Orthopaedic axial repair

Question 1

What extra considerations should we have for mandibular fractures

Answer 1

Do a full neuro exam since head trauma
MAy need to place a feeding tube due to instability caused by jaw movement

Question 2

What are the alternative techniques to repair a mandibular symphyseal separation apart from cerclage wire

Answer 2

Heavy gauge PDS as an alternative to wire to avoid needing sedation to remove

Intraoral splinting

Question 3

What do we need to think about when repairing maxillary fractures

Answer 3

If there is a palatine mucosal defect should repair this

Question 4

How to do conservative management for scapula fractures

Answer 4

cage rest +/- velpeau sling

Question 5

What is important to be aware of with pelvic fractures

Answer 5

there will be at least 2 fractures because the pelvis is a box shape

Question 6

After what fracture might we place an animal on stool softeners

Answer 6

Pelvic

Question 7

Which pelvic fractures are indications for surgery

Answer 7

Those along weight bearing axis i.e ilial body, acetabulum, sacroiliac joint

Articular joint fractures

> 30% narrowing

Nerve entrapment

Question 8

What do we need to be aware of with acetabular fracture repair

Answer 8

Need perfect anatomical reduction to slow osteoarthritic progression

Unless doing a total hip replacement

Question 9

What is the most common way to repair sacroiliac luxation

Answer 9

Lag screw that engages >60% width of sarcum

Question 10

What is delayed union

Answer 10

when fracture has not healed within anticipated time

Question 11

What is non-union

Answer 11

When fracture has stopped healing

Question 12

What is malunion

Answer 12

When a fracture has healed in an abnormal anatomical position

Question 13

What strain percentages do we consider relatively vs absolutely stable

Answer 13

Relative stability = <10% strain

Absolute stability = <2% strain

Question 14

What strain is needed for direct bone healing

Answer 14

Absolute stability i.e <2% strain

Question 15

Why might a fracture gap appear to increase during early stages of healing

Answer 15

Due to homeostatic principle of reducing strain

Question 16

What is the most important biological factor causing delayed or non-union

Answer 16

inadequate blood supply

Question 17

Biological factors contributing to delayed and non-union

Answer 17

 Inadequate blood supply**
 Loss of soft tissue coverage
 Systemic or metabolic disease
 Infection
 Excessive fracture gap

Question 18

Mechanical factors contributing to delayed and non-union

Answer 18

INadequate stability
Excessive fracture gap

Question 19

How can we deal with viable non-union treatment

Answer 19

Increase stability
Debride sclerotic bone ends and perforate to create vascular tunnels
Use bone graft

Question 20

How to deal with non-viable non-union fracture cases

Answer 20

REmove non-viable fragements
Debride
Open medullary cavity
INcrease stabilty
Use bone graft
Add in synthetic scaffolds
Can try distraction osteogenesis

Question 21

What is distraction osteogenesis

Answer 21

put external fixator device on bone ends and slowly pull apart (1mm/day) to keep producing bone and elongating

Question 22

How can we deal with varus or valgus malunion

Answer 22

Remove a wedge of bone at the centre of the abnormality for a closing wedge osteotomy

Or remove wedge from a different aspect and open the wedge up for an opening wedge osteotomy

Question 23

What is the most common cause of osteomyelitis

Answer 23

Bacterial infection
mostly iatrogenic

Question 24

WHat is osteomyelitis

Answer 24

Inflammation of the bone (marrow)

Question 25

Radiographic changes with osteomyelitis

Answer 25

periosteal and endosteal bone formation (usually irregular), bone resorption, may see bony sequestra (dead, hard, hyperdense bone), loosening of implants due to bone resorption

Question 26

Treatment of osteomyelitis

Answer 26

Broad spectrum antibiotics