Orthopedic coaptation devices and prosthetics

Question 1

Small and toy-breed dogs have up to an __________% incidence of malunion and nonunion when external coaptation is utilized as primary repair for fracture of the antebrachium.

Answer 1

83%

Question 2

Principles of external coaptation for fracture management include…

Answer 2

disruption to the fracture site is minimal, and the blood supply is not compromised. With no implants, the risk of infection is decreased, and complications such as loosening of the implants are eliminated. The cost can be much lower than that of surgical repair. Requires immobilization of a joint proximal and distal to the fracture and can result in severe disuse atrophy and fracture disease.

Question 3

External coaptation can effectively counteract _________and ________forces provided that the joint _________and _________ to the fracture are immobilized.

Answer 3

bending and rotation

proximal and distal

Question 4

Cortical positioning of fracture ends should have _______% contact to expect fracture healing. If closed reduction cannot be maintained, surgical intervention must be considered

Answer 4

50%

Question 5

ii. Maintaining a __________during application of bandages splints, and casts will encourage weight bearing during and after coaptation.

Answer 5

neutral standing position

Question 6

Sarmiento cast…

Answer 6

(below the knee cast) has been described for certain tibial fractures and allows almost full range of motion of the stifle joint

Question 7

Carpal flexion bandage

i. ________and maintains moderate _______of the carpus and prevents weight bearing of the forelimb, while allowing passive motion of the shoulder and elbow joints. Most commonly used to relieve the tension of flexor tendons after repair
ii. The carpus is placed in moderate ________and wrapped with cast padding beginning at the level of the toes, while leaving the distal aspect of the third and fourth digits exposed
iii. Permanent _________can result if the carpus is maintained in flexion for a prolonged period (typically

Answer 7

i. Immobilizes and flexion
ii. flexion
iii. contracture and 1-2 weeks

Question 8

Modified Robert Jones bandage

Answer 8

Useful for reduction or prevention of post-trauma or postoperative swelling, soft tissue protection and limb support after surgical fixation or removal of orthopedic devices. However, this is contraindicated in severe inflammation. Because it does not provide rigidity and complete immobilization of the limb, the modified Robert Jones bandage is not appropriate for temporary support of fractures or dislocations

Question 9

Reinforced Robert Jones bandage

Answer 9

1. Incorporates a rigid material into the modified Robert Jones bandage to enhance immobilization and support of the limb and joints.
2. Use of preformed splints requires additional padding which can result in increased occurrence of soft tissue complications and loss of rigid immobilization.
3. Molded splints are more efficient stabilizers of bones and joints and because they are custom fitted fewer soft tissue complications occur and patient tolerance is improved as compared with preformed splints.

Question 10

Spica splint

Answer 10

i. Used to immobilize the shoulder or hip joint. Placement on the hip is challenging especially in the male.
ii. Cage rest is required.
iii. Can be considered in young animals with greenstick (when a bone bends and cracks, instead of breaking completely into separate pieces. This type of broken bone most commonly occurs in children because their bones are softer and more flexible than are the bones of adults) fractures of the humerus or femur.

Question 11

Schroeder-Thomas splint

Answer 11

i. Resists tension and can counteract muscle forces and immobilize joints and certain fractures. Combination of wire frame and soft tissue bandage.
ii. Contraindicated for the shoulder and hip joints.

Question 12

Casts

1. are made from _______
2. advantages include casts being ____________ in comparision to plaster.
3. Juveniles must have a cast changed every __weeks.
4. Adults can have a cast in place for ______month

Answer 12

1. Made of thermomoldable and fiberglass/resin materials
2. Lightweight, radiolucent, and impact resistant and offer adequate strength for coaptation in small animal orthopedics. They conform well to the limb and are easy to apply.
3. 2 weeks
4. 1 month

Question 13

Hobbles – to allow weight bearing and walking but prevent _________ of the limbs.

i. Forelimb – allows weight bearing of the forelimbs while limiting ______, ______, and _______of the shoulder joint
1. Used for medial instability of the shoulder joint
ii. Hindlimb – prevent _______at the tarsus, but not at the stifles and distal femur.

Answer 13

abduction
abduction, flexion, and extension
abduction

Question 14

Stifle Hobbles prevent _____at the stifle and are used after closed reduction or internal repair of _______coxofemoral luxation.

Answer 14

abduction

caudoventral

Question 15

Ehmer sling

i. Maintains a ______position, preventing weight bearing, providing limb ______and ______rotation of the hip joint and limiting motion of the coxofemoral joint.
1. Used to maintain reduction after closed reduction of craniodorsal coxofemoral luxations.
2. Can also be useful after internal fixation of acetabular, femoral head and neck fractures and femoral fractures.
3. Can be useful in prevention of ______tie-down after internal fixation of femoral shaft, supracondylar, or distal physeal fractures in immature dogs
4. Contraindicated for ______or ______coxofemoral dislocations following reduction
5. Doglegs vest with Ehmer sling provides a superior option to the conventional bandage Ehmer sling.

Answer 15

i. flexed, abduction, inward
1. craniodorsal
3. quadriceps
4. caudal or ventral

Question 16

Pelvic Limb Sling (Robinson sling)

Answer 16

i. Prevents weight bearing while allowing for limited range of motion of the hip, stifle, and hock joints.
ii. Freedom of joint movement makes this sling an attractive option
iii. Used for tenuous acetabular femoral or tibial fracture repair; surgery of the stifle joint, or risk of compromise of the repair due to an overactive patient and/or questionable owner compliance.

Question 17

Velpeau Sling
Maintains the thoracic limb in _______and prevents weight bearing. Immobilizes the shoulder joint after closed and open reduction of shoulder luxation, as primary treatment for minimally displaced scapular fracture or after repair of more significant scapular fractures or after repair of more significant scapular fractures, after reconstruction for severe medial instability of the shoulder joint, and for other conditions for which non-weight bearing in the forelimb is desired.
ii. Close monitoring if used for longer than 2 weeks as joint _______may occur.
iii. DogLeggs Velpeau sling provides immobilization of the shoulder joint and offers access to the limb for rehabilitation therapy. Risk of _______compromise is considerably decreased.

Answer 17

flexion
contracture
vascular

Question 18

Orthosis is an externally applied device designed to ______, ______, ______, or ______the function of an existing limb or body part. Orthoses provide stabilization and support for weak, paralyzed, damaged, or diseased segments or joints; limit or augment motion across joints, control abnormal or spastic movements, and or unload distal segments

Answer 18

stabilize, support, supplement, or augment

Question 19

Prosthesis is an ________ _________for a missing body part that is used for functional and/or cosmetic reasons. Limb prostheses prevent further deformation and degeneration of existing joints, decrease leg-length discrepancies, increase exercise and activity levels, and provide means to participate in rehabilitation therapy and to maintain daily acts of living

Answer 19

artificial substitute

Question 20

Types of orthoses

i. _________– provide support without the added weight and bulk of a semi-rigid or rigid device. Offers only slight medial or lateral stability but it does provide some circumferential compression and musculoskeletal support to the limb.
ii. _______– have the added feature of a removable strut – a rigid support. Strut can be made from a variety of materials, including low or high temperature thermoplastics, carbon composites, and aluminum. As the patient progress through recovery, the struts can be modified and or removed to increase mobility and reduce unneeded support.
iii. _______ – made from high temperature thermoplastics and are used as a solid caudal shell, cranial shell, or bivalve type of design.

Answer 20

f. Types of orthoses
i. Nonrigid – provide support without the added weight and bulk of a semi-rigid or rigid device. Offers only slight medial or lateral stability but it does provide some circumferential compression and musculoskeletal support to the limb.
ii. Semi-rigid – have the added feature of a removable strut – a rigid support. Strut can be made from a variety of materials, including low or high temperature thermoplastics, carbon composites, and aluminum. As the patient progress through recovery, the struts can be modified and or removed to increase mobility and reduce unneeded support.
iii. Rigid – made from high temperature thermoplastics and are used as a solid caudal shell, cranial shell, or bivalve type of design.

Question 21

static versus dynamic braces

Answer 21

static braces maintain the joint in a flexed position while dynamic braces incorporate a hinge system and can allow for normal range of motion of a joint while preventing abnormal motion or they can limit range of motion.

Question 22

Dynamic braces are used to stabilize joints with ligament instability such as ______ ______ injuries, treatment of ______ disease, and provision of postoperative support.

Answer 22

Used to stabilize joints with ligament instability (Achilles tendon injury, treatment of contracture disease, and provision of postoperative support

Question 23

Sprains – most common injury in performance dogs and sprains to the _____joint are the most likely to go undiagnosed. This is an injury to a _____that can occur in the midportion of the ligament or at its attachment to bone.

1. Grade _____= mild and described as overstretching of the ligament without a tear or loss of function.
2. Grade _____= moderate in severity and are described as a partial tear. A low temperature thermoplastic structure can be added to the wrap to enhance stability and aid in the recovery process (semi-rigid support).
3. Grade _____= severe and involve complete disruption or tearing of the ligament, resulting in joint instability. Semirigid and rigid orthoses can provide support to the carpus in lieu of surgical arthrodesis or external skeletal fixation if the patient is not a surgical candidate.

Answer 23

i. Sprains – most common injury in performance dogs and sprains to the carpal joint are the most likely to go undiagnosed. This is an injury to a ligament that can occur in the midportion of the ligament or at its attachment to bone.
1. Grade 1 = mild and described as overstretching of the ligament without a tear or loss of function.
2. Grade 2 = moderate in severity and are described as a partial tear. A low temperature thermoplastic structure can be added to the wrap to enhance stability and aid in the recovery process (semi-rigid support).
3. Grade 3 = severe and involve complete disruption or tearing of the ligament, resulting in joint instability. Semirigid and rigid orthoses can provide support to the carpus in lieu of surgical arthrodesis or external skeletal fixation if the patient is not a surgical candidate.

Question 24

High temperature thermoplastics require a high temperature _____degrees F to mold and a stronger and more durable that low temperature thermoplastics that require a lower temperature _____degrees F.

Answer 24

High temperature thermoplastics require a high temperature 350 degrees F to mold and a stronger and more durable that low temperature thermoplastics that require a lower temperature 140 degrees F.

Question 25

what is the most critical factor in prosthetic success?

1. Amputation _________to the level of the carpus or tarsus are most successful in terms of prosthetic use however, most indications for amputation in small animals require more _________levels of amputation.
   ii. _________ prostehtics present a greater challenge because more weight is distributed through these limbs

Answer 25

Amputation level is the most critical factor in prosthetic success.

1. Amputation distal to the level of the carpus or tarsus are most successful in terms of prosthetic use however, most indications for amputation in small animals require more proximal levels of amputation.
   ii. Forelimb prostehtics present a greater challenge because more weight is distributed to the cranial aspect of the animal.

Question 26

Complications of prosthetics include…

Answer 26

Complications

i. Gait changes
ii. Refusal to use prosthetic
iii. Troubleshooting for comfort, fit, or function problems.
iv. Skin breakdown, excessive rubbing, sores over the bony prominence, and ulcers

Question 27

Osseointergration prosthesis

i. One report in a dog tibia

Answer 27

Involves threading the prosthesis onto a titanium bolt (Abutment) which is implanted into the bone of the residual limb and protrudes through the skin.

Question 28

Osseoperception –

Disadvantages

1. Two procedures required
2. Long rehabilitation period
3. Risk of deep infections and potential need for more extensive amputation if this occurs

Answer 28

• feeling of heightened perception of the environment.