Veterinary orthopaedic surgery Flashcards by Amy Carter

What considerations would you make to manage initial trauma?

Any other injury?

Any haemorrhage?

Is the animal in shock?

Is the animal at risk of causing further injury?

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How can you prevent further contamination in open fractures?

Cover the wound and bone ends

Immobilise the fracture

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Once stable, what can be done during surgery for fractures?

Lavage

Debride

Surgical management if possible

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What are non-surgical options for fractures?

Most common for fractures below the elbow or stifle

Secondary/indirect healing

Often not the treat of option for athletic or working animals

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What are the advantages of external coaptation?

Preservation of blood supply and tissues

Quick procedure

Generally cheaper

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What are the disadvantages of external coaptation?

High maintenance

Higher risk of fracture disease

Cannot manage soft tissue wounds at the same time

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Describe a plaster of paris cast

Very heavy = uncomfortable

Should not get wet

Can disintegrate over time

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Describe a fibreglass resin cast

Lighter

Stronger

Water resistant -> durable

More expensive

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Describe casts in general

Include joint above and below

Ample padding +/- stirrups

Left in-situ for 4-6 weeks

May need replacing in growing animals

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What complications can occur with casts?

Fracture disease (joint stiffness, muscle atrophy, tissue adhesions, etc)

Joint laxity

Limb swelling

Pressure sores

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Describe splints

More common in small animal practice

Place over padding and conforming bandage

Covered with conforming and vet wrap

Similar complications as with casts

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Describe fibreglass splints

Thermoplastic material

Can be moulded directly to contour of patient

Lighter and stronger

Complications less likely

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Describe a robert jones bandage

Multiple layers of cotton wool/soft ban and conforming bandage

Top layer of vet wrap

Pulled tightly to immobilise fracture sites

Tend to be heavy -> care in proximal limb

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Describe conservative management (general)

Rest - crate or box rest

Pain relief

Comfortable bedding

Flooring with good traction

Supervision during toilet breaks +/- sling

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Describe surgical management

Allows minimal interfragmentary strain and a minimal fracture gap

Earlier return to exercise
-Compressive forces accelerate healing

Allows management of soft tissue injuries

Specialised procedures

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Describe external fixators (general)

Percutaneous pins/wires + rigid frame of clamps, bars and epoxy resin

Useful with multiple fracture fragments

Ilizarov or linear

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What are the advantages of external fixators? (general)

Early return to limb usage

Minimally invasive

Well tolerated

Management of soft tissue injury

Allow staged removal

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What are the disadvantages of external fixators? (general)

Cumbersome

Risk of infection at pin sites

Require expertise and planning

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Describe internal fixation (general)

Invasive surgery

Reduce fracture site and use hardware to maintain

Careful pre-surgical planning

Range of equipment depending on fracture

Describe bone plates

Internal splints

Foxed to the bone using screws

Open and closed fractures
-Increased risk of infection with open

Name different types of bone plates

Dynamic compression plate

Neutralisation plate

Buttress plate

Describe a dynamic compression plate

Maximum contact between fragments as they are compressed together

Describe a neutralisation plate

Neutralises forces

Shares the load between plate and bone

Describe a buttress plate

When fracture cannot be reconstructed

Describe lag screws

Cross fracture gap Provides interfragmentary pressure

When are position screws used?

When lag screws may cause interfragmentary collapse Fracture fragments are too small

Compare cortical and cancellous screws

Cortical - Fixate both cortices - Closer; more shallow thread - Stronger Cancellous screws - Fixate cancellous bone - Wider threads

Compare self- and non-self-tapping screws

Self-tapping -Creates it's own thread as they are inserted Standard -Thread must be cute prior to screw being inserted

Describe intramedullary pins

Sit within the medullary cavity Good at resisting bending, NOT rotation or shearing Can be used with interlocking nails to resist all forces -Difficult as cannot see the holes!

Describe cerclage wire

Wire wrapped around the bone Compresses fragments together Commonly combined with an IM pin

Describe rush pins

Used in pairs Cross over within medullary cavity Commonly used for metaphyseal fractures Useful in growing animals

Describe kirschner wire

Hard wire Temporary fracture fixation Often used in combination with cerclage wire

Describe the general rules of management of large animal fractures

Fractures of the carpus/tarsus and below are more amenable to repair Muscle mass and body weight make it difficult to immobilise the proximal limb Better results in young animals Complications can occur in the contralateral limb

Give two examples of large animal management techniques

Conservative management Transfixation casting

Describe conservative management (large animal)

Splint bone fractures Scapular spine fractures

Describe transfixation casting

Pins through an external cast Takes the load away from the fracture site

Describe external fixators (large animal)

Not very well tolerated Some success seen in cows Useful for horses for mandibular fractures

Describe internal fixation (large animal)

Bone screws - Metacarpal/metatarsal fractures - PI and PII fractures Dynamic compression plates IM pins

Describe amputations

Salvage procedure Not performed in large animals Can remove mid-bone or disarticulate the joint Generally adapt very well Long term overloading of contralateral limb

Describe arthrodesis

Salvage procedure Fusion or ankylosis of a joint by joint ossification Immobilised the joint -> relieves pain Can take several weeks Common in lower-motion joints i.e. within the tarses

Describe arthroplasty

Joint replacement Only in small animal practice Implant that attaches to bone at either side -> mimics joint Hip and elbow +/- stifle

What are toggle pins

Toggle sutures Toggle two structures together Can be used for hip luxation

Describe arthroscopy

Diagnostic and therapeutic Useful for: - Debriding cartilage - Curetting bone - Removal of joint mice

Describe joint flushes

Flushing sterile saline into a joint to lavage Remove bacteria and debris Small animal -> general anaesthesia Horses -> general anaesthesia OR under standing sedation Carried out for cases of joint sepsis,septic arthritis,etc

Describe ligament prosthesis

Ligaments rarely surgically repaired Use non-absorbable sutures to mimic E.g. cranial cruciate ligament repair in small dogs

What tools may be used for orthopaedic surgery?

Power drill and jacobs chuck Various saws (oscillating) - Power - Hand Retractors Bone cutters (cut) Bone tongeurs (nibble) Osteotomes (slice) Periosteal elevators