

What are the functions of bone grafts?

A

Direct osteogenic effects (only fresh autografts)

Osteoinduction

Osteoconduction

Structural support

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26
Q

What are the common source sites for cancellous bone in bone grafting?

A

Greater tubercle

Iliac crest

Proximal tibia

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27
Q

What is osteoinduction?

A

Type of bone grafting that utilizes recruitment and differentiation of osteoprogenitor cells

Induces bone synthesis

Uses bone morphologic proteins

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28
Q

What is osteoconduction?

A

Bone graft in which the graft provides scaffolding for in-growth of capillaries and mesenchymal cells

Graft is eventually resorbed and replaced

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29
Q

What type of bone graft provides structural support?

A

Cortical allografts

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30
Q

What is coaptation?

A

Extra-corporal treatment modalities for musculoskeletal abnormalities

Casts, splints, slings, bandages, etc.

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31
Q

When is coaptation contraindicated?

A

Following open reduction and internal fixation

Will not increase stability and promotes fracture disease

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32
Q

What are the three different types of coaptation?

A

Schanz soft padded bandage

Lateral coaptation splints

Full and half cylinder casts

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33
Q

How would you pad the limb differently in rigid pre-formed splints and malleable splints?

A

Rigid pre-formed splints: pad depressions

Malleable splints: pad protuberances

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34
Q

What is one thing to remember with any type of coaptation of the limb?

A

LEAVE THE DIGITS EXPOSED

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35
Q

What is the cardinal rule of coaptation?

A

The joint proximal and distal to the injury must be immobilized!

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36
Q

*Which splint is most commonly used following closed reduction of elbow luxation?

A

Spica splint

Coaptation which extends proximally over midline

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37
Q

For what kind of injuries would you use a Robert Jones bandage?

A

Injuries distal to the elbow or distal to the stifle

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38
Q

For what type of injuries would you use a Mason-Meta Splint?

A

Injuries distal to the carpus and hock

Inappropriate for fractures of the radius and ulna!

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39
Q

For what type of injuries would you use a Velpeau sling?

A

Used for scapular fractures and some shoulder injuries

Prevents weight-bearing on forelimb

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40
Q

When would you use a Figure-of-8 sling?

A

Following reduction of coxofemoral luxations

Flexes, abduct, and internally rotates the hip and prevents weight-bearing of the hindlimb

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41
Q

When would you use an Ehmer sling?

A

Following reduction of coxofemoral luxations

Flexes, abducts, and internally rotates the hip and prevents weight-bearing of hindlimb

More effective than Figure-of- sling

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42
Q

When would you use 90/90 Flexion bandage?

A

Used to prevent “quadriceps tie-down” by maintaining the quadriceps mechanism in extension by keeping the stifle and hock at 90 degrees

Prevents weight-bearing

Used as a form of physical therapy to increase range of motion

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43
Q

What are the indications for external fixation?

A

Comminuted fractures

Open fractures

Infected and nonunion fractures

Arthrodeses

Transarticular stabilization

Limb deformities

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44
Q

What are the different types of external fixators?

A

Linear
Acrylic
Circular
Hybrid

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45
Q

What are the different nomenclatures (Type I, II, III) of external fixators?

A

Type I: Half-pin splintage and is uniplanar and unilateral (pins go through both cortices but only one skin surface)

Type II: Full-pin splintage and is uniplanar but bilateral (pins go through both cortices and skin surfaces)

Modified Type II: Utilizes both half and full-splintage

Type III: Utilizes both half and full-pin splintage and is biplanar and bilateral

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46
Q

What is the application of Type II external fixators limited to?

A

Disorders distal to the elbow and stifle

Due to impingement of the medial connecting column with the body wall

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47
Q

What is the weakest part of the external skeletal fixation construct?

A

The bone-pin interface

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48
Q

What are the disadvantages of the Kirschner-Ehmer (KE) Apparatus?

A

Cannot place positive profile pins directly through clamps

Pre-drilling pilot holes is difficult

Difficult to place a series of parallel full-pin splintage pins

Connecting system is not radiolucent

Connecting clamps only accept pins of limited diameter

Te connecting rod is relatively weak

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49
Q

What is the IMEX SK External Fixation System?

A

Innovative clamp design that allows pre-drilling of pilot holes and allows for variability in fixation pin diameter with better mechanics

Increased stability

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50
Q

What are some general guidelines for placing pins?

A

Place pins through small incisions

Don’t place pins through traumatic or surgical wounds

Close surgical wounds prior to placing pins

Avoid large muscle masses

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51
Q

What level of speed and torque would you use to drill your pilot hole? Place the fixation pin?

A

Pilot hole: High speed, low torque

Fixation pin: low speed, high torque

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52
Q

In what order do you place external fixator pins?

A

Place proximal and distal pins first

Place intermediate pins next, near the ends of the fracture segment

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53
Q

*Fixation pin diameter should not exceed what percentage of the diameter of the bone?

A

30%

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54
Q

The stiffness of a pin is proportional to what?

A

Radius ^ 4

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55
Q

What are the advantages of acrylic connecting columns?

A

Pins can be any diameter

Pins don’t have to be placed in the same longitudinal plane

Most are radiolucent

Minimizes the distance between connecting column and the cis-cortex of the bone

Light in weight

Limited inventory and expense

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56
Q

What are the disadvantages of acrylic connecting columns?

A

Difficult to maintain reduction if used for primary fixation

Polymerization of PMMA is an exothermic reaction

Fumes generated during polymerization of PMMS are neurotoxic and teratogenic

Difficult to make adjustments or remove individual interior fixation pins

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57
Q

What is the most common form of internal fixation?

A

Intramedullary Fixation

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58
Q

What are the different typed of intramedullary implants?

A

Steinmann pins

Kirschner wires

Rush pins

Interlocking nails

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59
Q

What are the three points of intramedullay fixation?

A
  1. Proximal epiphyseal/metaphyseal cancellous bone
  2. Endosteal surface of diaphysis
  3. Distal epiphyseal/metaphyseal cancellous bone
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60
Q

What forces do intramedually pins resist?

A

Bending forces!

No resistance to compression, torsion, or tension

Little resistance to shear

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61
Q

What are the three types of tips for intramedually pins?

A

Trocar
Threaded
Chisel

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62
Q

How do you insert an intramedually pin?

A

Manually with a Jacob’s chuck or low speed power drill

Normograde: pin is inserted at one end of the bone and driven across the fracture site

Retrograde: Pin is inserted through the fracture site, driven out one end of the bone, reduced and driven across the fracture site

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63
Q

What do you do with the ends of a pin after inserting an intramedually pin?

A

End cut flush with the bone: less irritation, difficult to retrieve)

End cut and countersunk: no irritation and difficult to retrieve

“Tied-In” (articulated): contributes to stability, prevents migration, easily retrieve, increased morbidity

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64
Q

What are Kirschner “K” Wires?

A

Small diameter, flexible trocar tipped pins

Divergent, trans-cortical implants (makes an X)

Used in small dogs and cats

Used in “the manner of Rush pins”

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65
Q

What are Rush Pins?

A

Curved, elastic pins which provide dynamic three-point fixation

Kirschner wires or small diameter Steinmann pins are often used “in the manner of Rush pins”

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66
Q

What is Stress Pinning?

A

Dynamic intramedually cross pins places “in the manner of Rush pins”

Pins are inserted at an angle such that the pins deflect off the endosteal cortical surfaces

May provide added strength

Commonly used in metaphyseal or physeal fractures

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67
Q

What are Interlocking Nails (intramedullary fixation)?

A

Nails positioned within the medullary cavity are penetrated (perpendicularly) with screws or bolts

At least one or two screws/bolt proximal and distal to the fracture

Placement determined with a “guide jig”

68
Q

What are the advantages of interlocking nails in intramedullary fixation?

A

Controls bending, rotational, and axial forces

Application fast and simple

Economical

69
Q

What is the preferred method of pin placement in intramedullary fixation of the femur?

A

Normograde

70
Q

*What is the preferred method of pin placement in intramedullary fixation of the tibia?

A

Normograde

71
Q

What should you be careful about when placing an intramedullary pin in the femur?

A

Avoid sciatic!

72
Q

What should you be careful about when placing an intramedullary pin in the tibia?

A

Do not enter the hock distally!

Don’t use malleoli as landmarks! They go past the end of the tibia

Cut the tip of the pin off

73
Q

Should you open the joint capsule when placing an intramedullary pin in the tibia?

A

No

74
Q

What should you know about intramedullary fixation of the radius?

A

DO NOT PIN THE RADIUS

JUST SAY NO

75
Q

How should you place intramedullary pins in the ulna?

A

Normograde or retrograde (either)

76
Q

How should you place intramedullary pins in the humerus?

A

Normograde or retrograde (retrograde is most common)

Greater tubercle to medial condyle

77
Q

What is the definition of cerclage wire?

A

Heavy gauge stainless steel wire placed circumferentially around bone to provide fragment apposition and adjunctive fixation

78
Q

What is the main function of cerclage wires?

A

Provide fragment apposition but inadequate stability to resist the forces of weight-baring alone

Neutralizes rotational, shearing, axial, and bending forces

79
Q

What is required for correct application of a cerclage wire?

A

360 degree anatomic reconstruction of the cylinder of bone at the level the wires are placed

80
Q

What are the main differences in the biomechanics of twist knots and loop knots?

A

(Lecture sites paper findings)

Loop knots produced greater tension than twist knots

Twist knot cerclage wires lost significant tension if bent over but provided greater resistance to distractive forces

Knot resistance to distractive forces increased with increasing diameter of the wire

81
Q

What are the advantages and disadvantages of twist wires?

A 
Advantages:
More resistant to distractive forces
Simpler to apply
Wires can be re-tightened
More economical

Disadvantages:
Final tension inferior to loop wires
Situated obliquely to the long axis of the bone
Twist protrudes into the surrounding soft tissue

82
Q

What are the advantages and disadvantages of loop wires?

A

Advantages:
Greater final tension
Situated perpendicular to the long axis of the bone
Does not protrude into surrounding soft tissue

Disadvantages:
Less resistant to distractive forces
Cannot re-tighten
More cumbersome to apply
Increased cost
83
Q

What are the 10 Commandments of cerclage wires?

A
  1. Wire must be of sufficient diameter
  2. Need 360 degree anatomic reconstruction
  3. Fracture must be oblique
  4. Never use a single wire
  5. Wires should be 1cm apart
  6. Wire must be 5mm from end of fracture segments
  7. No interpositioned soft tissue
  8. Wires must be placed perpendicular to the long axis of the bone
  9. Prevent slippage in regions where bone changes diameter
  10. Wires must be tight
84
Q

*What is the main function of pin and tension band fixation?

A

Convert distractive forces to compressive forces

85
Q

What are the 4 principles of internal fixation?

A
  1. Anatomic reduction
  2. Stable fixation
  3. Atraumatic technique of bone and soft tissue
  4. Early pain free return to function
86
Q

What are the 4 common screw designs?

A
  1. Cortical
  2. Cancellous
  3. Lag
  4. Locking
87
Q

What is the difference between cortical and cancellous screws?

A

Cortical has a larger core, used in diaphysis

Cancellous has larger threads, used in softer/metaphyseal bone

88
Q

What is the difference between a cortical screw and a locking screw?

A

Locking screw has a threaded head

89
Q

What is the most common use of screws?

A

Implant screws

90
Q

What are position screws?

A

Screws used to aid in initial reductio by holding bone fragment in place

Does not provide compression

91
Q

What is the main goal of placing a screw in lag fashion?

A

Compression

92
Q

What are the common plate types?

A

Dynamic compression plates (DCP)

Limited contact dynamic compression plates (LC-DCP)

Locking plate (LCP)

Specialty plates

93
Q

What are the common plate functions?

A

Compression

Neutralization

Bridging

94
Q

What is the function of a compression plate? Neutralization plate? Bridging plate?

A

Compression: Produces compression at the fracture site to provide absolute stability

Neutralization: Protects interfragmentary stabilization via lag screw, cerclage, hemicerclage, or wire from bending, shear, and torsional loading

Bridging: Acts as a splint to maintain limb length and joint alignment, prevents axial deformity via bending or shear forces

95
Q

What is the ideal fracture situation for internal fixation?

A 
Closed
Diaphyseal
Long bone
Adequate soft tissue coverage
Can apply on the tension side of the bone
96
Q

What are some basic goals for successful plate application?

A

6 cortices minimum on each side of the fracture

Plate contoured to bone

Screw are 30-40% bone diameter

Appropriate plate size

Plate applied to tension side of the bone

97
Q

What are the main orthopedic complications?

A

Delayed unions

Nonunion

Malunion

Osteomyelitis

Quadriceps contracture

98
Q

What is the expected time for normal fracture union?

A

3-6 mo old: 4-6 weeks

> 1 year old: 12 weeks

99
Q

What are the two main things normal fracture healing (without complications) requires?

A

Blood supply

Stable conditions

100
Q

What are the two biggest biological causes of delayed union?

A

Insufficient vascularity

Infection

101
Q

What are the main mechanical causes of delayed union?

A

Inadequate reduction and fixation

Excessive post-op activity

102
Q

What is a possible result of delayed union?

A

Implant failure secondary to implant fatigue

103
Q

In nonunion, what is necessary for the bone to heal?

A

Surgical intervention

104
Q

What are possible etiologies for nonunion?

A

Instability

Poor blood supply

Large gap between fracture segments

Soft tissue between fracture segments

Infection and sequestration

105
Q

What are the clinical signs of nonunion?

A

Palpable instability at fracture site

Muscle atrophy

Limb deformity

Impaired limb function

Lameness

Variable pain

106
Q

What are the radiographic signs of nonunion?

A

Fracture margins distinct

Pseudoarthrosis

Sclerosis (sealed marrow cavity)

Serial evaluation reveals arrest or regression of healing

107
Q

How do you classify a nonunion?

A

Viable

Non-viable

108
Q

What are characteristics of a viable nonunion?

A

Hypertrophic (elephant foot)

Slightly hypertrophic (horse foot)

Oligotrophic (no signs of healing, treated as non-viable)

109
Q

What are characteristics of a non-viable nonunion?

A

Dystrophic (poor vascularized fragment with partial healing)

Necrotic

Defect

Atrophic (resorption of adjacent bone ends)

110
Q

How do you treat a nonunion?

A

Consider underlying cause

Debridement of necrotic bone

Opening of medullary canal

Rigid internal fixation

Autogenous cancellous bone graft

111
Q

What causes a malunion? What can it result in?

A

Inadequate fracture reduction or stabilization

Position is not anatomic

Results in an angular, rotational, distracted, or over-riding deformity

112
Q

Does a malunion always cause clinical problems?

A

No

113
Q

What are the clinical fidings with a malunion?

A

Malalignment of limb

Fracture site palpably stable and non-painful

Lameness and/or decreased range of motion

114
Q

What is the treatment for malunion?

A

Corrective osteotomy

Realignment

Rigid fixation

115
Q

When is surgery indicated for malunion?

A

When there is:

Impaired limb function

Stenosis of pelvic canal

Jaw malocclusion

Patellar luxation

116
Q

What is osteomyelitis?

A

Inflammation of the bone and marrow

usually infectious in etiology

Adjacent soft tissue often involved

117
Q

What is the most common clinical entity in small animal practice?

A

Chronic, post-traumatic osteomyelitis

118
Q

What are contributing factors to osteomyelitis?

A

Tissue ischemia

Bacterial inoculation

Bone necrosis and sequestration

Fracture instability

Foreign material implantation

119
Q

What are the radiographic findings associated with osteomyelitis?

A

Soft tissue swelling

Irregular periosteal reaction far from fracture

Lysis/bone resorption

May be difficult to distinguish from normal healing or bone tumor

120
Q

What is a sequestrum?

A

Necrotic bone fragment

121
Q

What is an involcrum?

A

Periosteal reaction surrounding a sequestrum

122
Q

What is a cloaca?

A

Opening in involcrum, resulting in drainage

123
Q

How do you diagnose osteomyelitis?

A

Positive culture

124
Q

How do you treat osteomyelitis?

A

Meticulous debridement

Removal of all foreign material

Establishment of drainage

Rigid stabilization

Long-term antimicrobial therapy

125
Q

Will antibiotics alone cure osteomyelitis?

A

NO

126
Q

How can you minimize infection associated with fracture repairs?

A

Prophylactic antibiotics

Minimize duration of surgery/anesthesia

Debridement

Irrigation

Post-op cultures

127
Q

What are predispositions for quadriceps contracture?

A

Young, growing dogs

Femoral fracture

Excessive fibrous tissue

128
Q

What causes quadriceps contracture?

A

Quadriceps trauma with prolonged immobilization

129
Q

How can you prevent quadriceps contracture?

A

Early fracture management

Rigid fixation

Early return to function

Only temporary (or no) immobilization

130
Q

What is the treatment for quadriceps contracture?

A

Limb amputation

131
Q

What is considered an equine orthopedic emergency?

A

Any acute-onset, severe lameness

132
Q

What is the primary goal in initial management of an equine fracture?

A

Stabilize limb for transport

133
Q

What type of sedation would be appropriate in equine emergency fracture assessment?

A

200mg xylazine + 5mg butorphanol

Or

5mg detomidine + 5mg butophanol

134
Q

What should you avoid when sedating an equine patient with an orthopedic emergency?

A

Excessive ataxia

Acepromazine (hypotension)

135
Q

What are the goals of equine fracture stabilization?

A

Reduction of pain and anxiety

Minimize further trauma

Immobilize adjacent joints

136
Q

What are the goals of splinting equine fractures?

A

Neutralize damaging forces

Not overly cumbersome

Can be applied in difficult circumstances

Does not require anesthesia

Economical and accessible

Span the joint above and below when possible

137
Q

How would you bandage distal fractures (equine)?

A

Align dorsal cortices into straight line

Neutralize bending forces at fetlock joint and fracture site

Apply a light compression bandage (1,/2” thick)- NOT robert jones

138
Q

How would you bandage a mid-forelimb fracture (equine)?

A

Maintain bony alignment and immobilize distal to fracture site

Robert Jones bandage, ground to elbow (diameter = 3x limb)

Caudal and lateral splints

139
Q

How would you bandage mid and proximal metatarsal fractures (equine)?

A

Stabilize by using calcaneal tuberosity as extension of MT3

Apply lateral and plantar splints over Robert Jones bandage bandage

Caudal splints should extend from calcaneus to ground

140
Q

What is the main goal of bandaging mid and proximal radial fractures (equine)

A

Prevent abduction

Can lead to open fracture!

141
Q

How would you bandage mid and proximal radial fractures (equine)?

A

Robert Jones bandage with caudal splint (elbow to ground) and lateral splint (withers to ground)

142
Q

What is the main goal of immobilizing tarsus and tibial fractures (equine)?

A

Prevent abduction

143
Q

How would you bandage tarsal and tibial fractures (equine)?

A

Apply Robert Jones bandage from stifle to ground

Lateral splint from tuber coxae to ground

Width- resistance to rotational forces

Length- prevents abduction

144
Q

How do you bandage fractures proximal to elbow (equine)?

A

You don’t. No coaptation.

145
Q

What is the goal of coaptation for olecranon fractures (equine)?

A

Align bones
Fix carpus in extension
Allow weight bearing

Padded bandage (Not RJB)with caudal splint

146
Q

How would you bandage a fracture proximal to the stifle (equine)?

A

You don’t. No coaptation.

Bandaging/splinting could increase trauma by creating a pendulum effect.

147
Q

How do you manage an open fracture (equine)?

A

Clean woumnd before bandagin

Keep moist

Broad spectrum antibiotics

Tetanus toxoid

Analgesia

148
Q

What analgesia should be provided to equine patients with fractures?

A

1.1 mg/kg flunixin meglumine

Or

4.4 mg/kg phenylbutazone IV

149
Q

When is the best time to take radiographs of a fracture in equine patients?

A

At the referral hospital

150
Q

What are some key guidelines for transporting horses with fractures?

A

Minimize the distance the horse must walk

Hindlimb fractures: face front

Front limb fractures: face back

151
Q

What does fracture prognosis in equine patients depend on?

A
  1. Type, number, and location of fractures
  2. Open vs closed
  3. Degree of soft tissue damage or vascular injury
  4. Age, breed, and weight of the horse
  5. Nature of patient
  6. Time between injury and repair
  7. Effectiveness of first aid before referral
152
Q

Fractures in what bones are amenable to repair in equine?

A 
Phalanges
Sesamoids
MC/MT
Carpal
Tarsal
Patella
Ulna
153
Q

Fractures in what bones are difficult to repair in equine?

A 
Radius
Humerus
Scapula
Calcaneus
Tibia
Femur
Pelvis
154
Q

What are some unique characteristics of fracture healing in foals?

A

Heal faster than adults

Prone to angular limb deformities

Salter-harris fractures

More prone to cast sores and tendon laxity

155
Q

Stall rest is used for what kind of fractures?

A

Stress fractures

Splint bone fractures

third trochanter, deltoid tubercle

156
Q

What is the main risk of stall rest in fracture management?

A

Catastrophic propagation

157
Q

What splint is commonly used in fractures of small ruminants?

A

Thomas-Schroeder splint

158
Q

What are the indications for transfixation-pin casts in equine patients?

A

Comminuted phalangeal fractures

Distal MC/MT III fractures

MCP breakdown

159
Q

When are external fixators used in equine patients?

A

Usually with non-weightbearing fractures (mandible)

Foals

(Often do not provide enough axial support for anything else)

160
Q

What external fixator was specifically developed for comminuted phalanx, MC/MT III or MCP breakdown (equine)?

A

U-shaped apparatus with transosseus pins incorporated into tapered sleeves

161
Q

What are the key principles for internal fixation (equine)?

A

Anatomical reduction
Rigid fixation
Preservation of blood supplies
Early mobilization

162
Q

What is the minimum number of screws that need to be placed on each side of a fracture when plating in equine patients?

A

4

163
Q

What is the function of plate luting in equine fracture repair?

A

Optimized contact between plate and bone using PMMA

Increases frictional forces “lags” plate to bone

(Not performed in small animal)

164
Q

When should you remove implants (equine)?

A

Infection/loosening/lameness

Problems when returning to exercise

Screws: generally don’t remove unless there is a problem. Then -> staggered removal

165
Q

What are possible complications of fracture repair in horses?

A

Implant infection

Catastrophic breakdown

Osteoarthritis

Angular or flexural limb deformities (foals)

Supporting limb laminitis (founder)

Orthopedic Surgery (2 decks)

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