Smallies External Coaptation (LaFuente) Flashcards

1
Q

What 4 mechanical force can act on a fx?

A
  • bending
  • rotation
  • compression/shear
  • distraction
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2
Q

Which types of fx are stable? Which are unstable?

A
> stable 
- transverse
- green sick (buckling) 
> unstable
- oblique
- spiral 
- comminuted
- segmental?? 
- avulsion
- compression??
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3
Q

Which forces are neutralised by a cast? Which are not?

A
  • bending
  • rotation
    > as long as joints above and below are immobilised
    > compression/shear difficult to neutralise with a cast
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4
Q

What are distraction forces?

A
  • muscle tension
  • poorly neutralised by external coaptation
  • eg. olecranon fx, greater trochanter fx
    > sling to v weight bearing?
    > reduces muscle tension
    > reeduces tension force
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5
Q
  1. When is external coaptation indicated?
A
  • closed
  • minimally displaced (20% in contact minimal)
  • stable
  • pair of bones (ie. tibia and fibula)
  • young animals high healing potential
    > 50% contact rule
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6
Q

HOw long do fx take to heal in pupppies?

A

3-4weeks

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7
Q

What are the 5 basic guidelines for coaptation?

A
  1. When?
  2. Reduction
  3. ALignment
  4. Standing positino
  5. Join above and below
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8
Q
  1. how is reduction carried out? How much reduction is needed?
A

> heavy sedation/GA
- repeatras to ensure apposiiton remains throughout healing
adequate reduction 50% contact rule
- juveniles tolerate greater displacement without developing non-union cf. older

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9
Q
  1. aims for aligment? Consequences of malalignement?
A
  • perfect reduction rare
  • proper joint alignment must be maintained
  • failure to align major bone fragments to joints of limb -> angular/rotational malunion
  • functional gait abnormality
  • painful lamenss d/t 2* OA
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10
Q
  1. What position should the leg be fixed in?
A
  • normal standing position

- unless joint extension/flexion needed d/t soft tissue

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11
Q
  1. How many joints are immobbiised with a fx?
A

> one above and one below

  • most conventional splints cannot be used above the stifle/elbow so need surgical correction
  • spica splints can eb constructed to immobilise hip/shoulder
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12
Q

See lecture for diagram on immoobilising fx

A

-

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13
Q

How often is external coaptation used?

A

> infrequently
- hard to manage, severe complications, often better ways
commonly used for support after surgery esp arthrodesis (for 6 weeks)

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14
Q

Types of external coaptation?

A
> Robert JOnes
- thick
- modified RJ thinner
> spinted
> bilvalved cast 
- allowws frequent changes without ...
> Spica spint
- immobilise shoulder/hip
> Schroeder-Thomas??
> Walking bar
- aluminium bar at end of cast
- for digit fx
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15
Q

What is external coaptation dressing made up with?

A
  1. primary layer
    - cover and protect, absorb discharge, wet to dry debriding
    - eg. melolin, allevyn
  2. secondary layer
    - absorption, support and pressure
    - cotton wool (do not let it contact skin!!)
    - cast padding (less bulky, conforms better)
    - conforming gauze wrapped over to provide stability and occasionally compression
    +- casting tape for fx
  3. tertiary layer
    - holds inner layers, barrier against physical abrasion and environmental contaminantss
    - elastic conforming bandage most common
    - if this layer appears wet with discharge bacterial infection is possible - change the bandage!!
  4. +- stirrups
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16
Q

Advantages of external coaptation?

A
  • cheap (providing no complications)

- avoids surgery

17
Q

Disadvantages of external coaptation?

A
  • stable, min displaced fx
  • can -> bone/limb malalignment
  • can cause serious complications
  • complications more expensive /difficult to tx than original fx!
  • difficult to manage (slip, wet)
18
Q

Potential complications d/t external coaptation?

A
  • distal limb oedema/swelling (leave toes exposed to check)
  • skin rubbing, ulcers, necrosis (can use ‘donuts’)
  • soft tissue necorsis
  • cast slippage
    > amputation may be only option
19
Q

How can risks associated with external coaptation bandages eb minimised?

A
  • only use if necessary
  • plenty of padding esp bony prominence
  • change q1week initially then q2weeks
  • owner check daily for swelling and smell
20
Q

How regularly do casts need to be changed in puppies?

A

Weekly to compensate foro bone growth

21
Q

Outline the slater-harrie classification system. Which type of fx is this applicable to? LOOK UP

A
  • Fx across a growth plate (physis) = SALT pnumonic
    > type I: Slipped
    fracture plane passes all the way through the growth plate, not involving bone, cannot occur if the growth plate is fused reference required -good prognosis
    > type II: Above
    fracture passes across most of the growth plate and up through the metaphysis, good prognosis
    > type III: Lower
    fracture plane passes some distance along the growth plate and down through the epiphysis, poorer prognosis as the proliferative and reserve zones are interrupted
    > type IV: Through or transverse or together
    intra-articular
    fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis, poor prognosis as the proliferative and reserve zones are interrupted
    > type V: Ruined or rammed
    crushing type injury does not displace the growth plate but damages it by direct compression, worst prognosis
22
Q

If a fx came in as an emergency and could not be reduced until the next day, how would you manage the patient while waiting?

A
  • rest
  • restricted activity
  • NSAIDs
  • opioids
    +- cold compress
    +- sling
23
Q

What causes carpal hyperextension and how can it be treated?

A

rupture of palmar carpal ligaments and fibrocartilage, usually 2* to trauma
> Tx: pancarpal arthrodesis
- castless plate applied (special one for carpal arthrodesis with differnet sized screws

24
Q

Which side of a fx are splints usually placed? Exception? What effect does this have and how can these problems be overcome? What risks might occour 2* to this!?

A
  • usually on tension side
  • for carpal arthrodesis must go on dorsal aspect (compressive side)
    > ^ risk bend and breakage
  • to compensate, use external coaptation to protect implant and reduce the forces
    > risk of cast sores and cast slippage
  • do not place immediately postop, place RJ for 3-5d then cast when swelling educed
  • monitor 24hrs before sending home
  • change weekly d remove @6weeks
25
Q

How can distal limb integrity be assessed?

A

Needle in foot pad - if frank blood comes out then tissue is still viable

26
Q

Potential roles of external coaptation ?

A
  • temporary first aid
  • 2* support after surgical intervention
  • 1* support and stabilisation of selected fx