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Small Animal Surgery > Internal Fracture Fixation (2 of 4) > Flashcards

Internal Fracture Fixation (2 of 4) Flashcards

1
Q

What is orthopedic wire made of?

A

Stainless steel

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2
Q

What is the benefit of thicker wire (lower gauge)?

A

Increased tensile strength

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3
Q

What is orthopedic wire never used for?

A

The sole method of fx fixation

NOTE: Exception is some mandibular fractures

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4
Q

What 3 things is orthopedic wire typically used with?

A

IM pins
External skeletal fixators
Plates

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5
Q

What are 3 applications for orthopedic wire?

A 
Cerclage wire (+/- skewer pins)
Tension bands (avulsion fractures)
Interfragmentary wire
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6
Q

What is cerclage wire?

A

Wire places circumferentially around the bone column to cause compression across the fracture line (oblique fx)

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7
Q

What are the 5 major rules for cerclage wire placement?

A

Only use on long oblique or spiral fx
Place at least 2 cerclage wires
Place 0.5cm from fx ends, spaced ~0.5-1x bone diameter apart
Place the wire perpendicular to the bone
Cut the wire leaving 2-3 twists or a 5-10mm arm

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8
Q

When considering cerclage for long oblique or spiral fx, what 2 conditions must exist?

A

Fracture line >2x bone diameter

Must be able to reconstruct the bone column (so it can bear weight)

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9
Q

Why should you not bend over the twist in the cerclage wire?

A

It loosens the wire

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10
Q

What situation would you use cerclage and skewer pins?

A

Short oblique fractures

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11
Q

How is a cerclage and skewer pin applied?

A

K-wire placed through fracture segments perpendicular to the fracture and cerclage wire is placed around the bone to hold pieces together

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12
Q

What is the purpose of a tension band wire?

A

To neutralize the pull of muscle/tendons on the fracture fragment

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13
Q

When is a tension band wire indicated?

A

Avulsion fractures and some osteotomies

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14
Q

What are 6 clinical applications for a tension band wire?

A 
Acromion
Olecranon
Greater trochanter
Patella
Greater tuberosity
Lateral malleolus
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15
Q

What are the general 4 steps to applying a tension band wire?

A
  1. Reduce the fragment and drive 2 K-wires across the fx
  2. Drill hole through both bone cortices distal to the fx line to pass orthopedic wire
  3. Pass wire through the hole and figure-eight around the ends of the pins and back to other end of wire
  4. Tighten wire via twist
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16
Q

What is an interfragmentary wire?

A

Used like sutures to hold bone fragments together

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17
Q

What is the indication for an interfragmentary wire?

A

Simple fx of flat, non-weight bearing bones that interdigitate well

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18
Q

What is the most common use for an interfragmentary wire?

A

Mandibular and maxillary fx

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19
Q

What are Steinmann pins often referred to as?

A

Intramedullary pins

20
Q

What are Steinmann pins made of?

A

Stainless steel

21
Q

What are Kirschner wires?

A

Small Steinmann pins

NOTE: Can be easily bent

22
Q

What type of points can you find on a Steinmann pin?

A

Trochar vs. chisel

Smooth vs. threaded

23
Q

What type of points can you find on a Kirschner wire?

A

Trochar point

Smooth vs. threaded

24
Q

What are the 6 different Steinmann pin applications?

A 
Intramedullary placement
Cross pinning
Rush pinning
Diverging pins
Skewer pin
Tension band constructs
25
Q

What are two types of intramedullary placement of Steinmann pins?

A

Single pin

Stack pinning

26
Q

What is Cross pinning most commonly used for?

A

Salter-Harris fx

27
Q

What are 3 advantages of Steinmann pins?

A

Less expensive than plates/screws
Smaller surgical approach with less surgical time
Easy to remove if necessary

28
Q

What are 2 disadvantages of Steinmann pins?

A

Only resists bending (bone can still rotate and distract)

Pin migration

29
Q

How do you place an Intramedullary pin?

A

In medullary cavity of bone

30
Q

Why would you place an intramedullary pin?

A

To help restore length and maintain alignment

31
Q

What is an IM pin almost never indicated as the sole form of fixation?

A

Because only resists bending forces, needs to be fortified with other fixation methods

32
Q

What 6 bones can IM pins be used in?

A 
Humerus
Femur
Tibia
Ulna
Metatarsals
Metacarpals
33
Q

What bone is an IM pin contraindicated for?

A

Radius because of the shape, you will end up passing the pin through the articular surface

34
Q

What must IM pins NEVER do?

A

penetrate the joint surface

35
Q

What are 2 methods of placing and IM pin?

A

Normograde

Retrograde

36
Q

If you’re using an IM pin and cerclage, what diameter pin do you want?

A

70% canal fill

37
Q

If you’re using an IN pin and a place, what diameter pin do you want?

A

35-40% canal fill

NOTE: This smaller diameter is because you don’t want the pin to be in the way of the screws

38
Q

What is stack pinning?

A

Using 2 or more smaller diameter pins

39
Q

What are 3 reasons stack pinning is not really practiced anymore?

A

No mechanical advantage
Higher incidence of migration
Increased damage to medullary blood supply

40
Q

What is cross pinning?

A

Use of small diameter Steinmann pins or K-wiresto engage the near and far cotex

NOTE: Pins will cross above the fx line

41
Q

When is cross pinning indicated?

A

Simple, transverse fractures that are close to the joint, especially Salter-Harris type 1 and 2 fxs

42
Q

What is Rush pinning?

A

Uses 2 IM pins that are forced to curve and have 3 points of contact

43
Q

When is Rush pinning indicated?

A

Some Salter-Harris fxsx and supracondylar fxs

44
Q

What is a diverging pin technique used for?

A

To stabilize Salter-harris type 1 fxs of proximal humerus or femoral head

45
Q

What must a diverging pin technique do?

A

Achieve anatomical reduction to promote normal physeal anatomy and bone growth

Small Animal Surgery (13 decks)

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