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Fracture Repair 2 > Stabilisation of Radial Fractures > Flashcards

Stabilisation of Radial Fractures Flashcards

1
Q

What are skeletally immature animals with radius/ulna fractures at risk of?

A

Angular limb deformity

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2
Q

In any dog, and particularly cats, with antebrachial fractures, every effort must be made to maintain the natural motion that occurs between the radius and ulna.
What are we at risk at if not? (2)

A
  • implant failure
  • reduced QoL
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3
Q

What is the antebrachium composed of?

A

Radius and ulna

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4
Q

Proximally, the ulna ‘embraces’ the radial head with? (2)

A

the medial and lateral coronoid processes.

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5
Q

braces’ the radial head with the medial and lateral coronoid processes. Around 50% of thoracic limb weight-bearing is carried by..?

A

The proximal radial articular surface at the level of the elbow

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6
Q

Where is the 2nd largest area of the thoracic limb which is weight-bearing?

A

Ulna

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7
Q

What ligaments of the elbow joint tether the radius and ulna together? (2)

A

medial and lateral collateral

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8
Q

medial and lateral collateral

A

medial and lateral radial incisures of the ulna

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9
Q

How do the biceps brachii and brachialis muscles insert?

A

They have tendons of insertion that bifurcate and insert on the medial surface of radius and the ulna

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10
Q

Distal to the elbow joint the radius and ulna are joined by dense..?

A

Interosseous ligament

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11
Q

What muscles share their origination between radius and ulna at the level of the mid-diaphysis? (3)

A

Pronator quadratus,
Deep digital flexor
Abductor pollicis longus muscles.

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12
Q

If the radius and ulna are #, why is it that only the radius may need to be fixed in some cases?

A

The main weight bearing bone is the radius,

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13
Q

Radial #, Suitable cases for external coaptation? (3)

A

Isolated fracture of the radial or ulnar diaphysis

Stable fractures involving both radius and ulna

Young, medium-sized or larger dogs, or cats.

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14
Q

When to x-ray following external coaptation of the radius?

A

Initial, 4 weeks, 6 weeks, 12 weeks

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15
Q

T or F
External coaptation is a suitable method for radial # in toy or small breeds

A

FALSE - SHOULD NOT BE USED

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16
Q

What # tends to lead to angular limb deformity?

A

When growth plates involved

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17
Q

The distal ulna growth plate is most prone to injury, due to its conical shape it is prone to..?

A

Crushing

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18
Q

With growth plate is most prone to injury

A

Distal ulna

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19
Q

Which area of # is described when describing displacement?

A

distal component displacement in relation to the proximal component.

20
Q

Risk of proximal screws becoming a stress riser results in?

A

Poss #

21
Q

Standard approach to a radial #?

A

Medial

22
Q

How to approach a distal radial #?

A

Medial combined with cranial

23
Q

Approach to radius - T or F
Cephalic vein and tendon of abductor pollicis longus muscle may be sacrificed to allow adequate exposure.

A

True

24
Q

What is the tension side of the radius?

A

Cranial

25
Q

Cranial approach to the radius; only relatively short screws; why?

A

The cranio-caudal diameter of the distal radius.

26
Q

Standard site for radial plate?

A

Cranial

27
Q

On the cranial approach to the radius; what can become irritated; especially with distal #?

A

Extensor tendons

28
Q

Main advantage of a medial plate being applied to the radius?

A

Longer screws can be used due to shape

29
Q

What size plate and number of screws for a medial plate application of the radius?

A

Smaller plate - more screws over same distance

30
Q

When is it advised to repair the ulna as well as radial #? (2)

A
  • Multiple trauma
  • Animals with increased pronation supination and/or high forces acting (e.g., dogs with increased pronation/supination e.g., racing breeds, giant breeds, cats).
31
Q

What approach allows access to radius and ulna?

A

Lateral

32
Q

Minimally invasive application with locking plates: what is this?

A

The focus is shifted from filling all screw holes to preserving the soft tissue envelope while providing adequate stability.

33
Q

When can ESF be employed? (2)

A

Comminuted #
high grade open #

34
Q

Where is an ESF NOT recommended?

A

Toy breed

35
Q

Why do toy breeds provide a greater challenge to surgical repair? (3)

A
  • Antebrachii more susceptible to # due to morphology
  • Increased delayed healing; decreased vascular density at distal diaphyseal-metaphyseal junction of radius
  • Small cross sectional area of distal radius; adequate bone apposition a challenge
36
Q

Toy breed; Aim to provide rigid stabilisation, optimise apposition, and preserve blood supply. How can this be done? (3)

A

Internal fixation is the method of choice.

Consider a bone graft.

Consider how to preserve blood supply (gentle soft tissue handling etc).

Consider staged screw removal to avoid stress protection starting close to fracture site and waiting 3-4 weeks after removal.

37
Q

Medial approach to the radius:
Patient position?

A

Position patient in dorsal recumbency with hanging leg.

38
Q

Medial approach to the radius:
Where is the skin incision?

A

Skin incision from medial epicondyle of the humerus to styloid process of radius - protect cephalic vein crossing in distal portion.

39
Q

On the medial approach to the radius, the superficial fascia is incised. Then the deep fascia; this is between which 3 muscles?

A

Extensor carpi radialis muscle and pronator proximally,
Parallel to extensor muscles distally

40
Q

Medial approach to radius:
If access to proximal radius required, incise which 2 muscles insertion?

A

Pronator and supinator muscles

41
Q

Which nerve (located deep to proximal supinator) needs to be preserved on the medial approach to the radius?

A

Radial

42
Q

Lateral approach to the radius:
How is the patient positioned?

A

Lateral recumbency with hanging leg

43
Q

Lateral approach to the radius:
Where is the incision

A

Centre over lateral edge of radius; from radial head to distal radius

44
Q

Lateral approach to the radius:
Incise deep fascia along radial shaft and cranial border of common digital extensor muscle.

What muscles are then retracted and which direction? (2)

A

Common and lateral digital extensor

45
Q

Lateral approach to radius:
Retract which muscle medially or incise along ulna.

A

Abductor pollicis longus

46
Q

If there is a # distal ulna, what needs to be thought about whether this may benefit from fixation?

A

More pronounced movement of the ulna will be present during pronation and supination.

Fracture Repair 2 (10 decks)

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