Wound and Fracture Management

Question 1

What is the timeline on which skin heals?

Answer 1

Day 1-7 Inflammation
Day 4-14 Proliferation
Day 13-Months Maturation/Remodeling

Question 2

What cell is essential for inflammation?

Answer 2

Neutrophil

Question 3

What does inflammation do for a injured site?

Answer 3

Vascularizes it (vasoconstriction with platelet aggregation, vasodilation with clots, leukocyte eat bacteria)

Question 4

What is another key part of wound healing related to inflammation?

Answer 4

Debridement of tissue (necrotic) - macrophage helps with this

Question 5

What occurs during proliferation?

Answer 5

Fibroblast make extracellular matrix and collagen
Granulation tissue forms (capillaries and fibroblasts - protect wound and provide physical scaffolding

Question 6

What occurs during remodeling?

Answer 6

Collagen continues to remodel and re-orient for months
-Scar has decreased strength, vascularity and cellularity

Question 7

Describe the following types of wound:
-Clean:
-Clean Contaminated:
-Contaminated:
-Dirty:

Answer 7

-Clean: Non-traumatic, no break sterile tech (right flank pyloro-omntopexy abomasum)
-Clean Contaminated: Enter luminal organ without spillage (c-section)
-Contaminated: Enter luminal organ without spillage, fresh traumatic (Dehorn, castration, rumen cannulation, mam vein laceration)
-Dirty: Gross infected, old trauma, devitalized wound with necrotic tissue (wire injury, puncture, equipment wound)

Question 8

What are some considerations for patient preparation?

Answer 8

Restrain, chemical, pain control

Question 9

What does the intial wound assessment require?

Answer 9

Gloves, clip hair, clean would with mild soap clean gloves and cold pack to work on, lavage and debride

Question 10

What fluid should you use for a lavage?

Answer 10

Isotonic - more with pressure

Question 11

How should primary closure be performed?

Answer 11

Muscle and fascia - absorbable - chromic gut

Skin nonabsorbably - monofilament - polymamid or braunamid

Question 12

Why are tension relieving sutures important?

Answer 12

Prevent pressure necrosis, prevent suture failure, interrupt circulation, inhibit wound healing

Question 13

What are some tension relieving sutures?

Answer 13

Near far far near, Mattresses (verticle better for blood flow) - use simplex tubing to help make tension relieving stents

Question 14

What is dead space and why do we not want it?

Answer 14

Space left in wound after procedure that fills with blood or serum and increases the risk of infection while preventing tissue apposition and healing

Prevent by tacking upper plane to lower, drain or pressure bandage

Question 15

In FA rarely use drains but why would you use them?

Answer 15

Evacuation of accumulated fluid, prevent expected accumulation fluid, eliminate dead space
Not a fix for poor debridement and suturing

Question 16

What is delayed primary closure?

Answer 16

swelling and moderate contamination or delayed response - suture before granulation but after a few days of lavage

Question 17

What is secondary healing?

Answer 17

closed after granulation tissue often with skin flap and under tension

Question 18

What is healing by second intention?

Answer 18

Very common in FA - excessive contamination, delayed response and in field
-Left to heal by granulation tissue formation, wound contraction and epithelization

Question 19

What is Myiasis?

Answer 19

Fly Strike (sheep often have moisture in wool and flies lay egg that damage tissue)
Signs: discolored wool, falling out, decreased activity/eating

Question 20

How do you treat fly strike?

Answer 20

Shear (cm around area), spray with catron, clean well, debride, antibiotic and pain med, spray with catron daily

Question 21

What topical product should not be used in food animal species?

Answer 21

Furazone

Question 22

What topical treatment is ok?

Answer 22

Aluspray, new skin, aloe vera, silver sulfadiazine

Question 23

The majority of food animal wounds are…

Answer 23

Iatrogenic - c-section, DA, exenteration, claw amputation

Question 24

What are the advantages of surgical dehorning?

Answer 24

Shorter healing time and elimination of open wound

Question 25

Describe disbudding?

Answer 25

Caustic paste (isolate) - 1-3 days, bloodless
Disbudding - <4weeks ideal, goat <2 weeks, local anesthesia cornual block and pain meds

Question 26

What are some tips for barns dehorning?

Answer 26

Cornual nerve block
Clip hair
blade at start of hair
stop bleeding pull small vessel
gauze cover if open to sinus

Question 27

Keys to castration?

Answer 27

Good drainage
younger better
anesthesia local
fly spray

Question 28

What are the most common bones fractured in ruminants?

Answer 28

Metacarpus, metatarsus, tibia, radius/ulna, humerus and femur

Question 29

What are some advantages of fracture repair in ruminants?

Answer 29

Lay down more
good potential bone healing
rarely have contralateral limb break down
dont mind orthopedic device

Question 30

What are some things that decrease the prognosis for any repair?

Answer 30

Sepsis, nerve damage and vascular trauma

Question 31

What are some considerations in fracture repair of ruminants?

Answer 31

Economics, genetics, cause of fracture, pets and after care

Question 32

What are the bad kinds of fractures?

Answer 32

Open, articular and proximal limb in adult

Question 33

Is internal fixation an option in ruminants?

Answer 33

Yes! - need confinement up to 9 months, infection possible

Question 34

Can you externally fix a skeletal fracture?

Answer 34

Yes (equipment tricky), cheaper than internal, need stall rest

Question 35

How should you apply a cast? (where in relation to the fracture?)

Answer 35

the joint above and below the injury

Question 36

What should you tell the farmer about the cast?

Answer 36

Keep the cow in small pen, out of rain, will need bandage 2 week after off and confinement 4-8 week after removal

Question 37

How many layers of casting material?

Answer 37

4-6 if <330lb
8-12 if adult

Change e3 week 0-6month
e 6 week 6-12 month
6-8 week if older than 12 month

Question 38

Walk me through placing a cast:

Answer 38

1. Clean and dry the hoof well
2. Cotton cast padding 2 layers , 3 over dewclaw and joint
3. Vet wrap - firm
4. Casting Material (glove)
5. Duct tape over cast toe and sole
6. Elasticon to skin

Question 39

Whats the prognosis for an open fracture?

Answer 39

Poor to grave (cast make it worse) - need external fixation and lavage wound

Question 39

What type of fracture is common in calves?

Answer 39

Physeal fracture - Salter 1 and 2
(Distal metatruss/metacarpus, distal femur and radius or proximal tibia

Question 40

What considerations should you have for calves?

Answer 40

Immune system decreased- risk postop infection and concurrent disease (pneumonia and navel ill) Angular limb deformities possible )

Question 41

What is an important consideration for the Thomas Schroeder Splint?

Answer 41

If splinted leg down then cant get up

Question 42

If fracture is in the foot what should be done?

Answer 42

Block good foot and wire other toe in flexion
Digit amputation?

Question 43

Why is coxofemoral joint luxation more common in dairy than beef?

Answer 43

Floors, less muscling