Principles of Fracture Management Flashcards
Articular Fracture
Fracture within or around a joint
Non-articular Fracture
Away from a joint
Diaphyseal Fracture
Along shaft
Metaphyseal Fracture
At ‘neck’ of bone
Epiphyseal Fracture
At tip of bone
Transverse Fracture
Perpendicular to length
Oblique Fracture
At an angle to length
Butterfly Fracture
Two oblique lines leading to loss of fragment
Physeal fracture
At growth plate
Close fracture
Skin is intact
Open Fracture
Skin is ruptured - open wound
Simple Fracture
Only one site
Comminuted
Multiple locations
Avulsion Fracture
Small chink of bone attached to tendon or ligament pulled away
What are the steps in fracture repair?
- Assess and stabilise animal
- take two orthogonal radiographs
- Facture score
- Assess what forces will be applied
What are orthogonal radiographs and why do we do this?
Two radiographs taken at right angles
E.g. mediolateral and craniocaudal views
Using one view may not show a fracture - only visible in the other plane
How do we describe radiograph orientation?
The direction the beam is going rather than position of animal
E.g. DV means beam is going from dorsal to ventral, animal would be lying in ventral recumbency
What does a high fracture assessment score mean?
More complicated fracture
More difficulties in dealing with fracture may arise
What factors should be considered when fracture scoring?
Patient Factors
* Weight of animal
* Age
* Boisterousness and ability to manage cage rest
* Concurrent illnesses
Fracture Factors
* Type of fracture
* Open or closed?
* Associated soft tissue injuries
* Single or one of several fractures
Owner Factors
What factors should be considered when fracture scoring?
Patient Factors
* Weight of animal
* Age
* Boisterousness and ability to manage cage rest
* Concurrent illnesses
Fracture Factors
* Type of fracture
* Open or closed?
* Associated soft tissue injuries
* Single or one of several fractures
Owner Factors
* Finances
* Commitment to animal
Surgeon Factors
* Surgical expertise
* Equipment available
What are the 4 physiologic forces?
- Axial Compression
- Tension
- Bending
- Torsion
How does compression and tension affect long bones?
All long bones are asymmetrically loaded when weight barring
One side is compressed, the other undergoes tension
Where should you apply plate on a long bone and why?
Side with tension
Plate would be broken by compression but not tension
* Femur
○ Lateral aspect
* Tibia
○ Medial aspect
* Radius
○ Craniomedial aspect
* Humerus
○ Latero-cranial aspect
* Mandible
○ Dorsal aspect
What are the consequences of axial compression on fractures?
Good if the fracture is transverse
At right angles to the long bone
Good if the fracture interdigitates
Stops rotation
Not good if comminuted (i.e. multiple fragments)
Not good if oblique fracture
Causes collapse or shear
What are the consequences of tension on fractures?
Produced by ligaments or tendons pulling on one of the bone fragments
Causes fracture to be distracted
Needs to be overcome with lag screwing or tension bands
What are the consequences of torsion on fractures?
Results in rotation of the fracture site
Requires management with plates, external fixator or an interlocking nail
What are the consequences of bending on fractures?
Occurs due to the asymmetrical nature of the bone loading
Counteract with a pin in the centre of the medullary cavity
What is strain?
Changing in length / original length
What tissue has the highest strain?
Granulation tissue - 100%
How does strain change as a fracture repairs?
Strain slowly reduces
Bone has low strain - 2%
Why are post-op radiographs taken?
To assess:
○ Alignment of fracture
○ Positioning of implant
○ Encroachment of implants into joints or soft tissues
○ Bridging of growth plates in young animals
