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Ortho sx > Ortho complications (Dujo) > Flashcards

Ortho complications (Dujo) Flashcards

1
Q

Tension side depends on

A
  • overlying soft tissue
  • fracture
  • forces action on bone

*exceptions: big defect

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2
Q

Delayed unions

A
  • Fracture takes longer to heal than anticipated
    • adequate time but incomplete healing
    • healing progressing slower rate than expected
  • bone should be healed by
    • 3-4 months in adults
    • 1-2 months in growing animals
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3
Q

Delayed unions

biological causes

A
  • Poor vascularity
    • usually secondary to trauma
    • most common biological cause
  • presence of infection
  • Escessive postoperative activity
  • Systemic dz
  • Drugs
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4
Q

Delayed union

Biological causes

Systemic dz

A
  • Examples of systemic dz
    • Primary hyperthyroidism
    • Hyperadrenocorticism
    • Diabetes mellitus
    • Renal dz
    • Intestinal malabsorption
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5
Q

Delayed union

Biological causes

Drugs

A
  • Examples of drugs
    • corticosteroids
    • antineoplastic drugs
    • anticonvulsant drugs
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6
Q

Inadequate fracture fixation can result in

A
  • Instability and motion
    • results: prevention of callus maturation and bone healing
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7
Q

DX of delayed union

A
  • Slightly subjective
    • serial rads
  • Eval mechanical and biological factors
    • fracture margins distinct
    • pseudoarthrosis
    • sealed marrow cavity
    • arrest or regression of healing
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8
Q

TX of delayed unions

A
  • Autogenous cancelous bone graft
  • Vascularized graft or bone forage
  • More rigid fixation
  • Remove implants in infection
    • make sure there is enough healing
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9
Q

Nonunion

A
  • All healing processes have stopped with bone unhealed
  • two main types
    • viable
    • nonviable
  • surgical intervention necessary
  • etiology same as delayed union
    • plus seequestration
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10
Q

Viable

(biologically active)

A
  • Hypertrophic
  • Slightly hypertrophic
  • Oligotrophic
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11
Q

Nonviable

(Biologically inactive)

A
  • Dystrophic
  • Necrotic
  • Defect
  • Atrophic
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12
Q

Intraoperative findings of non-unions

A
  • usually combo of
    • fibrous tissue
    • instability
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13
Q

Hypertrophic non unions

A
  • abundant hypervascularized callus
  • usually seen in unstable fractures
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14
Q

mildly hypertrophic nonunions

A
  • Inadequate callus
  • mild sclerosis of medullary cavity at fracture site
  • associated with rotational instability
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15
Q

Oligotrophic nonunions

A
  • No visible callus
    • ends of medullary cavity sealed at fracture site
    • rounding of fragment ends
    • fibrous tissue and blood vessels between the fragment edges
    • still capable of a biologic response
    • seen in significant displacement of fracture fragments
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16
Q

nonviable nonunions

dystrophic nonunion

A
  • dystrophic nonunion
    • occur when secondary fragment has healed
  • main fragment is healed and devoid of callus

*kind of looks like the oligotrphic non-union

17
Q

Nonviable nonunions

Necrotic nonunion

A
  • Seen in highly comminuted fractures in poorly vascularized areas
  • Major fragments eventually die without being incorporated in the callus
18
Q

Nonviable nonunions

Defect nonunion

A
  • Results from
    • loss of fragments at time of injury or
    • resorption of fragment
19
Q

Nonviable nonunions

Atrophic nonunion

A
  • Atrophic nonunion
    • dystrophic, necrotic and defect nonunions can all lead to atrophic nonunions
    • characterized by bone resorption and osteoperosis
20
Q

Factors leading to nonunion

A
  • Infection
  • Inadequate fracture reduction
  • soft tissue disruption
  • poor surgical decision making
21
Q

DX of nonunions

A
  • Serial rads 3-6 weeks apart
  • compare for
    • periosteal bone formation
    • callus formation
    • changes in gap width
    • blunting of bone fragments
22
Q

Radiographic signs of nonunion

A
  • Sclerosis of bone ends at fracture site
  • no progression/changes over 3 months
  • progressive bowing at fracture site
  • bone atrophy
    • fracture ends become thinner and reabsorb
  • excess callus around fracture site with radioluscent lines in callus
23
Q

TX guidelines nonunion

A
  • Consider underling causes
    • lack of stability
    • lack of blood supply
  • debridement of necrotic bone
  • open medullary canal
  • rigid fixation
  • autogenous bone graft
    • can add allograft
24
Q

Malunion

A
  • Healing of bone in abnormal position
    • functional
    • nonfunctional
  • causes
    • inadequate fracture reduction/stabilization
    • nonanatomic positioning
  • Resulting deformities
    • angular
    • rotational
    • distracted
    • over-riding
25
Q

Treatment of malunion

A
  • corrective osteotomy
  • realignment
  • rigid fixation
  • surgery
    • imparied limb function
    • stenosis of pelvic canal
    • jaw malocclusion
    • patellar luxation
26
Q

Osteomyelitis

A
  • Hematogenous spread
  • spread from adjacent soft tissue infection
  • secondary to penetrating wound
  • infection associated with contaminated implant
27
Q

Pathophys of osteomyelitis

A
  • Factors
    • blood supply
    • soft tissue disruption
      • tissue necrosis
  • Bacteria form biofilm
    • adhere to implant
    • host defense can’t adequately reach bacteria
    • antibiotics less effective against biofilms
28
Q

Osteomyelitis

organisms

A
  • staph
  • fungal
    • blasto
    • crypto
    • coccidiomycosis
    • nocardia
    • actinmyces
29
Q

Radiographic findings

Osteomyelitis

A
  • Soft tissue swelling
  • irregular periosteal reaction far from fracture line
  • long zone of transition
  • can resemble a tumor

*To diagnose do bone core, submit for cultures

30
Q

Sequestrum

A
  • avascular/nonviable bone fragment
  • typically has sharp margins
  • can impede healing
  • can cause disfunction
31
Q

Ivolucrum

A
  • Periosteal reaction around a sequestrum
    • membrane around sequestrum
32
Q

Cloaca

A
  • Opening ininvolucrum
    • results in drainage
33
Q

External fixaters are really good at

A
  • Preserving the biology
34
Q

Bandage disasters

A
  • Ischemic bandage injuries
    • loss of tissue
    • excessive skin compression
    • tourniquet effect
35
Q

causes bandage disasters

A
  • Inadequate application of the bandage
  • Insufficient padding
  • Pre-existing vascular injury
  • Bandage changes not frequent enough
36
Q

Quadriceps contracture

A
  • young growing dogs
  • femoral fracture
  • excessive fibrous tissue
    • rigid and unfixable extension
  • secondary to
    • quadriceps muscle trauma
    • inadequate fixation and instability
    • prolonged immobilization
37
Q

Quadriceps contracture

Prevention

A
  • Early fracture treatment
  • Rigid fixation
  • Early return to function
  • Temporary immobilization
38
Q

Minimizing infection

A
  • No reason to use antibiotics more than 24 hours post-op prophylactically
  • Use
    • cefazolin 30-60 minutes prior to induction
    • then every 1.5-3 hours post-op
  • Don’t be fast and sloppy in sx
    • be efficient and plan out sx
39
Q

Minimizing infection

Contaminated surgical site

A
  • debride as much tissue as possible
  • irrigate with saline
  • obtain intraoperative cultures
    • positive cultures don’t mean a patient will develop an infection

Ortho sx (11 decks)

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