Test 1: complications Flashcards
delayed union
fracture that has not healed in adequate period of time
does not mean will never heal, just taking a long time
non-union
not healed bone fracture
failure of progressive change in Xrays for at least 3 months
reasons for non-union/delay
Inadequate reduction
* Inadequate stabilization
* Loss of blood supply
* Infection
* Systemic factors
during growth the — and — have separate blood supply. The periosteum is highly vascular
epiphysis
metaphysis
during maturity the diaphysis gets blood from the
nutrient artery
small anastomose with metaphysis
periosteal supply outer 1/3 cortex
where does fracture get blood supply
from surround soft tissue
helps form periosteal callus
medullary supply will eventually reform and take over
weber-cech classification
seperates non-unions into viable or non viable
Viable (vascular, reactive)
− Biologically active fracture, variable degrees of proliferative bone reaction, more common
1. Hypertrophic
2. Moderately Hypertrophic
3. Oligotrophic
Non-viable (avascular, non-reactive)
− More difficult to achieve union
1. Dystrophic
2. Necrotic
3. Defect
4. Atrophic
viable hypertrophic non-union
elephant foot
big callus but unable to bridge gap
usually caused by inadequate stabilization or excessive motion
what causes a viable hypertrophic non union (elephant foot)
big callus but unable to bridge gap
usually caused by inadequate stabilization or excessive motion
what is a horse foot
viable moderately hypertrophic non union
from excessive movement or inadequate stabilization
callus not as big as elephant foot
viable oligotrophic non-union
small callus- looks fuzzy or hazy
can be causes by excessive motion- implant loose or broken
what causes a viable oligotrophic non union
excessive motion or implant loose or broken in area of healing
non-viable dystrophic non union
One or both sides of the fracture
ends are non-viable
A fracture fragment that has
healed to one main fragment and not the other
Most often in distal radius/ulna in toy/miniature breeds
what kind of non union do toy breeds tend to get in distal radius and ulna
non-viable dystrophic non union
non viable necrotic non union
fracture fragment with no blood supply
sequestrum- dead bone
non viable defect non union
fracture gap to big to heal
>1.5 times the bone diameter
non viable atrophic non union
End result of other non-viable
non-unions
Resorption & rounding of edges, may have disuse osteoporosis
Complete cessation of osteogenic activity
Most difficult cases to resolve
clinical signs of delay or nonunion
pain at fracture site
not improved- still lame
disuse atrophy of limb
movement at fracture site
xray signs of non union
Fracture gap
No activity of fracture ends
Obliteration of marrow cavity
Osteopenia of surrounding bone
If callus present, it does not bridge the fracture gap
how to treat delay healing
give it more time
improve stabilization
enhance blood supply
bone graft
treat infection, fix gap, heal animal
3 things for surgery repair of non union
apply rigid fixation
culture and sensitivity
place cancellous bone graft
malunion
fracture that healed in non-anatomic position
4 A of post op fracture assessement
Alignment
apposition
apparatus
activity
— is Orientation of the
bone with respect to the normal anatomic axis in all planes
alignment
look at joints above and below
