Dealing with Non-Infectious Complications Flashcards
(42 cards)
Common complications of internal fixation. (7)
wound dehiscence
seroma
implant failure
necrosis of soft tissue
neurological damage
delayed union/non-union/malunion
infection
What specifics about # repair create a favourable environment for bacterial colonisation and multiplication? (3)
Metal implant
Haematoma
Necrotic tissue
What are the 3 possible results of inadequate mechanical or biological environment?
retarded healing (delayed union)
unsuccessful healing (non-union)
improper healing (malunion).
At what point should a patient be weigh bearing (toe touching) post surgical stabilisation?
48 hours
At what stage post-operatively should a more thorough investigation be performed if the animal is not weight-bearing?
3-5 days
A client reports that their dog (who has recently undergone fracture repair) has shown sudden deterioration in their lameness over the last 24 hours. What is your advice?
The dog should be seen for a thorough re-examination and may require more investigations, if this is indicated.
All animals that have deteriorated post-orthopaedic surgery usually need the following: (3)
- Full physical examination
- Radiographs to check for implant problems, evidence of infection, or bone complication such as fracture
- Samples for cytology and culture (likely arthrocentesis for articular fractures).
How to avoid wound dehiscence at tie of surgery? (2)
- Good wound closure
- Careful tissue handling
Self-trauma of the wound or surgical site infection can be contributing reasons. If implants are exposed in combination with lack of tissue, reconstruction often fails. What are your options? (3)
Treat as an open wound
May require implant removal for ultimate closure
Alternative stabilisation methods may need to be considered such as an external skeletal fixator.
Possible causes of seromas post surgical fixation? (3)
- leaving fascial planes open
- Dehiscence of sutures in middle layers
- Uncontrolled activity
Why should you NOT aspirate an FNA?
Introduce bacteria
How to reduce a seroma once formed?
Warm pack several times daily
If there is a large seroma, causing clinical signs. What may be needed?
A closed drain under aseptic conditions
Possible causes of haematoma post surgery? (2)
- Poor surgical technique
- Coagulation problems
If Hematomas are not associated with coagulation problems, what should be done?
They will disappear within a couple of days and do not need further therapy.
Common reason for implant failure?
Technical error.
Common technical errors causing implent failure?
Solitary use of an IM pin
Solitary use of an IM pin with cerclage wires
Use of cerclage wire that is too small in diameter
Use of an insufficient number of cerclage wires
Use of cerclage wires at unsuitable areas/fractures
Excessive or insufficient plate size due to a lack of inventory
Use of a short plate with too few screws
Use of a plate that is too short relative to the length of the bone
Unsuitable plate type
Non-adherence to the rules of plate uses
Erroneous analysis of the forces to neutralise.
Where are reconstruction plates not sufficiently strong?
Weight bearing diaphyseal bone
The implants used to stabilise a fracture restore the bone’s structure and function A) It is bone healing that restores it B)
A) Temporaily
B) Permanently
As a fracture heals, the load taken by the implants A) over time and the load taken by the bone B)
A) Decreases
B) Increases
If the bone fails to heal, then implants undergo cyclic fatigue and may A). All metalwork will B) eventually. Successful healing can be considered a race between bone healing and implant failure.
A) Fail
B) Fatigue
What are the types of implant failure? (6)
Mechanical failure
Metallurgic imperfections
Manufacturing faults
Acute overload failure
Fatigue failure
Corrosive degradation.
What is fatigue failure causes by?
repetitive cyclic loads that in isolation would not cause failure.
What is the most important mode of failure?
Fatigue
