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fracture repair 1 > Decision Making in Fracture Repair > Flashcards

Decision Making in Fracture Repair Flashcards

1
Q

Which fractures require most urgent tx? (3)

A
  • Open
  • Skull
  • Spine
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2
Q

How quickly should articular # and dislocations be dealt with?

A

24-48hours

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3
Q

Within what time period should long bone # be treated within?

A

5-7 days

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4
Q

What happens if there is a delay in # repair of long bones?

A

There is an increasing risk that the fracture cannot be reduced (or reduction will be more challenging) due to developing callus and muscle contracture.

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5
Q

What are the main aims of fixation? (3)

A
  • support #healing
  • Allow early ambulation
  • Patient return to normal asap
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6
Q

The aim with a bone fracture is to repair it with as simple and as reliable a method as possible. For a surgical repair, what would ideally be involved? (4)

A
  • Minimal disruption to the blood supply of the bone;
  • Minimal cost of implants;
  • Implants that do not need removal OR implants that can easily be completely removed once the fracture has healed with no need for a second operation;
  • Minimal rechecks required of the patient.
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7
Q

The decision as to which fixation technique to use depends on several factors. Can you think of some? (12)

A

1 The nature of the fracture (classification)

2 The size, age and nature of the animal

3 Circumstances and compliance of the owner

4 Type and quality of the bone(s) involved

5 Involvement of joint surfaces

6 Open or closed fracture

7 Single or multiple fractures

8 Single or multiple limb involvement

9 Magnitude and direction of forces acting at the fracture site

10 The availability of equipment

11 The experience of the surgeon

12 The expense of the procedure.

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8
Q

Name possible stabilisation options (5)

A
  • External coaptation
  • Plate and rod fixation
  • Interlocking nail
  • Plate and screws
  • ESF
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9
Q

Where can you NOT use external coaptation?

A

Upper limb

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10
Q

Where can you NOT use IM pins?

A

Radial #
Mandibuar #

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11
Q

What type of implant are IM pins?

A

Auxiallry (not primary)

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12
Q

Where are ESF best suited?

A

Lower limb

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13
Q

Where should we avoid ESF?

A

Where large muscles

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14
Q

What are the options for non-reconstrutvie #? (3)

A

OBDNT - Open but do not touch
Cosed application f ESF
MIPPO/MIPO - minimally invasive ‘percutaneous’ plating osteosynthesis

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15
Q

Non reconstructive # repair:
A) What is the bone length aim?
B) Angle malalignment aim?

A

A) spatial realignment with maintenance of bone length
B) Less than 5 degree of angular/rotational malalignment

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16
Q

Why can small + weaker implants be used in young animals?

A

Young animals (less than 6 months of age) heal rapidly. Smaller and weaker implants can be used as stability does not need to be maintained for such a long period

17
Q

How does an open physes affect # repair decision making?

A

Open physes require special consideration. An implant should be selected that will minimally damage these and allow continued growth, such as K-wires applied perpendicular to the growth plate.

18
Q

When is a more rigid fixation required? (2)

A

Active - anticipate slow bone
Older

19
Q

How does the O affect # repair technique?

A

The circumstances and likely compliance are important factors with the overall potential to define the overall success of the treatment.

20
Q

When do you expect a higher risk of implant related problems?

A
  • Young animals with soft bone
  • Osteopenic bone with poor screw holding
  • Underlying dx e.g. cushings
  • Chondrodystrophic
21
Q

What are the principles of articular repair? (4)

A
  • Anatomic reduction of the articular surface
  • Rigid internal fixation
  • Interfragmentary compression of the fracture gap (this usually involves the use of lag screws +/- plates)
  • Early mobilisation and use of the joint to minimise joint stiffness.
22
Q

What is a grade 1 open #?

A

Small wound with minimal soft tissue/muscle damage resulting from the bone itself penetrating the skin. Severe bruising (as in the image) can result in loss of a normal skin barrier and can be classified according to a type 1 open fracture.

23
Q

What is a grade 2 open #?

A

Larger skin wound caused by external trauma

24
Q

What is a grade 3 open #?

A

Extensive loss of skin and bone after severe fractures

25
Q

True or false?
Grade 1 open fractures can’t be treated as closed fractures.

A

False

26
Q

True or false
Grade 2 open fractures can be treated as closed fractures.

A

False

27
Q

True or false:
For Grade 3 open fractures a fixation that is away from the fracture site is recommended.

A

True

28
Q

What type of fixation is needed for multiple #?

A

Most rigid

29
Q

When considering the treatment options for a fracture, it is important to consider what forces?

A

Those acting across the fracture once it has been reduced.

30
Q

What degree do transverse fractures can resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion

A

A) -
B) +
C) +++
D) -

31
Q

What degree do oblique/spiral fractures can resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion

A

A) +
B) -
C) -
D) +

32
Q

What degree do comminuted fractures can resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion

A

A) -
B) -
C) -
D) -

33
Q

What needs to be considered when choosing an implant to use?

A

To neutralise the forces acting across reduce #

34
Q

What degree do IM pins resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion

A

A) +
B) -
C) -
D) -

35
Q

What degree do interlocking nails resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion

A

A) +
B) +
C) ++
D) +

36
Q

What degree do ESF resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion

A

A) ++
B) +
C) +
D) +

37
Q

What degree do plates and screws resist the acting forces:
A) Bending
B) Shear
C) Axial compression
D) Torsion

A

A) +
B) ++
C) +++
D) ++

38
Q

Should a transverse fracture that cannot resist torsional forces should be repaired with an IM pin?

A

NO - it also cannot resist torsion force

fracture repair 1 (10 decks)

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