Chapter 1 Flashcards
1
Q
What are musculoskeletal injuries commonly associated with?
A
Concurrent trauma to other organ systems.
Evaluate and treat the patient before concentrating on treat
POLYTRAUMA
2
Q
You should focus on providing life support prior to addressing orthopedic injuries.
A
True
3
Q
What is the AO fracture classification system used for?
A
Facilitating fracture repair planning and minimizing intraoperative time.
4
Q
What should be adhered to in order to avoid patient complications?
A
Proper preoperative assessment and preparation, surgical asepsis, and atraumatic fracture reduction techniques.
5
Q
What should be evaluated postoperatively?
A
Fracture fixation radiographically for reduction, stability, and joint alignment.
Alignment, Apparatus, Apposition, and Activity
6
Q
What is important to provide postoperatively to avoid detrimental effects?
A
Supportive care and early active rehabilitation.
7
Q
What are the four A’s during radiographic review of a fracture?
A
- Alignment
- Apparatus
- Apposition
- Activity
8
Q
What does ABCD stand for in triage?
A
- A = airway
- B = breathing
- C = circulatory
- D = other disabilities.
9
Q
What is the first priority in patient assessment and triage?
A
Recording vital signs to establish a baseline for treatment.
10
Q
What should be obtained and submitted for an emergency minimum database?
A
Blood and urine samples.
11
Q
How is airway patency evaluated?
A
By looking in the oral cavity and pharynx for signs of obstruction.
12
Q
How can oxygen be administered that does not cause stress?
A
- Via face mask
- Nasal insufflation (ex. high flow)
- Oxygen cage
- Flow-by technique
The recommended oxygen flow for nasal insufflation is 50 to 100 mL/kg/minute.
13
Q
What should be assessed to evaluate breathing?
A
Observation and auscultation.
14
Q
How can oxygen saturation be assessed?
A
By pulse oximetry
or an arterial blood gas test.
15
Q
What should be assessed to accurately evaluate a fracture injury?
A
The fracture and the surrounding soft tissue
This includes evaluating soft-tissue damage, embedded foreign debris, and neurovascular structures.
Make sure before treatment to complete a physical, orthopedic, and neurological examination. Including appropriate diagnostic imaging techniques.
16
Q
How should open fractures be handled immediately?
A
Cover them immediately
This helps to prevent contamination and further injury.
17
Q
What is the purpose of wet-to-dry dressings?
A
For continued debridement of necrotic tissue
These dressings facilitate the removal of nonviable tissue.
18
Q
What procedure should dyspneic animals undergo for pneumo- or hemothorax?
A
Thoracocentesis
This procedure helps relieve pressure in the thoracic cavity.
19
Q
What parameters are evaluated to assess circulatory function?
A
- Heart rate
- Rhythm
- EKG
- Pulse character
- Mucous membrane color
- Capillary refill time
These evaluations help determine the hemodynamic status of the patient.
20
Q
What should be established to treat hypovolemic shock?
A
Vascular access with an intravenous catheter
Crystalloid fluids are typically used to treat hypovolemic shock.This can be follow with hyptertonic saline.
21
Q
What should be done if crystalloid therapy does not improve hemodynamic status?
A
Consider colloid or blood product supplementation
This may be necessary to stabilize the patient’s condition.
22
Q
What is included in the emergency minimum database for trauma patients?
A
- Packed cell volume (PCV) / Total solids
- Blood glucose
- Blood urea nitrogen
- Activated clotting time
- Urine specific gravity
These parameters help detect preexisting disease.
Baseline blood work parameters should be perofmred the first 24-72 hours to monitor for changes.
23
Q
What imaging should be evaluated in all animals with external traumatic injuries?
A
Thoracic and abdominal radiographs
This evaluation is crucial before definitive therapy is instituted.
24
Q
What factors play a role in determining treatment options for musculoskeletal injuries?
A
- Extent of soft-tissue trauma
- Presence of embedded foreign debris
- Damage to underlying neurovascular structure
- Depth and width of wounds
These factors influence both treatment and functional outcomes.
25
What should be assessed for the neurological and circulatory status of an affected limb?
Sensation and vascular integrity
## Footnote
This includes evaluating voluntary motor and sensory function, skin perfusion, and peripheral pulses.
26
What is a simple non-invasive method for determining tissue viability?
Doppler ultrasound
## Footnote
This technique helps assess blood flow and tissue health.
27
What type of bandage is recommended for fractures below the elbow and stifle?
A Robert Jones bandage or a modified Robert Jones bandage with splints
## Footnote
These bandages provide support and immobilization.
28
What is required to accurately assess a fractured extremity?
A minimum of two orthogonal radiographic views
## Footnote
This ensures a comprehensive evaluation of the fracture.
29
What should be done if joint instability is suspected in a fractured bone?
Obtain stress radiographs
## Footnote
This helps to evaluate the stability of the joint.
30
What is important to consider when planning fracture treatment?
Radiographs of the contralateral intact bone can serve as a template
## Footnote
This is particularly useful in articular fractures.
31
What should be clearly communicated to the client before surgery?
The decision to operate and choice of procedure
## Footnote
Discussing advantages and risks is essential for informed consent.
32
Why is pain management essential?
To reduce anxiety, decrease stress and its associated hormonal and metabolic derangements, and to allow the patient to rest comfortably.
33
When are analgesics most effective?
When administered prior to the onset of pain.
34
What is preferred for pain management and why?
Multimodal or multiple agent analgesia, as it results in a synergistic analgesic effect.
35
What are common behavioral signs of pain in veterinary patients?
* Vocalization
* Postural changes
* Trembling
* Restlessness
* Depression
* Disrupted sleep cycles
* Inappetence
* Aggression
* Agitation
36
What are common physiological parameters indicative of pain?
* Tachypnea
* Tachycardia
* Hypertension
* Dilated pupils
* Ptyalism
37
Which patients benefit from pain management?
All trauma and surgical patients.
38
What phenomenon alters how the nervous system processes pain after surgery?
Sensitization.
39
How do nociceptor afferent fibers change peripherally after injury?
They display a reduced threshold for stimulation.
## Footnote
Sensitization
40
What is the effect on spinal cord neurons in the dorsal horn after injury?
They experience an increase in activity and excitation.
41
What are common agents used as preemptive analgesics?
* Opioids
* Nonsteroidal anti-inflammatory drugs (NSAIDs)
* Local anesthetics
42
What is the role of opioids in pain management?
They act at both peripheral and central sites to reduce afferent nociceptive transmission and alter spinal pathways.
43
What is the action of NSAIDs in pain management?
They reduce peripheral nociceptor activity and may have a central analgesic action.
44
What is the function of local anesthetics?
They act peripherally to prevent the transduction of noxious stimulus to the dorsal horn of the spinal cord.
45
What are less commonly employed analgesic adjunctive agents?
* α2-adrenergic agonists (medetomide, xylazine)
* NMDA antagonists (e.g., ketamine)
* Corticosteroids
46
What distinguishes single agent analgesia from multimodal analgesia?
Single agent involves the administration of a lone drug, while multimodal involves a combination of different classes of analgesic drugs.
47
What are the advantages of multimodal analgesia?
* Selectively targets several sites along the pain pathway
* Results in an additive or synergistic analgesic effect
* Reduces dosages of individual drugs
48
What benefits does multimodal analgesia provide when used preemptively?
* Inhibits surgery-induced sensitization
* Minimizes development of drug tolerance
* Suppresses the neuroendocrine stress response
* Shortens recovery time
49
What are the effective routes of drug delivery for pain management?
* Injectable
* Transdermal
* Oral
50
What is the benefit of continuous rate infusion (CRI) for narcotics?
It maintains a constant plasma level of a drug, eliminating periods of diminishing analgesia.
51
What should be avoided in pain management?
Waiting for the animal to show pain before implementing pain relief.
52
Which drugs are commonly used as CRI agents?
* Opioids (fentanyl, morphine, pethidine)
* NMDA antagonists (ketamine)
* Local anesthetics (lidocaine)
53
How should fentanyl patches be applied?
They must be applied 12–24 hours prior to surgery to reach therapeutic plasma concentration.
54
What is an important consideration when using transdermal patches?
They cannot be modified to change the dose delivered, so patients must be monitored closely.
55
What role do NSAIDs play in oral administration for pain management?
They are the most commonly used oral drugs but should not be used as a single analgesic agent except in minor procedures.
56
When are NSAIDs most effective?
When administered 12–24 hours prior to surgery.
57
What risks should be considered before using NSAIDs?
* Gastrointestinal ulceration
* Renal disease
* Coagulopathy
58
What should not be used in the management of chronic post-fracture repair pain?
Cyclooxygenase 2 (COX-2) inhibitors.
## Footnote
Due to there inhibitory affect on bone healing.
Examples: deracoxib, firocoxib, robenacoxib, mavacoxib, and cimicoxib
59
Name opioids used in dogs and cats?
Morphine
Oxymorphone
Fentanyl
Hydromorphone
Buprenorphine
60
Name adjunct analgesics with opioids?
Alpha adrenergic antagonist (Xylazine, Medetomidine)
NMDA receptors antagnoist (Ketamine)
Local anesthetic (lidocaine)
Tranquillizers (Ace, Diazepam, Midazolam)
61
Name two common agents used as sedatives in orthopedic procedures.
* Neuroleptanalgesic agents
* α2-adrenergic-agonist agents
62
What is neuroleptanalgesia?
A combination of a neuroleptic drug (acepromazine) and an analgesic drug (usually an opioid) that induces hypnosis and analgesia.
63
What are the benefits of using α2-adrenergic-agonists in orthopedic patients?
* Good muscle relaxation
* Easily reversible
* Can be combined with opioids for additional analgesia
64
True or False: α2-adrenergic-agonists are safe for dogs and cats with suspected cardiac dysfunction.
False
65
Why is a balanced anesthetic protocol required for orthopedic procedures?
Due to their high level of surgical stimulation.
66
What components are commonly included in anesthetic protocols for fracture repair?
* Analgesic premedication
* Injectable induction agents
* Inhaled gases for maintenance
67
List some common opioids used in preanesthetic drug combinations.
* Morphine
* Oxymorphone
* Hydromorphone
* Pethidine
* Fentanyl
* Meperidine
* Butorphanol
* Buprenorphine
68
What are the alternative combinations for preanesthetic sedation?
* α2-adrenergic-agonist (medetomidine, xylazine) and an opioid
* Benzodiazepine (diazepam or midazolam) and an opioid
69
What can be administered as a continuous rate infusion intraoperatively?
* Opioids (morphine or fentanyl)
* Ketamine
* Lidocaine
70
What is the purpose of local and regional anesthetics in surgery?
* Decrease intraoperative pain response
* Provide good muscle relaxation
* Attenuate autonomic and endocrine responses to surgery
71
How can NSAIDs be used prior to surgery?
Administered 12–24 hours prior to surgery for improved postoperative comfort.
72
Fill in the blank: Balanced anesthesia includes _______.
[analgesic premedication, injectable induction, inhaled gases, local and regional anesthetics]
73
What is the effect of balanced anesthesia during fracture treatment?
Provides excellent anesthesia, analgesia, and muscle relaxation.
74
What is the primary cause of orthopedic infections?
Staphylococcus intermedius originating from the skin
75
What is the infection rate of elective orthopedic surgery?
Between 2.5 and 4.8%
76
What are known host risk factors for infection in small animal surgical patients?
* Age of the patient (> 8 years)
* Presence of distant sites of infection
* Obesity
* Preexisting endocrinopathy
* Prior irradiation of the surgical site
77
What intraoperative factors increase the risk of infection?
* Preclipping the limb prior to anesthetic induction
* Inadequate skin preparation of the surgical site
* Prolonged anesthetic episode
* Administration of propofol as part of the anesthetic protocol
78
What are some intraoperative factors potentiating wound infection?
* Duration of surgery (> 90 minutes)
* Excessive use of electrocautery
* Break in surgical asepsis
* Use of braided or multifilament suture material
* Large orthopedic implants within the wound
79
Define perioperative antimicrobial prophylaxis.
Administration of an antimicrobial agent prior to a surgical incision
80
What is the effect of appropriately employed antimicrobial prophylaxis during clean orthopedic procedures?
A four-fold reduction in the rate of infection
81
When is *perioperative* antimicrobial prophylaxis traditionally not recommended?
In clean procedures except when:
* Procedure time exceeds 90 minutes
* Metallic implants are used
* Extensive soft-tissue injury is present
82
What characteristics should an ideal antimicrobial agent have?
* Bactericidal
* Low toxicity
* Cost-effective
* Parenterally administered
83
What is the antimicrobial of choice for most veterinary surgeons?
Cefazolin
84
What must occur for an antimicrobial to be effective?
It must be present within the tissue at maximal therapeutic concentrations at the time of contamination (or at the time of incision)
85
When should intravenous antimicrobials be administered prior to surgical incision?
At least 30 minutes prior (but not more than 60 minutes)
86
What happens if antimicrobials are administered after contamination has begun?
They have no effect in controlling wound infection
87
When is redosing of antimicrobials necessary?
Based on the known pharmacokinetic behavior of the drug and the time during which adequate concentrations are required
88
What are the criteria for classifying appendicular fractures?
Based on location, reducibility, direction, number of fracture lines, stability after anatomical reconstruction, and communication with the outside environment.
## Footnote
AO Vet has adapted a classification system from humans for small animals.
89
What number is assigned to the humerus in the fracture classification system?
1
## Footnote
The numbers represent different long bones.
90
What is the alphanumerical code for the radius/ulna?
2
## Footnote
Each long bone has a unique number for classification.
91
What is the meaning of 'A' in the fracture severity classification?
Single fracture
## Footnote
The severity classification includes types A, B, and C.
92
What does type B represent in fracture severity?
Wedge or butterfly fragment
## Footnote
This classification helps in understanding the complexity of the fracture.
93
What characterizes a type C fracture?
Complex or more than one fragment
## Footnote
This indicates a more severe fracture situation.
94
What defines a type I open fracture?
Small laceration (< 1 cm), clean
## Footnote
Type I fractures have minimal soft-tissue injury.
95
What is the size of the laceration for a type II open fracture?
Larger laceration (> 1 cm)
Mild soft tissue trauma
No flap or avulsions
## Footnote
Type II fractures involve mild soft-tissue trauma.
A skin wound that communicates with the fracture and more extensive soft-tissue injury due to external trauma
96
What distinguishes type III(a) open fractures?
Vast soft-tissue laceration or flaps or high-energy trauma, with soft tissue available for wound coverage.
## Footnote
This type indicates significant soft-tissue injury.
97
What are the characteristics of type III(b) open fractures?
Extensive soft-tissue injury loss, bone exposure present, periosteum stripped away from bone.
## Footnote
Indicates a severe level of injury.
98
What complication does type III(c) open fracture indicate?
Arterial supply to the distal limb damaged. Possibly requiring arterial repair for limb salvage.
## Footnote
This classification highlights critical vascular injury.
99
What distinguishes type III open fractures?
Severe comminution and extensive soft-tissue injury with variable skin loss
## Footnote
These fractures are usually caused by high-energy trauma such as gunshot injuries or vehicular trauma.
100
How are physeal fractures classified?
By the Salter-Harris classification system (I–VI)
## Footnote
This classification describes the fracture location with reference to the growth plate.
101
What is the characteristic of Salter-Harris type I fractures?
They run through the physis
## Footnote
This type does not involve the metaphysis or epiphysis.
102
What does Salter-Harris type II fractures involve?
They run through the physis and a portion of the metaphysis
## Footnote
This type is more common than type I.
103
Salter-Harris type III fractures run through which parts?
The physis and the epiphysis
## Footnote
These fractures are generally intra-articular.
104
What defines Salter-Harris type IV fractures?
They run through the epiphysis, across the physis, and through the metaphysis
## Footnote
These are also considered articular fractures.
105
What is unique about Salter-Harris type V fractures?
They involve a crushing of the physis that is not visible radiographically
## Footnote
This injury becomes evident several weeks later when physeal growth ceases.
106
How are Salter-Harris type VI fractures characterized?
By partial physeal closure due to damage to a portion of the physis
## Footnote
This type indicates a more complex injury to the growth plate.
107
What is the main objective of fracture treatment?
The early return of the patient to full function.
## Footnote
Detailed planning of the entire surgical procedure and postoperative care.
108
What are the consequences of failing to plan for fracture repair?
Prolonged operating time, excessive soft-tissue trauma, and technical errors.
## Footnote
Higher complication rate due to infection, implant failure, delayed healing, and non-union.
109
What patient considerations should be taken into account when choosing a method of fracture repair?
* Age
* Weight
* Presence of concurrent injuries
* Overall general health
* Expected activity level
* Intended use of the animal
* Ability of the owner to perform postoperative care.
110
What imaging is mandatory for a full analysis of the fracture?
Orthogonal views of the affected bone including the proximal and distal joints.
| Consider radiolographs of contrateral limb
111
What is essential for the restoration of the bone column?
Sharing of the weight-bearing load with the implant.
112
What is the risk of an unreconstructed fracture?
It relies solely on the implant to sustain axial loading.
113
What factors affect the demands placed on implants in animals with polytrauma?
They may be forced prematurely to take weight on an injured limb.
114
What factors are critical in determining healing times for fractures?
* Biological environment of the fracture
* Age of the animal
* Vascularity of the fracture site
* Soft-tissue injuries.
115
What type of fractures heal quickly, especially in young animals?
Metaphyseal fractures with an abundance of cancellous bone.
116
What type of fractures may have impaired vascularity and longer healing times?
Comminuted high-energy fractures.
117
What mechanical factors affect the load the implant will bear?
* Fracture configuration
* Potential for reconstruction
* Presence of concurrent musculoskeletal injuries.
118
What biological factors affect the length of time an implant must function?
* Age
* Fracture location
* Soft-tissue injury.
119
What methods are indicated for treating severely comminuted fractures?
* Plates
* Plate-rod combinations
* Locked intramedullary nails
* External fixators.
120
What is the difference between anatomical reconstruction and major segment alignment?
Anatomical reconstruction focuses on precise alignment, while major segment alignment may allow for less precise but functional alignment.
121
What is the first step in the fracture planning checklist?
Decide on appropriate fixation based on fracture and patient assessment.
## Footnote
Fracture planning checklist:
1. Decide on appropriate fixation based on fracture and patient assessment.
2. Plan fracture reduction.
3. Plan fracture fi xation.
4. Select surgical approach(es).
5. Check implant inventory.
6. Perform surgery.
7. Critically evaluate postoperative radiographs
122
What should be checked before performing surgery?
Check implant inventory.
## Footnote
Fracture planning checklist:
1. Decide on appropriate fixation based on fracture and patient assessment.
2. Plan fracture reduction.
3. Plan fracture fi xation.
4. Select surgical approach(es).
5. Check implant inventory.
6. Perform surgery.
7. Critically evaluate postoperative radiographs
123
What is the final step in the fracture planning checklist?
Critically evaluate postoperative radiographs.
## Footnote
Fracture planning checklist:
1. Decide on appropriate fixation based on fracture and patient assessment.
2. Plan fracture reduction.
3. Plan fracture fi xation.
4. Select surgical approach(es).
5. Check implant inventory.
6. Perform surgery.
7. Critically evaluate postoperative radiographs
124
When is open reduction preferred over closed reduction?
When bone grafting and anatomical reconstruction are needed in articular or comminuted fractures.
125
What are the disadvantages of open reduction?
Prolonging surgery time and impairing blood supply.
126
What type of fractures is closed reduction reserved for?
Minimally displaced or incomplete fractures, or comminuted fractures treated with external fixation.
## Footnote
Closed reduction perserves blood supply and biology of fracture.
127
What is the *direct overlay method* in fracture planning?
Using radiographic tracings of fracture fragments to plan reduction.
## Footnote
Use contralateral limb for planning
128
What is the primary benefit of closed reduction?
Preserves blood supply
also helps biology of the fracture.
129
Fill in the blank: Closed reduction is suitable for ____ fracture or incomplete fractures.
nondisplaced
130
True or False: Closed reduction can be used for all types of fractures.
False
131
What types of reduction is used for :
* Articular fractures
* Simple fractures
* Comminuted fractures w/ major segment alignment & cancellous bone grafting
Open reduction
132
What type of reduction is used for:
* Nondisplaced fractures
* Incomplete fractures
* Comminuted fractures treated with external fixation
Closed reduction
133
What is the recommended fasting period for patients prior to anesthetic induction?
6–12 hours
## Footnote
Continue to provide water
134
What tool is used for hair removal from the surgery site?
No. 40 clipper blade
## Footnote
Vacuum is used to collect the removed hair.
135
How far should the clipped area extend for orthopedic procedures of the axial skeleton?
At least 8–10 cm past the proposed site of incision.
136
What type of agent is used to cleanse the surgical site?
A general cleansing agent such as
* iodophors
* chlorhexidine
* alcohols
* hexachlorophene.
137
What draping techniques are used to create a sterile field?
Standard quadrant and fenestrated draping techniques.
138
What should persons with facial hair wear in the operating room?
Hoods
139
What is the main goal of fracture fixation?
To restore limb alignment and to stabilize the fracture.
140
What are the two surgical approaches to treat fractures?
Open reduction and closed reduction.
141
What is the advantage of closed reduction?
It preserves surrounding soft tissues and blood supply to the bone and decreases the possibility of iatrogenic contamination.
142
What is a disadvantage of closed reduction?
Cortical apposition of the fracture fragments is hindered since they cannot be seen.
143
How many times is the surgical site scrubbed during the procedure?
Once in the prep room and again after entering the operating room.
144
Is proper surgical attire mandatory for operating room personnel?
True.
145
What is indicated for both nondisplaced fractures and nonreducible fractures?
Closed reduction.
146
What is the major benefit of a fully reconstructed bone column?
It can share in the weight-bearing load of the limb during fracture healing.
147
What types of fractures is open fracture fixation reserved for?
* Transverse fractures
* Fractures with a large butterfly fragment
* Long oblique or spiral fractures
* Intraarticular fractures
148
What are potential disadvantages of open fracture reduction?
* Iatrogenic contamination
* Additional soft-tissue damage
* Impairment of blood supply
149
What are Halsted’s principles of fracture fixation?
* Preservation of all soft-tissue attachments to bone fragments
* Avoidance of excessive trauma
* Careful handling of soft tissues, nerves, and vessels
## Footnote
gentle tissue handling
preserving blood supply
strict aseptic technique
150
What instrument may be used to lever the bone segments into alignment?
Osteotome or spay hook.
151
What should be done if fissure lines are present in the bone?
Support the bone with cerclage wire before levering it into position.
152
How can eccentrically placed fractures be maintained in reduction?
By securing a contoured plate to the short distal segment and reducing the proximal segment to the plate.
153
What is the technique for reducing long oblique fractures?
* Secure bone segments with bone-holding forceps
* Distract the segments
* Use self-retaining pointed reduction forceps positioned obliquely
154
What does the 'open-but-do-not-touch' technique involve?
Viewing of fracture fragments without disturbing them while manipulating major bone segments.
155
What is the purpose of distraction in indirect reduction techniques?
To align fragments by distracting the bone ends instead of manipulating the fracture site.
156
What is the hanging limb technique?
A method of applying traction and countertraction by suspending the limb from a drip stand.
157
What is the primary goal of open reduction?
Anatomical alignment and stabilization of reducible fractures.
158
What factors determine the decision to perform open or closed fracture reduction?
* Fracture configuration
* Fracture location
* Types of implants used for stabilization
159
What is the four As mnemonic for reviewing postoperative radiographs?
* A = alignment
* A = apposition
* A = apparatus
* A = activity
160
What should be evaluated radiographically postoperatively for fractures?
Alignment
Reduction (Apposition)
Implant placement (appartus)
## Footnote
The evaluation is essential for proper postoperative management.
161
What does 'Alignment' refer to in postoperative evaluation?
The normal orientation of fracture fragments to prevent displacement
## Footnote
Orthogonal view radiographs should be used for inspection.
162
What percentage of cortical apposition is necessary to prevent delayed union?
50% cortical apposition
## Footnote
This applies when viewed in both craniocaudal and lateral projections.
163
What does 'Activity' refer to in the context of fracture healing?
The biological activity of the bone in response to fixation
## Footnote
It indicates whether the fracture is healing.
164
How often should fractures be radiographed to evaluate bone healing?
Every 6–8 weeks
## Footnote
This is important to monitor healing and implant position.
165
What may indicate a significant delay in return to function post-fracture repair?
Sudden onset of lameness
## Footnote
This could indicate implant loosening, failure, infection, or other complications.
166
What type of bandage is most patients with distal fractures placed in postoperatively?
Soft-padded or modified Robert Jones bandage
## Footnote
This is typically for 12–24 hours after fracture repair.
167
What is the purpose of a well-applied bandage postoperatively?
To reduce swelling, pain, and contamination, and to support the limb
## Footnote
It also improves patient comfort.
168
What should written discharge instructions include?
* Wound care
* Suture removal
* Exercise regimen
* Bandage, cast, or splint management
## Footnote
This encourages client cooperation and reduces misunderstandings.
169
What is the purpose of local hypothermia in the acute post-injury period?
To stimulate vasoconstriction, decrease nerve conduction velocity, and encourage skeletal muscle relaxation
## Footnote
Local hypothermia minimizes fluid leakage and edema by reducing arterial and capillary blood flow.
170
What is the recommended application method for local hypothermia?
Multiple short sessions (5–15 minutes up to four times daily)
## Footnote
This method prevents reflex vasodilation and edema.
171
What is local hyperthermia used for in the later stages of recovery?
To dilate capillaries, elevate capillary hydrostatic pressure, and increase capillary permeability
## Footnote
Local hyperthermia is combined with other forms of physical therapy like massage or exercise.
172
What are the benefits of massage in veterinary rehabilitation?
* Increased local circulation
* Reduced muscle spasm
* Attenuation of edema
* Breakdown of irregular scar tissue formation
## Footnote
Massage also enhances range of motion and limb mobility.
173
What are the contraindications for massage?
* Unstable or infected fractures
* Presence of malignancy
## Footnote
In most patients, massage is valuable, especially for trauma patients with restricted mobility.
174
What is passive range of motion (PROM) exercise?
Movement of limbs and joints by the therapist with no effort from the animal
## Footnote
PROM aims to maintain normal joint motion and prevent soft tissue and muscle contracture.
175
What is therapeutic exercise?
Controlled activity performed by the animal to build strength, muscle mass, agility, coordination, and cardiovascular health
## Footnote
It can be divided into passive and active forms.
176
What is the role of hydrotherapy in canine rehabilitation?
To remove lymphedema from extremities, relax the patient, and cleanse the limb
## Footnote
Cold-water hydrotherapy can be employed soon after surgery.
177
What is therapeutic ultrasound used for?
To produce the deepest form of physiological heat and treat chronic scar tissue and adhesions
## Footnote
Ultrasound has both thermal and nonthermal effects in rehabilitation.
178
What does neuromuscular stimulation do?
Creates artificial contractions in weakened or paralyzed muscle groups
## Footnote
It is indicated following fractures that necessitate prolonged joint immobility.
179
What are the physiological effects of therapeutic ultrasound?
* Increased connective tissue extensibility
* Increased vascularity
* Temporary nerve blockage
* Acceleration of inflammatory phase of healing
* Decrease in edema
## Footnote
Ultrasound also stimulates collagen synthesis and bone growth.
180
What is the recommended approach for rehabilitation after fracture stabilization?
Start with early massage and PROM exercises to reduce edema and muscle spasm
## Footnote
The number of treatments depends on the severity of the fracture and the animal's response.
