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RUSVM Small Animal Surgery I > SASx Exam I Material > Flashcards

SASx Exam I Material Flashcards

1
Q

What determines the bending strength of a screw?

A

Core diameter​

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2
Q

T/F: Animals with partial-thickness burns involving less than 15% TBSA require minimal supportive therapy, whereas those with burns involving more than 15% TBSA require emergency supportive care

A

True

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3
Q

T/F: For the best lag screw function, partially-threaded cancellous screws should be used

A

False

cortical screws are best

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4
Q

T/F: Surgical drains should never be placed directly under the suture line

A

True

This would increase risk of dehiscence

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5
Q

In the case of quadriceps contracture, muscle fibers are replaced by __________

A

fibrous tissue

Muscle fibers are replaced by fibrous tissue; adhesions form between muscle and bone. Changes result in severe decrease in limb mobility. Periarticular fibrosis/joint ankylosis/DJD further inhibits limb function. This is often irreversible

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6
Q

If a dog presents with burns covering both of his hind limbs and his tail, approximately what percentage of his total body surface area (TBSA) is burned?

A

~37%

  • Each hind limb is ~18% TBSA. The tail is ~1%.*
  • 18 + 18 + 1 = 37*
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7
Q

What type of flap is pictured below?

A

Single Pedicle Advancement Flap

  • Donor skin available on only one side
  • Subdermal plexus flap
  • Used when simple undermining and advancement would result in excessive tension or distortion of surrounding tissue
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8
Q

What type of fixator is shown in the image?

A

Type I a

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9
Q

What percentage of the intramedullary canal should be filled when an intramedullary (IM) pin is used with cerclage wire?

A

70%

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10
Q

You see a dog on emergency with a laceration as a result of a dog fight. You debride and lavage the wound but are not sure it is appropriate for closure so you decide to leave it open for additional observation and lavage. Two days later you decide it is ready for closure. What type of closure is this?

A

Delayed primary closure

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11
Q

T/F: Hybrid fixators are useful for treatment of metaphyseal fractures

A

True

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12
Q

How far apart from the fracture ends should cerclage wires be placed?

A

0.5 cm

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13
Q

T/F: Tightening a position screw pulls the trans cortex closer to the cis cortex causing compressions across the fracture

A

False

Tightening a _lag screw_ pulls the trans cortex closer to the cis cortex causing compressions across the fracture

_Position screws_ are placed across a fracture line to hold a fragments in place; No compression across the fracture is achieved

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14
Q

T/F: Split-thickness graft is the most common type of skin grafting technique

A

No.

Full-thickness graft is the most common grafting technique

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15
Q

What is the best method for intraoperatively detecting radiolucent foreign bodies?

A

Ultrasound

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16
Q

The ratio of volume of open space to volume of total bone is termed:

A

Porosity

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17
Q

When placing cerclage wires, they should be placed ~0.5 cm from the fracture ends. How far apart from each other should they be placed?

A

~0.5 - 1.0x bone diameter

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18
Q

T/F: Drains should always exit through the primary incision to prevent excessive maceration to tissues

A

False

Drains should never exit thru the incision line! This may inhibit proper wound healing

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19
Q

When a wound is closed within 1 to 3 days after injury, when they are free of infection but before granulation tissue has appeared, this is known as:

A

delayed primary wound closure​

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20
Q

T/F: When using external skeletal fixation, fractures will heal by primary bone healing

A

False.

When using external skeletal fixation, fractures will heal by secondary bone healing

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21
Q

What are the risk factors associated with quadriceps contracture?

A
  • Distal femoral fractures
  • Young patients (< 6 months)
  • Prolonged immobilization
  • Extensive muscle/ST trauma
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22
Q

What type of closure is shown here?

A

secondary closure

wound closure after granulation tissue covers the wound

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23
Q

T/F: You should never use orthopedic wire as a sole method of fracture fixation, with the exception of some mandibular fractures

A

True

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24
Q

With what bone plate application does the implant bear all of the weight load at the level of the fracture?

A

Bridging plate application

  • No load sharing at level of fracture due to lack of anatomic reconstruction
  • Screw holes left empty at level of fracture
  • Micro-motion at fracture site promotes secondary bone healing
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25
Q

T/F: Intramedullary pins have good resistance to bending forces, but poor resistance to axial and rotational forces

A

True

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26
Q

When placing transfixation pins, pins should be placed ____ away from the fracture and each other

A

When placing transfixation pins, pins should be placed 1/2 bone diameter away from the fracture and each other

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27
Q

What types of fractures are suited for repair/stabilization via cross pinning?

A

simple, transverse fractures close to the joint

  • Usually young animals, Salter Harris I and II
  • Fragments must have good contact to provide load sharing
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28
Q

What type of screw is best for use in metaphyseal and epiphyseal bone?

A

Cancellous Screws

  • Best for use in metaphyseal and epiphyseal bone (trabecular bone)
    • Increased outer diameter to core diameter ratio
    • Deeper thread
    • Larger pitch
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29
Q

Name the cerclage wiring technique used on short oblique fractures in conjunction with a K-wire:

A

Skewer pin

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30
Q

Screw diameter should not exceed ____% of bone diameter when used in diaphyseal bone

A

40%

Screw diameter should not exceed 40% of bone diameter when used in diaphyseal bone

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31
Q

Cortical bone has a porosity of ~______%

A

5-10%

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32
Q

What is the term used for the dotted line in the image below?

A

bridging incision

Incision (red arrow) that connects base of flap and recipient site – avoids having to tube flap over intact skin

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33
Q

What is the most common complication associated with external skeletal fixation?

A

Pin tract morbidity/drainage/infection

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34
Q

Povidone iodine’s duration of activity in a wound is approximately:

A

4-6 hours

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35
Q

What are the general indications for external coaptation?

A

fractures below the knee and the elbow

  • Minimally displaced fractures and those amenable to reduction
  • Transverse, simple, closed fractures
  • Greenstick fractures
  • Non-articular fractures
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36
Q

What are the two types of non-union fracture healing complications?

A

viable and non-viable

  • Viable: Biologically active fracture with cartilage and fibrous tissue between fracture ends
  • Nonviable: Fracture ends are sclerotic with rounded bone edges and visible fracture gap
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37
Q

A wound is left open for 2-5 days and closed prior to visible formation of granulation tissue. How would you classify this wound closure?

A

Delayed primary closure

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38
Q

What are the “Four A’s” of radiographic evaluation when reviewing post-op or recheck radiographs of a fracture repair?

A

Apposition, Alignment, Apparatus, Activity

  • Apposition
    • Are fracture fragments well apposed?
    • Not important w/ biologic osteosynthesis
  • Alignment
    • Are the joints above and below the fracture aligned to promote normal limb use?
    • Include joints in all x-rays
  • Apparatus
    • Is the fixator/implants appropriately positioned?
      • Screw/pin length and positioning
      • No penetration of joint surfaces
    • Is there evidence of implant loosening or failure?
  • Activity. Is there evidence of:
    • Bone healing; infection; osteopenia; malunion
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39
Q

What is the most common source of surgical wound contamination?

A

patient’s endogenous flora

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40
Q

When placing a transfixation pin, the pin diameter should be no more than ___% of the bone diameter

A

25%

When placing a transfixation pin, the pin diameter should be no more than _25%_ of the bone diameter

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41
Q

What are the two approaches to internal fixation?

A
  1. open anatomic reduction/reconstruction
  2. biological osteosynthesis
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42
Q

What type of bone plate would be appropriate for fractures of curved bones (mandible, ileum, etc.)?

A

reconstruction plate

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43
Q

What wound dressings would you use to promote granulation tissue formation?

A

calcium alginate, honey, sugar, maltodextrin

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44
Q

Name the forces that are overcome by external coaptation:

A

bending & rotation (to a degree)

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45
Q

When using conventional bone plates, stable repair requires screw purchase of at least ____ cortices above and below fracture

A

Six

When using conventional bone plates, stable repair requires screw purchase of at least 6 cortices above and below fracture​

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46
Q

What does the acronym MIPO stand for?

A

Minimally Invasive Plate Osteosynthesis

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47
Q

How would you classify this open fracture?

A

Type II

  • Open wound > 1 cm in size

    • Wound from external source
  • Mild soft tissue trauma-Without extensive soft tissue damage
  • No flaps or avulsions 

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48
Q

Debridement that begins at the top layer and works toward the deepest describes:

A

layered debridement

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49
Q

How soon before surgery are pre-sutures usually placed?

A

<24 hours

Usually placed the day before surgery. Pre-suturing takes advantage of the properties of mechanical creep and stress relaxation

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50
Q

Salter-Harris Type ____ fractures run through the physis and the epiphysis and are generally articular fractures

A

Salter-Harris Type III fractures run through the physis and the epiphysis and are generally articular fractures

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51
Q

__________ fractures have multiple fracture lines

A

comminuted

Comminuted fractures have multiple fracture lines

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52
Q

A __________ fracture, occurring in immature animals, is an incomplete fracture in which a portion of the cortex is intact, thus stabilizing the bone to some extent

A

greenstick

A greenstick fracture, occurring in immature animals, is an incomplete fracture in which a portion of the cortex is intact, thus stabilizing the bone to some extent

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53
Q

Identify the type of external skeletal fixator:

A

Type Ia

unilateral-uniplanar​

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54
Q

What two types of Salter Harris fractures might go undiagnosed on initial radiographs?

A

Type I and Type V

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55
Q

Cancellous bone has a porosity of ~_____%

A

75-95%

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56
Q

What bone plate mode is used in biological osteosynthesis/MIPO?

A

bridging mode

  • Plate spans fractured area which cannot be anatomically reconstructed (comminuted area)
    • Plate must “bridge” fracture gap
  • Plate bears all load at level of fracture
    • No load sharing at level of fracture due to lack of anatomic reconstruction
    • Screw holes left empty at level of fracture
    • Micro-motion at fracture site promotes secondary bone healing
  • Longer plate with fewer screws
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57
Q

In biomechanics, what is the term for the point at which a material transitions from elastic to plastic deformation?

A

Yield Point

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58
Q

When a wound is closed immediately, this is known as:

A

primary closure

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59
Q

What bone plate type is illustrated below?

A

dynamic compression plate (DCP)

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60
Q

Wound closure after granulation tissue formation is considered what type of closure?

A

Secondary closure

61
Q

What antibiotic is the best first choice for treatment of an open fracture?

A

Cefazolin

62
Q

If a dog presents with burns covering his left front limb and his right hind limb, approximately what percentage of his total body surface area (TBSA) is burned?

A

~27%

  • Front limb is ~9% TBSA. Back leg is ~18%*
  • 9 + 18 = 27*
63
Q

Which of the following three types of screws is the strongest under bending stress:

cancellous, cortical, locking

A

locking screw​

The locking screw is strongest under bending stress b/c it has the largest core diameter; it’s only placed perpendicularly to the plate hole

64
Q

What are the four primary bone tumors diagnosed in our small animal population?

A

osteosarcoma, chondrosarcoma, fibrosarcoma, hemangiosarcoma

65
Q

Salter-Harris Type ____ fractures run through the physis and a portion of the metaphysis

A

Salter-Harris Type II fractures run through the physis and a portion of the metaphysis

66
Q

To reduce a fracture, implants are placed through incisions distant to the fracture itself.

This describes what approach to fracture reduction?

A

minimally invasive osteosynthesis

  • Implants are placed through incisions distant to the fracture
    • Fracture is not approached
    • Closed reduction
  • ​I**ntra-operative fluoroscopy is used to guide placement of implants and to confirm fracture reduction and alignment
  • Steep learning curve

**is thought to promote faster bone healing**

67
Q

T/F: Mechanically, a properly applied cast immobilizes the joints above and below the fractured bone, neutralizing bending, rotational, and axial forces on the fracture

A

False

  • Mechanically, a properly applied cast immobilizes the joints above and below the fractured bone, neutralizing bending and rotational forces on the fracture.*
  • A cast does not counteract axial forces applied to the fractured bone*
68
Q

What technique is used to stabilize Salter Harris Type 1 fractures of the proximal humerus?

A

Diverging Pin Technique

69
Q

How would you classify an open fracture with bone exposure and extensive soft tissue loss?

A

Type III B

70
Q

__________ fractures occur when the insertion point of a tendon or ligament is fractured and distracted from the rest of the bone

A

avulsion

Avulsion fractures occur when the insertion point of a tendon or ligament is fractured and distracted from the rest of the bone

71
Q

What type of screw has the largest core diameter?

A

locking screws

  • Screw type with largest core diameter
    • 3.5 mm locking screw = 2.9 mm core diameter
    • 3.5 mm cortical screw = 2.4mm core diameter
  • Self-tapping
  • Threaded head locks into threaded hole in locking plate
    • Can only be placed perpendicular through hole
  • Only for use with locking plates
72
Q

Briefly describe the “open but do not touch” approach to fracture reduction:

A
  • Fracture is surgically approached and visualized
  • Fracture ends are NOT manipulated during placement of implants
    • Fracture reduced via traction or manipulation of bone away from fracture
    • Minimal disturbance of fracture hematoma, periosteum, and blood supply
73
Q

What type of bone plate is most often used for minimally invasive plate osteosynthesis (MIPO)?

A

locking plate (LCP)

74
Q

What percentage of the intramedullary canal should be filled when an intramedullary (IM) pin is used along with plating?

A

35-40%

75
Q

When using locking bone plates, stable repair requires screw purchase of at least ____ cortices above and below fracture​

A

Four

When using locking bone plates, stable repair requires screw purchase of at least 4 cortices above and below fracture​

76
Q

What fracture configuration is ideal for the use of cerclage wire?

A

Long Oblique

Fracture line should be greater than 2x the diameter of the bone

77
Q

Dynamization is typically recommended at ~_____ post-repair

A

Dynamization is typically recommended at ~6 weeks post-repair

Dynamization is the Incremental destabilization of the construct. This allows increased axial loading of the fracture to enhance callus hypertrophy and remodeling of the fracture

78
Q

Identify the type of external skeletal fixator:

A

Type IIb

bilateral-uniplanar; use of full pins and half pins

79
Q

What is the difference between anatomic and physiologic degloving injuries?

A
  • Physiologic: skin devitalized but still in place
  • Anatomic: skin avulsed from underlying tissue
80
Q

“bone remodels based on the forces that are applied” describes what theory?

A

Wolff’s Law

81
Q

What fixation methods (2) cannot be used in the radius?

A

Interlocking nails and Intramedullary pins

82
Q

T/F: Tension bands are appropriate for many long oblique fractures

A

No.

Tension bands are indicated for avulsion fractures and some osteotomies

83
Q

surgical immobilization of a joint by fusion of the adjacent bones is termed:

A

arthrodesis

84
Q

T/F: Punch grafts are used to enhance epithelization

A

True

85
Q

T/F: Lag screws should be positioned parallel to the fracture line

A

False

Lag screws should be positioned PERPENDICULAR to the fracture line

86
Q

When is the diverging pin technique used?

A

to stabilize Salter Harris 1 fractures of the proximal humerus and the femoral head

87
Q

Elastic Plate Osteosynthesis is only appropriate for what type of patient?

A

skeletally immature animals

less than 5-6 months of age is ideal​

88
Q

T/F: There is less risk of infection with active drains compared to passive drains

A

True

89
Q

The most common bone plates are composed of stainless steel and are very stiff. How do these plates fail?

A

bending forces

90
Q

Classify this open fracture

A

Type I

A type I open fracture is caused by the bone penetrating through the skin and is characterized by a small puncture hole located in the skin in the proximity of the fracture. Depending upon the amount of soft-tissue coverage, the bone may or may not be visible in the wound.

91
Q

What type of fixation would be best for treatment of a Grade IIIA open fracture?

A

External Skeletal Fixation

92
Q

What fractures must always be anatomically reconstructed?

A

Articular fractures​

93
Q

T/F: Interlocking nails are used to treat diaphyseal comminuted fractures

A

TRUE

94
Q

This plate is being used in __________ mode

A

buttress

  • Used in a metaphyseal fractures to prevent collapse of the adjacent articular surface
  • Will frequently incorporate lag screws
  • Plate is subject to full loading
    • Axial forces do not help with fracture compression and do not promote load sharing by the bone)
    • Plate supports cortex and resists displacement
  • Most or all screw holes should be filled
95
Q

Name the condition that can occur when a young animal’s comminuted femoral fracture is treated with rigid immobilization for an extended period of time

A

Quadriceps contracture

96
Q

What types of fractures are best repaired by tension band?

A

avulsion fractures and some osteotomies​

97
Q

What is the general goal of Minimally Invasive Plate Osteosynthesis (MIPO)?

A

To return limb alignment and length to normal without disruption of fracture

98
Q

What are some indications for circular fixator devices?

A
  • Complicated fractures of the tibia and radius
  • Distraction Osteogenesis
    • Bone lengthening procedures
  • Correction of angular limb deformities
99
Q

__________ are small, parallel, staggered incisions made in skin adjacent to a wound to allow closure with reduced tension

A

Multiple punctate relaxing incisions

100
Q

What is the most common organism associated with bite wounds in small animals?

A

Pasteurella multocida​

101
Q

Identify the fracture:

A

lateral humeral condylar fracture

102
Q

What is the main difference between a dynamic compression plate (DCP) and a limited contact DCP (LC-DCP)?

A

LC-DCP has a contoured underside

  • Allows stress to be more evenly distributed across plate (less stress at screw hole)*
  • Less contact with bone = less disruption of periosteal vascularity, which reduces the porotic changes under the plate*
103
Q

Which of the following materials is most likely to result in chronically draining non-healing wound?

  • Glass shard from a Stag bottle on the strip
  • Steel pellets found in a Stag bottle on the strip
  • Grass awns found around a Stag bottle on the strip
  • Lead bullet fragments
A

grass awns

104
Q

Salter-Harris type ____ classification has been used to describe the partial physeal closures resulting from damage to a portion of the physis and causing asymmetric physeal closure

A

Salter-Harris type VI classification has been used to describe the partial physeal closures resulting from damage to a portion of the physis and causing asymmetric physeal closure

105
Q

Because the screws are fixed within the hole of the plate, frictional forces between the plate and bone are unnecessary with what type of bone plate?

A

locking compression plate (LCP)

  • Locking plates and screw systems provide fragment stability with the locking mechanism between the screw and the plate. In a locking plate, because the screws are fixed within the hole of the plate, frictional forces between the plate and bone are unnecessary.*
  • The principal method of load transfer is directly through the plate and screw, and termed “screw-only” mode force transfer.*
  • **little to no contouring is required with LCP***
106
Q

What types of fractures are best repaired by interfragmentary wire?

A

Simple fractures of flat, non-weight bearing bones that interdigitate well

Most commonly used for certain mandibular and maxillary fractures

107
Q

T/F: Bone plates should be applied to the tension side of bone

A

True!

108
Q

What is the term used to describe a reversible change in shape in which material returns to its original shape when load is removed?

A

Elastic deformation

109
Q

For what patient populations are acrylic frames best suited?

A

toy breed dogs, cats, and exotics

110
Q

Salter-Harris type ____ fractures are crushing injuries of the physis that are not visible radiographically but that become evident several weeks later when physeal function ceases

A

Salter-Harris type V fractures are crushing injuries of the physis that are not visible radiographically but that become evident several weeks later when physeal function ceases

111
Q

Name the forces that are overcome by interlocking nails:

A

all forces​

biatch!

112
Q

Plates that are used in addition to primarily placed lag or positional screws are in __________ mode

A

neutralization

Plate acts to protect/neutralize against shearing, bending, and rotational forces which would otherwise damage the interfragmentary repair achieved by the screws​

113
Q

T/F: When performing surgery on a clean wound, risk of infection generally doubles every 3 hours

A

False

When performing surgery on a clean wound, risk of infection generally doubles every hour

114
Q

Identify the type of external skeletal fixator:

A

Type Ib

  • unilateral-biplanar​
  • Pins 60-90 degrees from each other
  • Interconnecting bars increases rigidity (more stable than IA)
  • Only types IA and IB can be used on humerus and femur
115
Q

What type of pinning is illustrated below?

A

Retrograde pinning

116
Q

What bone tumor locations are amenable to treatment by limb sparing?

A

Distal radial lesions have best outcome

High complication rates though

117
Q

Name the forces that are overcome by plating:

A

loading, bending, torsion

118
Q

What type of screw is shown in the image below?

A

self-tapping screw

You can tell because of the fluted tip. This screw does not require tapping (pre-cutting the thread pattern into the bone following drilling)

119
Q

What type of screw is best for use in dense, cortical bone?

A

cortical screws

  • Best for use in dense, cortical bone
    • Decreased outer diameter to core diameter
    • More shallow thread
    • Decreased pitch
120
Q

When placing transfixation pins, you should place at least ___ pins in each bone segment

A

Two

When placing transfixation pins, you should place at least 2 pins in each bone segment. 3 pins per segment is ideal for optimal stabilization

121
Q

An incomplete fracture in which a portion of the cortex is intact, thus stabilizing the bone to some extent, is termed:

A

Incomplete (Greenstick) fracture

122
Q

What osteosarcoma treatment option is associated with the longest median survival time?

A

Amputation + chemotherapy

Together mean survival time is ~9-12 months

123
Q

Dirty jokes aside, what is the main indication for “tubing the flap”?

A

“Tubing the flap” avoids making bridge incision but will require a second surgery to cut the flap free after it has healed in the wound bed – usually 14-21 days

124
Q

What are some complications associated with external skeletal fixation?

A
  • Pintract drainage: possible infection of soft tissues
  • Loosening of pins/wires
    • Pin bone interface sustains high stress loads, resulting in bone resoprtion
    • Loose pins/wires must be removed
  • Osteomyelitis
  • Ring sequestrum
  • Nerve or vascular damage
125
Q

How would you classify an open fracture in which the wound is smaller than 1 cm, with mild to moderate soft tissue contusion?

A

Type I

126
Q

Why are hybrid fixators particularly useful for treatment of fractures that are close to articular surfaces?

A

thin wires or a circular fixator allow for multiple sites of bone purchase in a smaller bone fragment​

hybrid fixators utilize components of linear and circular ESFs

127
Q

What tumor types are specific to the digits in the dog?

A

SCC and melanoma

128
Q

inflammation within a joint is termed:

A

arthritis

129
Q

What fixation technique would be ideal for treatment of an avulsion fracture?

A

Tension band​

130
Q

__________ is considered to be the single most important element for prevention/treatment of osteoarthritis

A

weight management

131
Q

Open anatomic reduction is most appropriate for repair of what type of fractures:

A

transverse, oblique, segmental, and minimally comminuted fractures

**open anatomic reduction is required for articular fractures**

132
Q

Name the primary implants that were discussed in lecture:

A

bone plates, interlocking nails, external skeletal fixators (ESFs)

133
Q

Of the four A’s that are evaluated in post-op fracture repair radiographs, which term relates to the positioning of the joints?

A

Alignment

134
Q

T/F: Axial pattern flaps are considered transpositional flaps

A

True

135
Q

When placing cerclage wires, how should they be positioned in reference to the long axis of the bone?

A

Perpendicular

136
Q

T/F: Fractures classified as Salter I and II have an articular component

A

False

137
Q

A fracture line perpendicular to the long axis of the bone is a __________ fracture

A

transverse

A fracture line perpendicular to the long axis of the bone is a transverse fracture

138
Q

Other than obvious implant migration, what is a radiographic change that would be indicative of implant loosening?

A

lucency around the pin

139
Q

What is the term used to describe a permanent change in shape in which material DOES NOT return to its original shape when load is removed

A

Plastic deformation

140
Q

spontaneous fusion of joint; end stage of joint disease is termed:

A

ankylosis

141
Q

T/F: Osteochondrosis is a defect in endochondral ossification

A

True

142
Q

This posture is characteristic for:

A

Infraspinatus Contracture​

  • Elbow adducted, antebrachium abducted
  • Scapulohumeral joint can’t be internally rotated-scapula elevates when shoulder is rotated
  • Limited range of motion
  • Usually no pain on manipulation of joint
143
Q

Muscle shortening not caused by active contraction is termed:

A

contracture

144
Q

What is the most common direction of traumatic shoulder luxation?

A

medial

145
Q

What form of coaptation should be applied for medial shoulder luxation?

A

Velpeau Sling

146
Q

What form of coaptation should be applied for lateral, cranial, and caudal shoulder luxation?

A

Spica Splint

147
Q

This procedure uses heat to shrink and tighten the shoulder capsule:

A

capsulorrhaphy

148
Q

A dog presents with acute onset of pain on palpation of the shoulder. You note malpositioning of greater tubercle. What is your diagnosis?

A

traumatic shoulder luxation

RUSVM Small Animal Surgery I (15 decks)

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