Fracture repairs

Question 1

What counteracts all forces and can be contoured to the shape of the bone?

Answer 1

Bone plates

Question 2

Dynamic compression plates aka DCP plates-

Answer 2

Oval shaped screw holes, can be used to compress the fracture, screws may be placed neutrally and DO NOT compress
Screwing in middle of the holes means neutral, lack of compression
Offset of the holes means more compression

Question 3

DCP plates promote ____ healing

Answer 3

primary

Question 4

______ plates have limited contact between the bone and plate and easier to contour the plate.

Answer 4

LC-DCP

Question 5

How do LC-DCP plates avoid obstruction of bf??

Answer 5

by decreasing the contact between bone and plate

Question 6

What are the three types of plates?

Answer 6

Compression plates, locking plates, specialty plates

Question 7

What is the ORIF technique? What is its goal?

Answer 7

Open Reduction with Internal Fixation

primary goal is primary bone healing! Most stable form of repair but causes more damage to the bf and soft tissue surrounding the bone

Question 8

MIPO aka Minimally Invasive Plate Osteosynthesis- Goal is to….

Answer 8

goal is to stabilize and align the fracture without disrupting the bf

Align joint and preserve the length of bone

Question 9

Open but do not touch principle-

Answer 9

Open repair of fracture with minimal incision, fracture site hematoma is not disrupted and still allows for anatomic alignment with plate placed across the bone
Avoid disrupting bf and hematoma
Best of both world if able to do it

Question 10

We need ___ screws above and ___ screws below. Be sure to make ___ cortices min with DCP plates.
___ cortices min. with locking plates

Answer 10

3;3;6 with DCP plates; 5 min with locking plates

Question 11

Plate placement- plate should be placed on side with greatest _____ to overcome bending. where is this not the case?

Answer 11

tension; except in femur where the tension is cranial but the plate is on the lateral side due to soft tissues

Question 12

where to put the plate in the…

1. Radius
2. Tibia
3. Humerus

Answer 12

1. Radius- dorsal
2. Tibia- medial
3. Humerus- lateral

Question 13

Avoid placing screws towards the _____ ____

Answer 13

fracture line

Question 14

____ and ____ screws are based on the type of bone, locking vs. nonlocking heads.

Answer 14

cortical and cancellous screws

Question 15

___ screw is not a type of screw, it is a type of positioning of the screw.

Answer 15

Lag

Question 16

Near side aka ____ _____ is where the hole matches the OUTER diameter of the screw

Answer 16

CIS CORTEX

Question 17

Far side aka ___ ____ is where the hole matches the shaft diameter of the screw

Answer 17

TRANS CORTEX

Question 18

What form of plating is where the bone does not bear the weight, walking on their plate.

Answer 18

Buttress aka bridging

Question 19

When do we use Buttress aka bridging? What is our goal?

Answer 19

Too much of a gap in the bone. We have to rely on callus formation without primary bone healing and our goal is to maintain bone length!!!

Question 20

What method of plating is where implant shares the load with the bone and does not compress the fracture. Bone is not bearing full weight, relies on callus formation without primary bone healing.

Answer 20

Neutralization

Question 21

String of pearls (SOP_ plate is rounded with larger holes, best for ____

Answer 21

Contouring to the bone

Question 22

Why cant we only use a pin by itself?

Answer 22

NEVERR use a pin by itself because they can only prevent bending and shearing, but NOT strong, and does not work against torsion or compression

Question 23

Normograde insertion of pins vs. retrograde insertion of pins:

Answer 23

Normograde- fracture is reduced, pin is driven down into bone, across fracture and into opposite bone segment
Retrograde is where pin is driven up trough the distal portion of the fragment- fracture is reduced- pin is driven across the fracture and seated in the opposite (proximal) segment

Question 24

Kirchner aka K wires are similar to _____ pins but not as strong

Answer 24

Steinmann

Question 25

Interlocking nails are very strong and can be placed with minimal invasiveness. What are the pros and cons?

Answer 25

Pros- can be placed minimally invasively in some bones, does not damage hematoma
Cons- thick so impacts bone supply in the medullary cavity

Question 26

Fracture line must be ____ x the diameter of the bone to use full cerclage wire**

Answer 26

More than 2x

Question 27

**Full cerclage wires should be spaced ____ cm apart and ___ cm from end of fracture lines. Must be min of ___ wires

Answer 27

about 1cm; 0.5cm; 2 wires

Question 28

For full cerclage wires– Wires are placed _____ to long axis of bone shaft

Answer 28

Perpendicular

Question 29

Tie in configuration is used when there is fracture of what two bones?

Answer 29

femur or humerus

Question 30

ESF clamped into IM pin in the bone is called

Answer 30

Tie-in configuration

Question 31

circular fixators (CESF) are when we use small wires as _____ pins

Answer 31

transfixation

Question 32

When do we use circular fixators (CESF)

Answer 32

Fracture fixation, limb lengthening, angular limb deformity correction

Question 33

Hybrid fixations (components of both CESF and linear ESF) makes use of ___ and ____ compartments

Answer 33

linear and circular;

Question 34

Criteria for sx of pelvic fx:

Answer 34

Articular fracture (acetabulum), weight bearing axis (ilial body fx, or SI luxation), marked decrease in pelvic canal

Question 35

What is the most common pelvic fracture and how do we repair it?

Answer 35

Ilial body fx, repair with plate and screws

Question 36

SI luxation repair involves __ screw placement

Answer 36

Lag screw

Question 37

____ fractures are usually concurrent damage to femoral head cartilage, joint surface must be reconstructed, likely to result in long term arthritis

Answer 37

Acetabular

Question 38

When is it okay to do without sx for pelvic sx?

Answer 38

If only CAUDAL (non weight bearing) part is affected-

Question 39

Physeal fractures usually occur in patients less than ___ years old.

Answer 39

1 year

Question 40

During physeal fracture, damage to growth plates may result in ___ ____ or limb shortening

Answer 40

angular deformities

Question 41

The process by which growing cartilage is systemically replaced by bone is called ______ _____

Answer 41

Endochondral ossification

Question 42

Stabilization of spinal fx requires surgical fixation with ____ ____

Answer 42

internal fixation

Question 43

What are the 4 A’s of fracture assessment*?

Answer 43

Alignment, Apposition, Apparatus, Activity

Question 44

Must have more than ___% apposition for healing

Answer 44

50%

Question 45

____ is the assessment of the surgical implants themselves and how they are placed and if they are the right size

Answer 45

Apparatus

Question 46

Activity is the bone healing process in terms of..

Answer 46

function maintained and is assessed using pre-op, post-op and follow up rads

Question 47

Neuropraxia nerve damage-

Answer 47

short term, temporary neuro deficiencies, with inflammation that resolves on its own

Question 48

Nerve damaged from increased pressure in the muscle….

Answer 48

aka “compartment syndrome” which is common around the femur where it puts pressure on the nerve

Question 49

What are some possible joint complications?

Answer 49

decreased range of motion- loss of mobility in the joint, called “ankylosis”

Question 50

soft tissues of delayed/non-union include decreased bf in distal antebrachium usually in small dogs. Most common location is the ?

Answer 50

Distal radius

Question 51

Involucrum definition:

Answer 51

Periosteal new bone surrounding the sequestrum, may look sclerotic on rads