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Small Animal Final Year > Post Op Managment > Flashcards

Post Op Managment Flashcards

1
Q

What 3 things do we look at in a post fracture repair radiological assessment?

A
  • Alignment >50% ESF
  • Assess for any rotation that has occurred as implants tightened
  • Implant positioning avoiding joints, fracture site and on occasions growth plates (unless you have lag screwed it)
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2
Q

What is the allignment in “open but do not touch” fractures?

A

At least 50% overlap
in both planes. Doesn’t have to be perfectly aligned.

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3
Q

Do you deserve cereal in melted chocolate?

A

Yes.

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4
Q

What is the allignment in ‘ORIF’ (open reduction, internal fixation)?

A

Must be near 100%

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5
Q

What can be seen in relation to the fracture on a radiograph of a fracture repair with an external fixator?

A

the fracture lines

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6
Q

What are the 3 major causes of inappropriate fixation?

A
  • Implants too small or too large
  • Fail to address forces applied
  • Too rigid, especially external fixator
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7
Q

What is the consensus about using casts in veterinary?

A
  • Many complications, e.g. pressure sores and loss of digits
  • Avoid this method of immobilization
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8
Q

Where are pressure sores most common with robert Jones dressings?

A
  • Accessory carpal bone
  • Calcaneus
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9
Q

Post fracture repair what rrestrictions should we give tto dogs in general?

A

Garden on lead for 3 weeks and then to lead for another 8 weeks

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10
Q

How long should we restrict cats

A

8 weeks

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11
Q

When are antibiotics recommended on fracture discharge?

A

60-90mins + surgery

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12
Q

What instructions do we give to owners for dressing management?

A
  • Keep dry. Heavy duty polythene protected with sock only when outside
  • Check toes and top of dressing twice daily
  • Any smell to bring to surgery
  • If off colour, bring to surgery
  • If veterinary surgeon in any doubt remove dressing or cast
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13
Q

What fixation failure do we have with pins?

A

Fracture rotates or collapses

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14
Q

What fixation failure do we have with cerclage wires?

A

Loosen and fail to maintain reduction of fragments resulting in instability

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15
Q

What fixation failure do we have with a plate?

A
  • Loss of trans cortex with cyclical loading results in plate breaking
  • If too strong, stress protection of the bone
  • Stress riser – rigid piece of bone next to area of bone not plated and can break
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16
Q

What fixation failure do we have with an ESF?

A
  • Pin tract infection common
  • Fracture through pin tract
  • If too strong get delayed healing of fracture
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17
Q

What is a common IM pin failure in a cat femur?

A

Damages sciatic nerve especially in the cat

•an affected animal will show a great degree of pain – you have to do something straight away otherwise you get neuropathy

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18
Q

What failure is common if there is a retrograde placement of an IM Pin?

A

Can enter a joint

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19
Q

What happens if there is eccentric loading of bones during weight bearing + muscle contraction?

A

Bending

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20
Q

What happens if there is a defect in compression surface +/- weak implants with the plates and screws?

A

Angulation of bone

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21
Q

When are plates weak against bending?

A

If cyclically loaded

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22
Q

What are the threee options for a buttress fixation?

A
  • Very strong broad DCP plate
  • Bridging plate – strong central section without screw holes
  • Combination fixation; pin-plate
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23
Q

What are problems with placing an external skeletal fixator?

A
  • Failing to place pins within safe corridors
  • Pin tract sepsis and premature pin loosening
  • Iatrogenic bone fracture (pins > 25-30% of bone diameter, or close to fracture lines)
  • Placing clamps / bars too close to skin = pressure necrosis
  • Using too weak / strong a frame
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24
Q

How do we know this is loosening?

A

Start to see radiolucency

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25
Q

Where is fractur disease more common?

A

The young animal

26
Q

Name 3 possible fracture diseases (5)

A
  • Joint stiffness
  • Osteoporosis
  • Stress protection
  • Infection
  • Quadriceps contracture
27
Q

What is seen in distal femoral fracture? (3)

A

Muscle atrophy

Joint stiffness

Muscle contracture (quadriceps tie-down)= stifle hyperextension

28
Q

What might be the only treatment for quadriceps contracture?

A

Amputation

29
Q

Other than amputation what might treat quadriceps contracture?

A
  • Avoid external coaption
  • Rigid internal fixation
  • Encourage early use of the limb – appropriate use of analgesia
  • Early physio- and hydrotherapy
30
Q

What is involved with acute osteomyelitis?

A

Soft tissue and associated periosteum

31
Q

How can you treat osteomyelitiis?

A

Antibiotics

32
Q

What is chronic osteomyelitis?

A

Primarily bone infection and established around implants

33
Q

What radiographic changes are seen with fracture disease? (5)

A
  • Proliferative changes to the periosteum
  • Sclerotic margin to infected area
  • Bone lysis, particularly around implants
  • Development of involucrum and sequestrum
  • Soft tissue swelling
34
Q

What can be seen here?

A
35
Q

What is Involucrum?

A

Pus filled in bone

36
Q

How can we treat fracture disease?

A
  • Remove necrotic bone and sequestrum (a dead fragment of bone)
  • Appropriate antibiotics – swab taken at surgery not from any discharging sinus
  • Stabilise the fracture – it will heal in the presence of infection if no movement
  • When fracture healed remove implants
37
Q

When will fractures heal in the prescence of infection?

A

If rigid stability is ensured

38
Q

When we have secondary bone healing with instability?

A

If mild

39
Q

What happens if forces at the fracture site exceed the tolerance of granulation tissue?

A

This will result in tearing of the blood vessels that are bridging the fracture site, preventing the sequential deposition of cartilage and eventually bone = delayed or non-union.

40
Q

What is the blood supply to the inner 2/3 of cortex in a normal bone?

A

Endosteal origin

41
Q

What is the blood supply to the outer 1/3 of cortex in a normal bone?

A

Periosteal

42
Q

What happens to the blood supply with a fracture?

A

Normal blood supply is disrupted and initial vascular supply required for fracture healing comes from the surrounding soft tissues, such as muscles – extraosseus blood supply.

43
Q

How can we manage a delayed healing fracture?

A
  • Patience
  • Stage down fixator to encourage bone loading
  • Physiotherapy to encourage weight bearing
44
Q

What is atrophic non-unions and what may it require?

A

Non-viable – may require amputation

45
Q

What is hypertropic non-unions? How can we treat?

A

Viable

Treat

  • Debride fracture ends and open medullary cavity
  • Compress fracture
  • Apply cancellous bone graft or equivalent
46
Q

Where is the most common sites for non-unions? (2)

A

Radius and femur

47
Q

What age and weight is non-unions most common?

A
  • 2-7 years old
  • Weighing between 7-14 kg
48
Q

When is the best oppurtunity to heal a fracture?

A

The first attempt

49
Q

What is the main complication of a fracture?

A

Instability

50
Q

What is mal-union?

A

Fracture does not heal in the correct allignment

51
Q

When is mal-union bad?

A

When there is rotation

52
Q

When is mal-union fine?

A

A cranialcaudal bend

53
Q

When is a mal-union maybe ok but depends on severiy?

A

If it heals in a medial-lateral plane

54
Q

When is fracture scoring done and what is it?

A

Done before fracture repair

A means by which the fracture is given a score to determine the likelihood of uneventful healing

55
Q

What does a high fracture score mean in general?

A

Guarded prognosis

56
Q

What factors are considered for fracture scoring?

A

Patient factors

  • Weight of animal: heavier have a higher score
  • Age: younger animals lower score
  • Boisterousness and ability to manage cage rest
  • Concurrent illnesses

Fracture

  • Type of fracture: does it allow compression plating or require
    external fixator, etc. If you can get a plate on it – lower the score. EF – higher score. Open – higher (contamination and infection affects healing)
  • Open or closed?
  • Associated soft tissue injuries
  • Single or one of several – multiple limbs – higher score

Owner factors

  • Will they comply with post-op instructions?
  • Finances – if they have no money don’t start

Surgeon

  • Are they able to manage this fracture?

Is the correct equipment available?

57
Q

What can we do for a fracture in an aggressive animal?

A

Use plates - don’t need to see the animal again

58
Q

What age is this animal?

A

Young

59
Q

Discuss

A

Air gun + debris

comminuted fracture

60
Q

What is the cause of this fracture?

A

Pathology

Small Animal Final Year (317 decks)

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