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VM733: SURGERY > Small Animal Fractures > Flashcards

Small Animal Fractures Flashcards

1
Q

What dictates the type of healing governed by mechanical strain?

A

Fracture gap width and stability

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2
Q

Direct Bone Healing

A

“Intramembranous Ossification”
Cutter cone composed of osteocytes and osteoblasts (and led by osteoclasts) cross fracture line
Slower, takes months

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3
Q

Indirect Bone Healing

A

“Endochondral Ossification”
1. Hematoma formation
2. Fibrocartilaginous callus formation
3. Bony callus formation
4. Bone remodeling
Faster, takes weeks to months

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4
Q

How can we promote direct bone healing?

A

Increase rigidity to decrease strain
Not always an advantage as can be slower and places increased load on implants over time

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5
Q

How can we promote indirect bone healing?

A

Decrease rigidity to stimulate healing
Too much movement can impair healing and result in implant failure

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6
Q

Define: Fracture Gap Width

A

Change in gap width/Original gap width

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7
Q

What is the strain on a comminuted fracture?

A

Lots of pieces
Small change in gap width/Large original gap width
Low strain

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8
Q

What is the strain on a simple fracture?

A

2 pieces
Large change in gap width/Small original gap width
High strain

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9
Q

How can strain be reduced?

A

Increase stability (bone callus diameter)
Increase resorption

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10
Q

Ideal fixation rigidity balances what 2 things?

A

Biology (viability)
Mechanics (stability)

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11
Q

Grade I Open Fracture

A

Minimal soft tissue damage

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12
Q

Grade II Open Fracture

A

Significant soft tissue damage penetration from outside

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13
Q

Grade III Open Fracture

A

Severe soft tissue and vascular damage with bone loss and continued exposure

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14
Q

Transverse Fracture

A
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15
Q

Oblique Fracture

A

Long v short
Long = fracture line >2x bone diameter

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16
Q

Characteristics of simple fractures

A

Segmental
Reconstructable
Load-sharing

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17
Q
A

Oblique Fx

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18
Q
A

Oblique Fx

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19
Q

Comminuted Fracture

A
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20
Q

A majority of comminuted fractures are ___________________.

A

Non-reconstructable

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21
Q
A

Comminuted

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22
Q

Identify the regions

A
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23
Q

How is fracture displacement described?

A

Displacement of distal segment in relation to the rest of the body
Cranial/caudal (lateral)
Medial/lateral (AP)
Overriding/distracted

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24
Q

Identify the forces

A
  1. Bending
  2. Axial compression
  3. Torsion
  4. Tensions
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25
Q

What are the 10 words used for fracture description?

A
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26
Q

Classify the fracture

A

Traumatic
Closed
Transverse
Reconstructable
Distal diaphyseal
Left radius/ulna
Caudo-lateral displacement
Weakest to rotation

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27
Q

Robert Jones Bandage

A

Distal to stifle or elbow
Mechanical support
Compression
Wound protection
First 1-3 days
Facilitates any definitive tx, MUST be changed after 48hrs, can augment with splint

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28
Q

Initial stabilization: fx distal to stifle or elbow

A

Robert Jones

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29
Q

Initial stabilization: fx proximal to stifle or elbow

A

Crate rest
Analgesia
Nursing support

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30
Q

Forces: Casting

A

Okay for bending and rotation forces
NOT GOOD for axial compression forces (weight bearing)

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31
Q

Best Fx Types to be Casted

A

Useful on simple, transverse fractures
Useful for fractures with internal support (metacarpal, paired bones like radius/ulna, partial fractures)
NOT suitable for unstable oblique or comminuted fractures

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32
Q

Joint Immobilization: Casting

A

Must immobilize the joint above and the joint below the fracture
Fx below elbow or stifle

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33
Q

What is required for fracture reduction?

A

Requires >50% true overlap of fractured ends for predicable healing

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34
Q

Stability: Splint

A

Inherent rotational stability
Single vs multiple metacarpals, partial (greenstick) fractures
Step down from cast
Soft tissue injury: sprain (ligament), strain (tendon)

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35
Q

Morbidity associated with coaptation (casting)

A

No joint range of motion
Muscle atrophy
Osteopenia
Pressure sores
Dermatitis
Bandage change rechecks (weekly)
Maintenance and care

36
Q

Why should coaptation be avoided in toy breeds?

A

Poor blood supply to distal radius and ulna
Very slow bone healing

37
Q

Advantages: External Skeletal Fixator

A

Affordable, reusable
Closed or minimally invasive approach
Can adjust stability for phase of healing
Minor procedure to remove implants once healed

38
Q

Disadvantages: External Skeletal Fixator

A

Soft tissue irritation from pins, avenues for infection
Not suitable for all bones or patients
Eccentric position of connecting bar is weak
Weekly post-op care is necessary

39
Q

What forces can ESF combat?

A

All fx forces

40
Q

Common Fx Indications: ESF

A

Tibia-fibula, radius/ulna
Open fxs
Some mandibular fxs
Most fx configurations are suitable
Exotics (birds)

41
Q

Common Other Indications: ESF

A

Angular limb deformity correction
Limb lengthening (distraction osteogenesis)

42
Q

ESF not great for

A

Articular (joint) fractures
Pelvic fractures
Upper limb (more muscling)
Non-compliant owners
Fractious patients

43
Q

What are the components of a linear ESF?

A

Fixation Pins
Connecting Clamps
Connecting Bars

44
Q

Compare full and half-pins

A
45
Q

What type of frame configuration?

A

Unilateral - Uniplanar

46
Q

What type of frame configuration?

A

Unilateral - Biplanar

47
Q

What type of frame configuration?

A

Bilateral - Uniplanar

48
Q

What type of frame configuration?

A

Bilateral - Biplanar

49
Q

Define: Staged Disassembly

A

Frame gradually dismantled to allow increased loading by the healing fracture
Remove pins causing morbidity
Downgrade frame configuration

50
Q

Advantages: IM Pin + Wire

A

Affordable
“Simple” application (but commonly misused)

51
Q

Limitations: IM Pin + Wire

A

Limited suitable fracture scenarios
Requires rapid healing
Provides limited stability
Prone to complications (technical errors, case selection errors)

52
Q

IM Pin Forces

A

CAN resist bending (proportional to pin radius, aim for 60-70% canal fill)
CANT resist compression/shear, rotation, tension

53
Q

Common IM Pin Additions

A

Cerclage wire (must be perfectly reconstructed)
External fixator (tied in)
Plate and screws

54
Q

Cerclage Wiring Application

A

Properly applied full-cerclage induces interfragmentary compression
NEVER used as sole method of fixation

55
Q

Vascular Supply: Cerclage Wiring

A

Tight, small diameter wires do NOT impede blood supply
Loose wire devascularizes and disrupts callus formation

56
Q

Cerclage Rules: Fx Configuration

A

Long oblique
Single large oblique
Long spiral

57
Q

How oblique must a fracture be for cerclage wire application?

A

Fracture line must be at least 2x the diameter of the bone

58
Q

Cerclage Number and Spacing

A

At least 2 wires
Spaced 1/2 bone diameter apart

59
Q

What are the general rules of IM pins and cerclage wires?

A

Perfect anatomical reconstruction
Only long oblique/spiral configuration
Properly spaced wires
>2 cerclage wires
No loose wires
Do NOT entrap soft tissues
IM pin 60-70% canal diameter

60
Q

Interlocking Nail

A

IM pin combined with bolts that lock into the IM pin
Resists bending, rotation, and axial compression forces

61
Q

What type of fixation?

A

Interlocking Nail

62
Q

What type of fixation?

A

IM pin and cerclage wire

63
Q

What type of fixation?

A

IM pin and cerclage wire

64
Q

Advantages: Plate + Screw Fixation

A

Suitable for reconstruction or bridging
Highly stable and durable fixation
Allows early return to comfortable limb use
Low post-op maintenance vs coaptation or ESF

65
Q

Disadvantages: Plate + Screw Fixation

A

Expensive and extensive inventory
Technically challenging

66
Q

Neutralization Plating

A

Anatomic reconstruction of fracture
Plate neither compresses nor distracts but holds everything in its current place
Axial load is shared by implants and bony column

67
Q

Compression Plating

A

Specially designed plate holes –> tightening the eccentrically-placed screw, slides the plate along the bone, compressing the fracture

68
Q

Buttress/Bridge Plating

A

Non-reconstructable approach
Plate spans a gap to prevent collapse of fracture
Plate is holding bone “out to length”, correct spatial alignment
All weight bearing forces are transmitted through the plate and screws

69
Q

Locking Bone Plates

A

Rigid link between locking screw and bone plate
Fixed screw angle
Bone plate functions as “internal fixator”

70
Q

Lag vs positional screws

A

Positional: holds fragments in place
Lag: compresses fragments, interfragmentary compression

71
Q

Lag screw method

A

Regular bone screw used in lag fashion
Screw threads don’t engage the side of bone closest to the screw head

72
Q

What factors go into the fracture case assessment score?

A

Mechanical: load sharing, pt size, palp stability, dysfunctional limbs,
Biological: pt age, systemic health, fx pattern, limb condition, fx stability, open/closed fx
Clinical: follow-up, activity restriction

73
Q

3 steps to improved fx treatment success

A
  1. What forces are acting on fx? What fixation is needed to resist those forces?
  2. Reconstructable vs non-reconstructable
  3. FCAS
74
Q

High FCAS

A
75
Q

Low FCAS

A
76
Q

Define: Delayed Union

A

Fracture that takes longer to heal than anticipated

77
Q

Define: Non-Union

A

Fracture that failed to heal and will not heal without intervention

78
Q

Anticipated Bone Healing Times

A
79
Q

Risk Factors for Fx Complications

A

Poor mechanics: inadequate mobilization
Poor biology: vascular compromise (initial trauma, pt factors, sx trauma), infection
Usually combination or imbalance of both

80
Q

Define: Malunion

A

Fracture that healed in non-anatomic position

81
Q

Varus

A

Frontal plane
Inward angulation of distal segment

82
Q

Valgus

A

Frontal plane
Outward angulation of distal segment

83
Q

Procurvatum

A

Sagittal plane
Cranial bowing

84
Q

Recurvatum

A

Sagittal plane
Caudal bowing

85
Q

Pronation

A

Axial plane
Internal rotation

86
Q

Supination

A

Axial plane
External rotation

VM733: SURGERY (15 decks)

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