Soft tissue handling Flashcards
AO principles?
1) Accurate anatomic reduction
2) Rigid stabilisation appropriate for the requirement of the fracture
3) Preservation of blood supply to the soft tissues and bone
4) Early and safe mobilisation of the limb and patient
Halsted’s seven principles?
1) Gentle handling of tissues
2) Meticulous haemostasis
3) Preservation of blood supply
4) Strict aseptic technique
5) Minimum tension on tissues
6) Accurate tissue apposition
7) Obliteration of dead-space
Methods of fracture reduction?
Open (carpenter)
minimally invasive
closed (gardener)
Advantages of closed reduction?
Preserves soft tissues
Preserves blood supply
Preserves haematoma
Decreased contamination
Reduced operating time
Reduced infection
Improved healing potential
Disadvantages of closed reduction?
Cortical apposition hindered by lack of visualiseration
Not applicable to articular fractures
Can be challenging
Can be time consuming
Methods to assist closed reduction?
Avoid delay (swelling increase with time)
Use traction, counter-traction, manipulation or bending
Apply a tie around the affected extremity and hoist the leg up to a drip stand so animal is suspended in air
Advantages of open reduction?
Fracture can be visualised
Plates can be contoured accurately
Bones can be reconstructed (transverse, butterfly, oblique, spiral and intra-articular)
Load sharing of fracture
Application of graft
Disadvantages of open reduction?
Iatrogenic contamination
Soft tissue damage
Impaired blood supply from dissection and disturbing fracture fragments
Dead-space is created
Loss of fracture haematoma
Key guidelines for open reduction include?
Gentle soft tissue handling
Strict haemostasis
Follow separations between muscles and fascial planes
Cut muscles near origin or insertion
Know anatomy (including bloodvessels and nerves)
Preserve soft tissue attachments
Use suction
Use moist sponges
Irrigate lots
Methods of distraction and reduction?
1) Direct force
2) Traciton and counter traction
3) Use self-retaining reduction forceps to maintain reduction
4) Toggling
5) Levering
6) Push-pull technique
Distraction method?
Apply direct force using bone holding forceps on one or more fragments
Traction and counter traction?
Direct application of force on two bone fragments
Use handheld or self retaining bone holders to apply traction to bone
Self retaining reduction?
Using self retaining reduction forceps to maintain reduction
Toggling?
Transverse fractures - bend fracture, engage ends, straighten limb
Levering?
Use an osteotome or Hohman retractor
Push pull technique?
Rely on a temporary implant placed in the bone (e.g. screw) with which to distract or compress
Care not to exert excessive force or may risk further fracture
Bone holding forceps?
