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small animal final year > Principles of Fracture Management 1 > Flashcards

Principles of Fracture Management 1 Flashcards

1
Q

What are the 3 best ways of achieving stability?

A

–Non-invasive

–Minimally-invasive, or

–Open techniques

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2
Q

What are the 9 ways of classifying a fracture?

A
  1. Which Bone e.g. Tibia +/- Fibula
  2. Position within bone e.g. Proximal third of Diaphysis
  3. Fracture Pattern e.g. long oblique
  4. Open / Closed e.g. is there an open wound?
  5. Extra features e.g. Articular / Fissure lines
  6. Over-riding e.g. Moderate over-riding
  7. Displacement of distal segment relative to proximal
  8. Degree of malalignment (only if minimally displaced)
  9. Soft tissue swelling
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3
Q

Which 2 orthogonal views do we take to evaluate a fracture?

A

Craniocaudal & mediolateral

Dorsopalmar & mediolateral

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4
Q

What is the issue here?

A

Tibial fracture

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5
Q

What are the different anatomical locations of a bone?

A

Epiphysis - articular

Physis = growth plate

Metaphysis – wider bone

Diaphysis – 80%

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6
Q

What is a simple fracture?

A

Only 1 fracture line i.e. bone split into 2 pieces

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7
Q

What are the 3 types of simple fracture?

A
  • Transverse
  • Olique
  • Spiral
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8
Q

What is a transverse fracture?

A
  • Fracture ≤ 30 degrees perpendicular to long axis of bone
  • Inter-digitating i.e. fracture surface irregular with spikes and depressions on both ends of fractured bone that “interdigitate” with each other
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9
Q

Label this image showing the fracture types

A

Yellow – long axis of bone

Red – perpendicular to the long axis = transverse fracture or 30 degrees off

Green – oblique more than 30 degrees off the red line

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10
Q

Discuss this x ray

A

Transverse Fracture – interdigitating where bits of bones stick into each other. Straight across the bone

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11
Q

What type of fracture is this?

A

Transverse Interdigitating – average pattern is straight across. Interdigiting – more stable! Stable to rotation

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12
Q

What is an interdigiting fracture stable to?

A

Rotation

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13
Q

What is an oblique fracture?

A

Fracture line > 30 perpendicular to long axis of bone

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14
Q

What is a spiral fracture?

A

Curves/spirals around the bone

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15
Q

At what angle is this oblique fracture?

A

50-60 degrees

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16
Q

What angle is this fracture at?

A

40-50 degrees

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17
Q

What type of fracture is this?

A

Spiral fracture

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18
Q

Define spiral fracture

A

Long oblique fracture that curves / spirals around the bone

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19
Q

How do spiral fractures come about?

A
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20
Q

What could a spiral fracture mean?

A

May mean there is a underlying bone pathology

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21
Q

What is a comminuted fracture?

A
  • More than one fracture line that connect
  • May be multiple joining fractures
  • End result = 3 or more pieces of bone
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22
Q

What is going on here?

A

Comminuted fracture – left 6 pieces of bone. Moderately to highly comminuted.

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23
Q

What usually caues a comminutted fracture?

A

High impact to smash the bones

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24
Q

What is this?

A

Comminuted – radius fracture with adjacent ulnar.

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25
Q

What is a segmental fracture?

A

A rare type of comminuted fracture.

  • 2 or more fracture lines that do not connect
  • Each bone is a complete piece of cortex
  • Result = 3 or more intact pieces of bone
  • Wedge / Butterfly
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26
Q

What is this fracture?

A

Segmental

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27
Q

What is this?

A

Avulsion fracture

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28
Q

What is an avulsion fracture? How does it normally happen?

A
  • Apophyseal bone avulsed - insertion point of tendon or ligament
  • Usually puppies kittens landing with leg extending, will pull off the tibial tuberosity. Typical in staffies. “Landing” injury from a short height
  • Open growth plate = physis = weaker than bone
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29
Q

What type of fractures happen in the skeletally immature?

A

Physeal fracture

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30
Q

What is the classification for physeal fractures?

A

Salter Harris, types 1 to 5

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31
Q

What is type 1 of the salter harris physeal frature classification?

A

A complete physeal feacture with or without displacement

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32
Q

What is type 2 of the salter harris physeal frature classification?

A

A physeal fracture wthat extends through the metaphysis, producing a chip fracture of the metaphysis (which may be very small)

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33
Q

What is type 3 of the salter harris physeal frature classification?

A

A physeal fracture that extends through the epiphysis

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34
Q

What is type 4 of the salter harris physeal frature classification?

A

A physeal fracture plus epiphyseal and metaphyseal fractures

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35
Q

What is type 5 of the salter harris physeal frature classification?

A

A compression fracture of the growth plate

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36
Q

What are the 5 primary physiologic forces acting on a normal bone?

A

Axial compression

Bending

Shear

Torsion

Tension

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37
Q

Label these primary physiological forces acting on the bone

A
  1. Axial compression
  2. Bending
  3. Shear
  4. Torsion
  5. Tension
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38
Q

Define axial compression

A

Main force of weight bearing

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39
Q

Define bending (the force not bending over you sarcastic bitches)

A

Compresive force eccentrically loading of bone

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40
Q

Define shear

A

Sideways bone displacement

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41
Q

Define torsion

A

Axial rotation/twisting

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42
Q

Define tension

A

Only apples at point of insertion of ligaments (apophysis) NOT DIAPHYSEAL BONE

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43
Q

What do external forces produce on bone/fractures?

A

Internal stresses/strains

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44
Q

Label the coloured arrows as forces.

A

Red - shear

Yellow - torsion (axial rotation)

Green - bending

Blue - compression

Black - avulsion

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45
Q

What is tension avulsion?

A

EXTERNAL FORCE
Occurs when ligaments or tendons apply a distractive force, eg the patella tendon on the tibial tuberosity

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46
Q

Give 2 locations of tension avulson (3)

A
  • Gluteal muscles, greater trochanter
  • Patella tendon on the tibial tuberosity Triceps, olecranon of ulna
  • Common calcaneal tendon, calcaneous
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47
Q

A) What is axial compression?

B) Where is it good?

C) What does an oblique force produce?

A

A) Produces a compressive force

B) If fracture is transverse or fragment ends interdigitate

C) On an oblique fracture produces a shear force –> over-riding and collapse of fracture e.g. if oblique or comminuted

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48
Q

Is the compression of a transverse fracture stable?

A

Yes

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49
Q

What does compression occur in oblique/sprial fracture?

A

Fracture ends shear over each other

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50
Q

What are the two sides to the bbone when axial compression creates a bending force within bone?

A

Compression and tension sides

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51
Q

What forces do these two arrows resemble?

A

Green - tension

Blue compresion

52
Q

What are the force surfaces on the left and right of this bone?

A

Left - tension

Right - Compression and bending

53
Q

Where do you put a plate for a transverse fracture?

A

On bending/compression side

54
Q

For transverse fracture with intact trans conrtex, where are plates put?

A

Plates placed on the tension side (opposite to compression)

STRONG

Very unlikely to fail early

55
Q

Where are the tension surfaces accessed surgically for:

A) Humerus?

B) Radius?

C) Femur?

D) Tibia?

A

A) Lateral and cranil

B) Cranial and medial

C) Lateral

D) Medial and cranial

56
Q

What is shear force?

A

Force that displaces bone perpendicular

57
Q

What is a rotating or torsion force?

A

Twisting along long axis of the bone

58
Q

What are the 4 long bone forces?

A
  • Shear
  • Torsion (axial rotation)
  • Bending
  • Compression
59
Q

What is the tendon/ligament force?

A

Avulsion

60
Q

What will the fixation of a fracture depend on?

A
  • Fracture type
  • Patient factors (biological healing score)
  • Equipment available
  • Surgeon experience / confidence with fixation method
61
Q

Which two fracture types are unstable to all forces?

A

Comminuted or non-reconstructed

62
Q

What is the strain theory?

A
  • Measurement of the strain (% movement) at the fracture. How much the fracture is moving.
  • Strain is a measure of the distance moved by the fracture ends as the animal weight bears
  • Different healing tissue types can cope with different degrees of deformation
  • An indication of the degree of stability required of the implants
  • Amount of movement divided by original fracture length
  • Bone can only tolerate so much movement before it fails to heal
63
Q

What are the fractured bone phases of healing tissue?

A
  • Fracture haematoma
  • Granulation
  • Fibrous
  • Cartilage
  • Bone
64
Q

Define strain

A

% tissue deformation relative to fracture gap

65
Q

Name 2 things strain is reduced by (3)

A
  • Increasing the distance between the fracture ends, i.E. Big fracture gap or resorbing some of the bone as occurs early in fracture
  • Reducing movement = fracture repair and stabilising
  • Reducing movement = as callus develops
66
Q

What is the equation for strain?

A

Change in length/original length

67
Q

What is the % deformation to rupture in granulation tissue?

A

100%

68
Q

What is the % deformation to rupture in fibrous connective tissue?

A

20%

69
Q

What is the % deformation to rupture in fibrocartilage?

A

10%

70
Q

What is the % deformation to rupture in woven lamellar bone?

A
71
Q

What is gap strain?

A

Measure of fracture gap movement / stability

72
Q

Do we want a high or low gap strain to allow the tissue to heal?

A

Low

73
Q

What 2 situation can we set up for a low strain and enable tissue to heal?

A
  • FRACTURE reduced & compressed
  • COMMINUTED FRACTURE
74
Q

What is primary healing?

A

Bone apposition & reduction = stability (ideally compression)

75
Q

What is involved in secondary healing?

A

Bone not apposed reconstructed

Relative movement instability

Callus formation

Small amount of movement

76
Q

Define reconstruction in relation to fracture repair

A

All pieces can be put back together

77
Q

What type of fracture can be reconstructed?

A

Simple fracture:

  • Transverse
  • Oblique
  • Spiral
78
Q

Which type of fracture can be reconstructed, but only a maybe?

A

Segmental fracture

79
Q

Which type of fracture cannot be reconstructed?

A

Communuted

80
Q

What type of healing do you get if a bone is reconstructed and a compression plate,lag screw and positional screw was used?

A

Primary

81
Q

What type of healing do you have if a bone is not reconstructed, using an ESF and bridging plate?

A

Secondary

82
Q

What is involved in an Open Reduction Internal Fixation (ORIF)?

A

Precise anatomical reduction of bone fragments

  • Bone takes some load = decreasing the stress on the implants
  • Rigid fixation creates stability at fracture site
    • Better load sharing bone / implant
    • Less chance of implant failure
    • Primary bone healing more likely
83
Q

Name 2 issues with Open Reduction Internal Fixation as it requires more extensive surgical approach (3)

A
  • Greater soft tissue disruption
  • Compromises bone blood supply
  • Bone needs blood supply to heal
84
Q

Name the 3 issues of having small gaps between fracture ends results in

A

High STRAIN

Plate BENDING

Implant FAILURE

85
Q

Name 2 problems if an implant is too stiff (3)

A
  • Implants take too much load
  • Reduced load to bone
  • Wolff’s Law - bone constantly remodels to be of a strength required to manage the load placed upon it
86
Q

What are the 4 surgical approaches to fixing a fracture?

A
  1. Open approach
  2. Open look-but-do-not-touch
  3. Minimally invasive - MIPO
  4. Closed approach
87
Q

What two things do we use for non reconstructable fractures?

A
  • Bridging Plates
  • External Skeletal Fixators
88
Q

What three things do you use for reconstructable frcactures?

A
  • Dynamic Compression Plates
  • Lag / Positional screws & Neutralisation plates
  • K-wires (physeal fractures)
89
Q

Name 4 benefits of closed redcution (5)

A
  • Most biologic
  • No surgical incision
  • No surgical dissection
  • No bone devascularisation
  • Fracture haematoma & growth factors undisturbed
90
Q

What is involved with MIPO Minimally Invasive Plate Osteosynthesis?

A
  • Limited surgical incisions for implant placement only
  • A bit more dissection than closed but not much
  • Fluorosocpy / intra-operative X-ray guidance
  • Small incision dorsally to place the screws and this preserves he biology of the bone much better!
91
Q

What are the positives of using a “look but do not touch” approach?

A
  • But minimise dissection to that required place implants (bridging)
  • Leave fracture haematoma alone
  • Allows for lag screws / compression plate i.e. reconstruction
  • Leave the fragments
92
Q

What is the problem of the “ look but do not touch” approach?

A

Big incisions, more dissection and trauma

93
Q

What are the benefits of using the reconstruction method?

A
  • Minimise dissection to that required place implants
  • If possible, leave fracture haematoma alone
  • Allows for lag screws / compression plate i.e. reconstruction
94
Q

Name 4 fracture factors with how likely a fracture is to heal (6)

A

–Open or closed

–Site, single or multiple, simple or comminuted

–Quality of bone

–Joint involvement

–Associated soft tissue damage

–Reconstructable and able to load-share?

95
Q

Name 3 patient factors asscoiated with how likely a fracture is to heal (5)

A
  • Is there associated (non-orthopaedic) trauma ?
  • Age
  • Bodyweight
  • Activity levels
  • Concurrent disease.
96
Q

Name 6 factors which will give a fracture healing score of 10 (7)

A
  • Young
  • No disease/good health
  • Cancellous bone
  • Low veolcity injury
  • Simple transverse/oblique fracture
  • Single limb injury
  • Closed surgical approach
97
Q

What implant does this show?

A

Intra-medullary pins (IM pins)

98
Q

Here is a table, I could not make it into a flashcard. But do enjoy xo

A

R u enjoying?

99
Q

Name 4 indiciations or IM pins (6)

A
  • Non-reconstructed comminuted fractures
  • IM pin addition augments fixation strength
  • COMBINE with ESF (external skeletal fixator) or bridging plate
  • For intra-operative fracture alignment

–Then ESF or plate application

–Restores fracture length & stabilizes bones

•Long oblique fracture e.g. cat femur

–Combine wide IM pin with multiple cerclage

–BUT CARE as cerclage wires easily loosen & lose stability

–RARELY best choice as more stable methods available

100
Q

Define normograde IM pin placement

A

From end of bone towards the fracture – generally the best way but more difficult to achieve. Harder to do and get in the right place.

101
Q

Define retograde IM pins

A

From from fracture towards the bone ends – easier but can enter joints, e.g. stifle with tibial fracture or damage nerves (sciatic). No control where it exits, can exit into meniscus. Easier but harder to control exit.

102
Q

Where can you not use IM pins?

A

Radius

103
Q

Name the 4 places we can use IM pins

A
  • Humerus
  • Femur
  • Tibia
  • Ulna
104
Q

Can an IM pin resist compression?

A

No

105
Q

Which two fracture types will a pin not prevent compression?

A

Oblique or comminuted

106
Q

What does compression lead to with a transverse fracture?

A

Stable

107
Q

What does compression cause with an oblique/spiral fracture?

A

Shear

108
Q

What are IM pins strong against?

A

Bending as positioned in the ‘neutral’ axis

109
Q

What can IM pins not resist?

A

Rotation

110
Q

What are the 3 things wire can be used as?

A
  • Cerclage wire
  • Tension band
  • Hemicerclage wire / other
111
Q

Define cerclage wire

A

Orthopaedic wire used as a loop around bone

112
Q

What does this show?

A

Cerclage

113
Q

What does this show?

A

Hemi-cerclage

114
Q

What is Newton’s 2nd law?

A

To every action there is an equal and opposite reaction
For each force there is an equal and opposite force

115
Q

What are the principles of tension band wire?

A
  • The wire resists major forces so must be thick
  • Pins maintain alignment and prevent shear
  • Cortex that forms the bending point must be intact
  • Most effective when animal is weight-bearing (dynamic)
116
Q

Name 3 common problems of cerclage wire? (4)

A
  • Placed inappropriately
  • Require more dissection to place
  • Loosen quickly and easily
  • Once loose, wobble and cause injury to bone & vessels that prevents / retards healing
117
Q

Name 7 of the main principles of using cerclage wire? (9)

A
  • Cerclage wires encircle the bone and the two ends are twisted to tighten and reconstruct the column of bone
  • Important to twist wires around each other
  • Reconstructable fracture
  • Oblique / spiral fractures only
  • Bone must have even shape, not narrowing
  • Length of fracture line must be at least 2 x bone diameter
  • Minimum 2 cerclage wires
  • Wires placed 1cm apart
  • Wires placed at least 5 mm from fracture end
118
Q

What do you do with the ends of the cerclage twist wires?

A
  • Must always pull (exert tension) as you twist so that ends twist around each other evenly
  • Either cut ends short (1.5 twists), or leave longer (3-4 twists) and bend end over
119
Q

When is most of the tension of cerclage twist wires lost?

A

When ends are bent

120
Q

How many twists must you leave in cerclage wire?

A

At least 3-4

121
Q

With a cerclage wire singleloop, what 2 things do you need?

A
  • Single eyed cerclage wire
  • Single wire tightener
122
Q

What are the 2 advantages of using cerclage wire as a single loop?

A

More robust & neater

Easier to place well

123
Q

What 2 things do we need to place a double loop cerclage wire?

A
  • Normal orthopaedic wire
  • Double wire tightener
124
Q

Cerclage wire - double loop:

A) What is an advantage?

B) What is the disadvantage?

A

A) Robust

B) Difficult to place

125
Q

Cerlcage wire twist:

A) Name the advantage

B) Name 2 disadvantages (4)

A

A) Cheapest & “simplest”

B) Weakest, most likely to fail

Need to “pull” and twist” to get even twist - each wire round the other

Leave at least 3-4 twists.

Bending over loses tension in the know

small animal final year (317 decks)

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