Exam 1

Question 1

Two Advantages of which Type of Distant Flap:

Flap Remains attached to the Donor site at Both Ends- Likelyhood Of Vascular Compromised is Reduced

Flap itself helps to Support the Leg along the Side

Answer 1

Pouch Flap

Question 2

______ Profile Threaded Pins for External Skeletal Fixators:

Strongest of 3 Styles

Increased Bone Purchase compared to Smooth Pins

Increased Strength in Bending due to Uniform Pin Diameter

Threads are Outside of the Core Diameter (Not cutting into Pin to Create Threads)

Answer 2

Positive

*Three Types of External Skeletal Fixator Pins- Smooth Pins, Positive Profile Threaded Pins, Negative Profile Threaded Pins

*Almost Always use Positive Profie Threaded Pins when placing External Skeletal Fixators

Question 3

Match these Open Fracture Classifications to Description:

A. Adequate Soft Tissue for Wound Coverage/ Large Soft Tissue Laceration or Flap

B. Extensive Soft Tissue Loss/Bone Exposure/Stripped Periosteum

C. Arterial +/- Nerve Supply to Distal Limb Compromised/Requires Microvascular Anastomosis or Amputation

1. Type IIIB

2. Type IIIA

3. Type IIIC

Answer 3

A. Type IIIA

B. Type IIIB

C. Type IIIC

Question 4

Indications for _____:

Dead Space Cannot be Obliterated

Fluid Accumulation Likely

Infection

Answer 4

Surgical Drains

*Drains are used to Remove Fluid/Exudate from Wounds. Drains are Also used to Remove Exudate from Infected Wounds

Question 5

Two most commly used Antiseptics for Wound Lavage

Answer 5

Chlorhexidine

Povidone-Iodine

Question 6

______ Review of Bone Repair and Healing is useful for Assessment of Outcome of Repair and to See if any changes are Required

Answer 6

Radiographic

*Recheck Radiographs are done every 4-6 Weeks to see if the Bone is Healing, If the Implants are Stable, and if Any other Changes are Occuring

Question 7

True/False: Elbow Dysplasia is Heritable- Do NOT Breed

Answer 7

True

Question 8

Presentation for which Disease of the Elbow?

Answer 8

Elbow Dysplasia

Question 9

True/False: Proper Postoperative Managment is Essential to successful Skin Grafting

Answer 9

True

Question 10

_____Profile Threaded Pin for External Skeletal Fixator:

Threads are Cut into the Core Diameter of the Pin

Decreased Strength

Answer 10

Negative

Question 11

Drains should NOT Lie directly under Suture Line. Drains that Lie Directly under Suture Lines or Exit through them can Interfere with Wound Healing and Result in Wound ______

Answer 11

Dehiscence

Question 12

True/False: Lateral Shoulder Luxation is more Common

Answer 12

False

*Medial Shoulder Luxation is more Common

Question 13

Cerclage Wires need to be Placed _____ to the Bone

Answer 13

Perpendicular

*Apply wires Tightly to achieve rigid fixation of fracture segments- Twist the Wire

Question 14

A ____ MUST be present to achieve benefits of Dynamization

Answer 14

Callus

Question 15

Puckering of Skin that can occur at the ends of a Suture Line during Wound Closure. This occurs because the Two Sides of the Wound are of unequal length or because the direction of movement of the Skin to Close the Wound causes the Surrounding Skin to Pucker

Answer 15

Dog Ears

Question 16

External Skeletal Fixator that is a:

Combination of a Linear and Circular External Skeletal Fixator

Useful for Treatment of Metaphyseal Fractures

Thin Wires or Circular Fixator allows for Multiple Sites of Bone Purchase in a Smaller Bone Fragment

Answer 16

Hybrid Fixator

Question 17

Screws with these Characteristics:

Best for use in Dense, Cortical Bone

Decreased Outer Diameter

More Shallow Thread

Decreased Pitch

Answer 17

Cortical Screws

*Most commonly used Screws. Best for use in Dense Bone- Most Fractures will be Diaphyseal

Decreased Outer Diameter- More Likely to Pull out

Question 18

What type of Bone Fracture must be Fixed with:

Internal Fixation with Open Anatomic Reduction/Reconstruction

Primary Bone Healing

Answer 18

Articular Fractures

*Open Anatomic Reconstruction is REQUIRED for Articular Fractures

Question 19

Four A’s used in Assessment of Post Op Fracture Repair Radiographs

Answer 19

Apposition

Alignment

Apparatus

Activity

*KNOW These for the Exam!

Question 20

Common Wound Lavage Solutions

Answer 20

Balanced Electrolyte Solution (Most Common)

Tap Water

Antiseptic Solutions

Antibiotics

Question 21

____ is Typically Recommended at 6 weeks Post Repair with External Skeletal Fixators

Answer 21

Dynamization

*Roughly at about 6 weeks is when we start considering Dynamization (Destabilization)

Question 22

Indications for ______:

Skin Defects on Extermities- Ex. Degloving

Extensive Burn Wounds

Large Wounds Resulting from Excision of Masses

Answer 22

Skin Grafts

Question 23

Plate Function Described Below:

Plates that are used in Addition to Primarily Placed Lag or Positional Screws

Plate Acts to Promote/Neutralize Against Shearing, Bending, and Rotational Forces which would otherwise damage the Interfragmentary Repair Achieved by the Screws

Answer 23

Neutralization Mode

*When you Place a Lag Screw, it needs to be Perpendicular to the Fracture Line

*The Plate itself isn’t stabilizing the Fracture- The plate is only meant to Neutralize/Protect the Lag or Positional Screws

Question 24

Screw Type that has a Wider Outer Diameter and is:

Less Likely to Pull out

More Likely to Bend

Answer 24

Cancellous Screw

Question 25

Answer 25

**Closed Mid-Diaphyseal Spiral Comminuted Fracture with Medial and Proximal Displacement** \*Spiral Fracture- Can see Butterfly Fragments (Diamond Shaped Fragments) \*_Whatever the Top Segment of Bone is doing, Consider that to be Normal_

Question 26

True/False: When an animal is Presented with an Open Wound, the urge to "Take a Peak" should be Resisted

Answer 26

**True**

Question 27

Most common cause of **Sinus Tracts** (Draining Tracts)

Answer 27

**Plant Material Foreign Bodies**

Question 28

When use of **External Skeletal Fixation**, Fractures will heal by ____ Bone Healing

Answer 28

**Secondary**

Question 29

Postoperative ____ can have Devastating Results. ____ between the **Graft** and Recipient Bed may result in Dissolution of the Fibrin Seal, or the Graft may be Physically Elevated from the Graft Bed by Exudate Produced

Answer 29

**Infection**

Question 30

**Steinmann Pin** Technique: _Used to Stabilize **Salter Harris Type I Fractures of the Proximal Humerus and Femoral Head**_ _Must Achieve anatomical Reductio_n

Answer 30

**Diverging Pin Technique** **\***Pins placed across fracture in order to engage the _Femoral Head_

Question 31

True/False: A Sugar Paste for **Wound Management** can be made from Castor Sugar, Icing Sugar, Glycerin and 3% Hydrogen Peroxide

Answer 31

**True** **\***Alternatively the wound can be covered with a thick layer of Granulated sugar

Question 32

When Performing the **Walking Suture** Technique, Sutures must engage _____ and _____ to have Adequate Holding Power

Answer 32

**Dermis** **Fascia** **\***These Sutures must engage the Dermis and Fascia otherwise they will likely pull out when the knot is tied \*_First Suture Bite - Dermis_ _Second Suture Bite- Fascia_

Question 33

True/False: **Bite Wounds,** where Puncture wounds and small Lacerations are the only apparent Injury should be cleaned and the Patient should be given antibiotics for a few days

Answer 33

**False** \*_There is often Tremendous Damage to the underlying subcutaneous Tissue and Muscle which will later Necrose and provide and excellent enviornment for Bacterial Growth and Abscess Formation_ _\*Bite wounds are often called "Iceberg Lesions" because most of the Trauma is hidden below the Surface_

Question 34

Gold Standard Treatment for **Fragmented Coronoid Process and OCD** with Elbow Dysplasia

Answer 34

**Arthroscopic Treatment** **\***Fragment Removal and Debridment of Lesion Bed

Question 35

If an Animal has a **Developmental Joint Disease**, it is Probably ____ with a ____ Age Grouping

Answer 35

**Bilateral** **Biphasic**

Question 36

**Bone Plate** with the Following Characteristics: Similar to DCP Except, _Contoured Underside the Allows Stress to be more evenly Distributed Across the Plate_ _Less Disruption of Periosteal Vascularity_

Answer 36

**Limited Contact DCP** _**\***Less Contact with Bone = Less Disruption of Periosteal Vascularity_ _\*Scalloped Bottom_

Question 37

Most **Traumatic Wound** Healing Occurs by which Method?

Answer 37

**Repair** **\***Repair- Replacement of Damaged Tissue with Nonfunctional Scar Composed primarily of Fibrous Tissue and Blood Vessels

Question 38

When Placing a **Caudal Superficial Epigastric Axial Pattern Flap,** Making the Flap ____ to the side of the wound is Perferred when there is a Shorter Distance and Results in _Less Risk of Kinking Vessels_

Answer 38

**Contralateral** _**\***Placing Flap on Same (Ispilateral) Side of the wound has a Greater Risk of Kinking Vessels_

Question 39

In order to ____ the Graft, Leave the Graft attached to the Sterile Cardboard and Cut Staggered Rows of Parallel Slits in the Graft. The Distance between the Slits and Between Rows is usually 1cm

Answer 39

**Mesh**

Question 40

**Degloving Injury** where Skin is Partially or Completely torn away creating an Open Wound

Answer 40

**Anatomic**

Question 41

In Normally Healing wounds, **Wound Contraction** Ceases for which Three Reasons

Answer 41

**1. The Wound Edges are apposed and healing is Complete** **2. The Tension on the Skin Surrounding the wound is Greater than the Pull of the Myofibroblasts** **3. The Granulation Tissue is Chronic with a High Content of mature Collagen and Ground Substance and Few Fibroblasts**

Question 42

Complication of **Second Intention Healing,** where Scar Tissue Forms that Interferes with Normal Function of that Structure

Answer 42

**Wound Contracture**

Question 43

**Steinmann Pins** placed in _Medullary Cavity of Bone_ to Help Restore Length and Maintain Alignment

Answer 43

**Intramedullary Pins**

Question 44

Surgical Treatment for **Traumatic Shoulder Luxation**

Answer 44

**Arthrotomy to Evaluate Joint** ## Footnote **Glenohumerual Ligament Reconstruction**

Question 45

Since the **Cutaneous Trunci Muscle** is closely attached to the skin and many Blood Vessels pass from the Muscle to the Subdermal Plexus, Undermining the Skin on the trunk should be performed in the Loose Connective tissue ____ the Cutaneous Trunci Muscle

Answer 45

**Below**

Question 46

**Antiseptic** used for Wound Lavage that has:

Answer 46

**Chlorhexidine** _\*Sideffects are Uncommon_ \*Use a 1:40 Dilution

Question 47

Surgical Treatment for **Arthritis** Characterized Below: _Remodeling of Joint without Replacement- Ex. Femoral Head and Neck Excision (FHO)_ _Less Technically Challenging_ _Less Specialized Instruments/Training_

Answer 47

**Arthroplasty- Partial Excision** **\***_Arthroplasty- Removing Part of the Joint rather than Removing all of the Joint_

Question 48

Best Diagnostic Technique for Evaluating **Shoulder Instability**

Answer 48

**Arthroscopy** **\***Best for Evaluating Joint

Question 49

Incisions made ____ to Skin Tension Lines gape Less and are Easier to close because the Tension will cause the Tissue to want to separate more in the direction ____ to these Lines.

Answer 49

**Parallel** _**\***Make Incision Lines or Wound Closures on the Trunk PARALLEL to Skin Tension lines- Gape Less and Heal Faster_ _\*Skin Incisions made across Skin Tension Lines gape open more widely and are under greater tension during Closure_

Question 50

The **Cutaneous Trunci Muscle and Superficial Subcutaneous Tissue** must be Removed from the Graft before it is Applied to Enhance \_\_\_\_\_

Answer 50

**Revascularization**

Question 51

True/False: Vast Majority of **Elbow Dysplasia** Cases will Progress to Osteoarthritis Despite Treatment

Answer 51

**True**

Question 52

Best Diagnostic Technique for **Biceps Brachii Tendinopathy**

Answer 52

**Arthroscopy** **\***Diagostic and Therapeutic

Question 53

**Core Diameter** of Screw Determines _____ Strength

Answer 53

**Bending**

Question 54

**Steinmann Pin** Technique Indicated for: _Simple, Transverse Fractures close to the Joint_ _Typically Youg Animals with **Salter Harris Type 1 and II Fractures**_ _Uses Smaller Diameter Steinmann Pins or K Wires_ _Engage Near and Far Cortex with K Wire_ **_Pins Cross above Fracture Line_**

Answer 54

**Cross Pinning**

Question 55

True/False: While **Radiographs** are widely used for Diagnosing **Arthritis**, sometimes you can have fairly advanced Disease with Minimal Radiographic Change. Therefore, Radiographs are not a Great way for Diagnosing Arthritis

Answer 55

**True** _**\***Radiographs don't always reflect the Clinical Picture_

Question 56

Indications for which Type of **Fracture Fixation**: _Fractures Below the Knee and Elbow_ _Fractures Expected to Heal Rapidly_

Answer 56

**External Coaptation** _**\***Only use Casts on Fractures that are Below the Knee and Elbow_ _Transverse Fractures are more Amenable to External Coaptation_- Cast will Prevent Collapse at the Edge

Question 57

Post Op Fracture Assessment that asks: ## Footnote **Is the Fixator/Implants Appropriately Positioned?** **Is there Evidence of Implant Lossening or Failure?**

Answer 57

**Apparatus** _**\***You can Tell that a Screw is Loose if there is Radiolucency around the Screw_

Question 58

Injuries Resulting from Shear Forces which Sever Cutaneous Vessels supplying skin

Answer 58

**Degloving Injuries** _**\***Physiologic- Skin Devitalized by still in Place_ _\*Anatomic- Skin Avulsed from Underlying Tissue_

Question 59

Postoperative Managment of which **Arthritis** Surgical Treatment: _Coaptation (Splint or ESF)- 6-8 weeks_ _Activity Restriction until Bony Fusion_ _Prolonged Healing Common- 3 Months Minimum_

Answer 59

**Arthrodesis**

Question 60

Diagnosis based on this Radiograph

Answer 60

**Osteochondrosis (OCD)**

Question 61

In Cases of **Open Fractures,** once the Patient is \_\_\_\_\_: _Assess Tissue Damage, Vascular and Nerve Supply_ _Assess Neurovascular Status of Distal Limb_ _Imaging_ _Clean Wound, Collect Culture, Start Treatment_

Answer 61

**Stable**

Question 62

Diagnosis based on this Radiograph

Answer 62

**Ununited Anconeal Process**

Question 63

**Skin Flaps** Characterized Below: _Semicircular Flaps that are Best Suited for Triangular or Circular Shaped Defects_ _Flap moves about a Pivot Point_

Answer 63

**Rotation Flaps**

Question 64

Name Three _Disease Modifying Agents_ used to Treat **Arthritis**

Answer 64

**Polysulfated Glycosaminoglycan (Adequan)-** Most Common **Pentosan Polusulfate** **Hyaluronic Acid-** Synovial Fluid/Restores Joint Viscosity

Question 65

**Outer Diameter** of a Screw Determines _____ Strength

Answer 65

**Pull Out**

Question 66

How to Apply _____ **Wires**: _Reduce Fragment and Drive 2 K Wires across Fracture_ _Drill Hole through Both Bone Cortices Distal to Fracture_ _Pass Wire through the Hole and Around the Ends of the Pin and Back to the Other end of the Wire Creating a Figure 8_ _Tighten Wire via Twist Method_ _Bend the K-Wire and Cut (2-3 Twists Remain)_

Answer 66

**Tension Band Wire**

Question 67

Type ____ **External Skeletal Fixator**: **_Unilateral-Biplaner-_** Pins are only being Placed Externally though One side of the Bone. Another Set of Pins are Also Unilateral that are in a Different Plane then the First set of Pins _Pins are Placed 60-90 Degrees from Each Other_ _Uses Half Pins_

Answer 67

**Type 1B**

Question 68

Law that States: _Bone Remodels based on the Forces that are Applied:_ Bone Remodels and Thickens in Response to Increased Forces Bone Resorbs and Weakens in Response to Decreased Forces

Answer 68

**Wolff's Law** _\*Healing Fractures- we need Forces Applied across the Bone in order for Bone to Remodel and Thicken_

Question 69

**Tracking Drains** in the Wound with _____ Suture is NOT Recommended because of the potential that a piece of the Drain might Break off and be retained in the Wound as a Foreign Body

Answer 69

**Buried**

Question 70

When using _____ **Plates**, the _Plate should be Precisely Contoured to Match the Normal shape of the Bone_ in order to: _Maximizes Contact between Bone and Plate to Increase Strength of Repair_ _Prevents Distraction of Fracture Ends during Screw Placement_

Answer 70

**Conventional Plates** _**\***Need Bone and Plate Contact to generate Friction and lend Stability to the Plate_

Question 71

What is the Best Option for Repair of this Fracture?

Answer 71

**External Skeletal Fixator**

Question 72

**Immediate Closure** of a Wound for: _Clean Wounds_ _Clean-Contaminated Wounds_

Answer 72

**Primary Closure**

Question 73

True/False: **Prophylactic Antibiotic** Administration should be considered when Procedures are anticipated to last more than 90 Minutes, when nonabsorbable implants are Placed, and when Infection would be Catastrophic to the outcome of the Procedure

Answer 73

**True**

Question 74

Answer 74

**Closed Mid-Diaphyseal Short Oblique Simple Tibial Fracture with Proximal and Lateral Displacement** **\***Simple = Non Comminuted

Question 75

**Plate Function** described Below: _Plate Spans Fractures Area which cannot be Anatomicaly Reconstructed (Comminuted Area)_ **_Plate Bears all Load at level of Fracture_** _Longer Plate with Fewer Screws_ **_Mode used in Biological Osteosynthesis/MIPO_**

Answer 75

**Bridging Mode** _\*Plate must Bridge Fracture Gap_

Question 76

More Expensive Type of **Bone Plate** that is: _Less Stiff/Strong_ _Have Better Fatigue Resistance (Longer Elastic Phase)_ _Less Reactive_

Answer 76

**Titanium Plates** **\***Have more of an Elastic Component

Question 77

Noninflammatory ____ **Osteoarthritis**: _Developmental- OCD, Hip Dysplasia_ _Acquired- Trauma, Neoplasia_

Answer 77

**Secondary**

Question 78

When using a **Conventional Plate**, a Stable Repair requires Screw Purchase of at least ___ Cortices above and Below the Fracture

Answer 78

**6** **\***When we are placing screws, we place them Bi-Cortically- Through the Cis Cortex (Near Cortex) and then again through the Trans Cortex (Far Cortex) _\*Ideally we want Three Screws Above and Three Screws below the Fracture = 6 Cortices_

Question 79

**Passive Drains** are Sometimes Placed with ____ Exit Sites. Making Two Stab Incisions facilitates Placement of the Drain in the Fluid Cavity. To Remove Drains placed in this Manner, Cut the Dorsal Fixation Suture while Holding the Drain with Forceps. Gently Pull on the Drain to Stretch it and Cut off the Portion of the Drain that has been Outside the Wound at the Level of the Skin. Remove the Remainder of the Drain through the Ventral Opening

Answer 79

**Two** _**\***Penrose Double Exit Drain_ _\*Avoid Dragging any of the Exteriorized Portions of the Drain through the Wound_

Question 80

Treatment for a **Closed Reduction Shoulder Luxation** (Recent Injury/No Fractures)

Answer 80

**Under General Anesthesia** **Distract Limb- Move Humerus Toward Glenoid** **Stabilize Joint- Apply Coaptation for 2 Weeeks (**Velpeau Sling)

Question 81

True/False: Ability to **Undermine Skin** is Influenced by: _1. Species- Differences in Blood Supply to Skin_ _2. Breed (Dogs)- Some Breeds have a lot more Loose Skin than Others_

Answer 81

**True**

Question 82

In General, _____ **Antibiotics** are preferred for Prophylactic and Preventative Administration

Answer 82

**"Cidal"** _**\***Dead Bugs Don't Mutate_

Question 83

For Fixation of **Short Oblique Fractures**, we can use _Cerclage Wire_ with \_\_\_\_\_, to aid in Maintenance of Reduction and Promote Compression across Fracture Line

Answer 83

**Skewer Pins** **\***Place Skewer Pin Perpendicular to Fracture Line

Question 84

In Patients with **Ununited Anconeal Process**, there is a Separate Anconeal Center of \_\_\_\_\_

Answer 84

**Ossification** _**\***The Ulna usually Fuses at 16-20 Weeks, therefore if you have a Dog that is Older than 24 weeks with a Separate Anconeal Process then the Dog has Ununited Anconeal Process_

Question 85

**Grafts** Transferred between Individuals of the _Same Species_

Answer 85

**Allografts**

Question 86

Best **Prophylactic Antibiotic** to use for _Non-GI Tract_ Related Surgeries

Answer 86

**Cefazolin**

Question 87

_First Priority_ in Cases of **Open Fractures**

Answer 87

**Systemic Stabilization** \*If Wound is Highly Contaminated- _Rinse with Water and put a Sterile Bandage on it_

Question 88

Technique used to Slowly Stretch the skin surrounding a **_Chronic Wound._** Where there has been Increased Collagen Deposition and Thickening of the Skin, a Continuous Intradermal Pattern is Placed. The Suture exits out onto the Skin Surface and through a **Button**. The Suture is Tightened from both ends until the Tension is even along the entire length of the suture line. A this point, **Split-Shot** is Crimped Across the Suture to Maintiain the Tension. Each day more Tension is applied to the suture and Split Shot is Replaced.

Answer 88

**Adjustable Horizontal Mattress Sutures** _\*Works better with Chronic Wounds with Established Granulation Tissue_

Question 89

**Bone Plate** with the Following Characteristics: Screw Holes designed to Allow Screw Placement that _Promotes Compression of Fracture Ends_ _Oval Screw Holes allow for Screw Angulation_ _All Plate Surfaces are Flat_

Answer 89

**Dynamic Compression Plate (DCP)** _\*Screw Holes are Oval and there is a Graduated Drop into the Screwhole- Tightening the Screws moves Fracture Ends Closer Together_

Question 90

External Force Applied to any Cross Sectional Area

Answer 90

**Stress** **\***Stress- Actual Force that is being Applied to something

Question 91

True/False: When Initially Managing a Traumatic Wound it is important to do a Physical Exam and check Neurologic Status of Limb Injuries prior to Administering Pain Meds

Answer 91

**True** **\***Make sure Superficial and Deep Pain is Adequate

Question 92

\_\_\_\_\_ is the Most Common Cause of **Active Drain** Failure, caused by Tissue Debris left in the Wound at Closure

Answer 92

**Obstruction**

Question 93

Approach for **Internal Fracture Fixation** characterized by: _Primary Bone Healing (\< 1mm Gap at Fracture Ends)_ _Perfect Bone Reconstruction_ _Rigid Fixation with Compressions at Bone Ends_

Answer 93

**Open Anatomic Reduction/Reconstruction** **\***Perfect Bone Reconstruction and Rigid Fixation

Question 94

During the Placement of **Active Drains**, the Exit hole must be kept ____ to Minimize Air Leakage

Answer 94

**Small** **\***An Airtight Skin Closure is Necessary I_f the Incision is too Large, air leakage into the wound is more likely when suction is applied_

Question 95

True/False: **Plant Fiber Foreign Bodies** can be Difficult to Diagnose and even when suspected they can be difficult to find and Remove

Answer 95

**True** **\***Plant Fiber Foreign Bodies tend to Migrate A lot

Question 96

**Porcine Small Intestinal Submucosa** is most commonly applied as a sheet after wound Debridement and Lavage. It should be Sutured to the edges of the wound with the ____ Side Down

Answer 96

**Rough** **\***Rough Side needs to be in contact with Wound Surface

Question 97

Physical Exam findings with which **Shoulder Disease**

Answer 97

**Shoulder Instability** _**\*Increased Abduction Angle** of the Limb!!- Medial Instability_

Question 98

**Plate Function** described Below: **_Used for Transverse or Short Oblique Fractures_** _Axial Compression is Achieved through Eccentrically Loading Screws_ _**Load is Carried Mostly by the Bone** and to a lesser Extent by the Plate_

Answer 98

**Compression Mode** _\*When plates are Applied to Achieve Compression across the Fracture Ends_

Question 99

**Bone Disease** Described Below: _Developmental Orthopedic Disorder_ **_Defect in Endochondral Ossification_** _Starts from Epiphyseal Center of Ossification and Travels Outward- Ossification Wave_

Answer 99

**Osteochondrosis** **\***Endochondral Ossification- Process by which Epiphyseal Cartilage Becomes Bone

Question 100

When Applying **Tension Band Wires**, you Reduce the Fragment and Always Drive ___ K-Wires Across the Fracture

Answer 100

**2** _**\***Wires are Driven Perpendicular to the Fracture Line._ The Wires are Parallel to Eachother

Question 101

In some Instance the Wound is Left Open until Healing is Complete. Healing by this method is called \_\_\_\_\_\_

Answer 101

**Contraction and Epithelialization** (Second Intention Healing)

Question 102

**Deformation** of a Loading Material as Compared to its Original Form

Answer 102

**Strain** \*Strain- Actual Calculated Change in a Material

Question 103

**Topical Wound Medication** that generates "Inhibines" such as Hydrogen Peroxide and Phenolic Acids during its Metabolism that provide _Antibacterial Activity_

Answer 103

**Honey**

Question 104

Portion of Skin that is Completely detached from its Original Location and transferred to a Recipient Site where it Becomes Revascularized by the ingrowth of Blood Vessels from the Recipient Bed

Answer 104

**Skin Graft** **\***Blood Vessels from the Recipient Site may create new Vascular Channels within the Dermis or may Anastomose directly with Existing vessels within the Graft

Question 105

**Drains** are Removed when the Amount of Drainage Decreases and it becomes Serous in Appearance, which is typically ____ Days after Placement

Answer 105

**3-7 Days**

Question 106

Some _____ Dressings are Impregnated with Antimicrobials (Ex. Keralix AMD Sponges). These Sponges are useful in wounds producing a lot of Exudate because they are applied Dry but Elute the Antiseptic into the wound as they Absorb Wound Fluid

Answer 106

**Dry-to-Dry Dressings**

Question 107

**Inflammation** in Several Joints _Simultaneously_

Answer 107

**Polyarthritis**

Question 108

**Moisture Retentive Dressing** that is made from a Highly Absorbent semiocclusive sponge like material that can be used as a primary Dressing on wounds in either the Inflammatory or Reparative Stage.

Answer 108

**Polyurethane Foam Dressing**

Question 109

Two Surgical Treatments used for **Ununited Anconeal Process**

Answer 109

**Fragment Excision** **Osteotomy + Fixation** (Ulna Lengthens)

Question 110

Advantages and Disadvantages of \_\_\_\_\_\_

Answer 110

**Steinmann Pins** _**\***Only used for Very Specific Fractures and have Minimal Application as a Primary Fixation_

Question 111

Three Disadvantages of **Second Intention Healing**

Answer 111

**1. The Legth of time needed for Complete Healing to Occur** **2. Contraction and Epithelialization may Cease Before the Wound is Closed** **3. Wound Contraction can interfere with normal Function (Wound Contracture)**

Question 112

When performing **Axial Pattern Flaps,** a Drain can be Placed if there is concern about ____ Formation

Answer 112

**Seroma** **\***Drains can be placed to Control Seroma Formation

Question 113

Classification of **Wound:** _Surgically Created Wound_ _Organ Normally Containing Bacteria is Opened but No Contents are Spilled_ _Minor Break in Technique Occurs- Ex. Hole in Glove_

Answer 113

**Clean-Contaminated** _**\***GIT is the Most common type of Clean-Contaminated wound Encountered_

Question 114

\_\_\_\_ Bone has a **Low Porosity** of 5-10%, characterized by: _Steep and Short Elastic Phase_ _Higher Yield Point- Takes Higher Stress to reach Yield Point_

Answer 114

**Cortical** **\***_Takes a Very Strong Force for Cortical Bone to Reach Yield Point, and begin to enter Plastic Deformation_ \*Cortical Bone has Low Elastic Deformation- Cannot Strech and Recover

Question 115

Two Types of **Moisture Retentive Dressings** that are Better than Adherent Dressings for _Wounds in late Debridement/Proliferative Phase_ because they optimize the body's inherent wound healing abilities

Answer 115

**Hydrocolloid** **Polyurethane**

Question 116

Most Common **Passive Drain** used in Veterinary Medicine

Answer 116

**Penrose Drain** **\***The Drain allows Fluid to escape from the wound and for us to asses what kind of Exudate is being produced. If the Exudate begins to look Purulent, the wound may be Infected

Question 117

This is a Radiograph of a ____ Fracture

Answer 117

**Complete** **\***Fracture through all Cortices

Question 118

Prognosis for **Biceps Brachii Tendinopathy**

Answer 118

**Medical Treatment- Good to Poor** **Surgical Treatment- Good to Excellent** \*_Tenotomy- Excellent Results Reported_

Question 119

**Plates** should be applied to the ____ Side of the Bone

Answer 119

**Tension** _Tension Side- Side of the Bone where the Fracture wants to Open up when Load is Applied_

Question 120

When using ____ **Plates**, _Minimal to No Contouring is Required_. Stable Repair Requires Screw Purchase of at least ____ Cortices above and Below Fracture

Answer 120

**Locking Plate** **4** **\***For a Locking Plate, you only need Purchase of 4 Cortices Above and Below the Fracture (2 Screws Above and 2 Screws Below)

Question 121

Removal of Devitalized Tissue and Foreign Bodies

Answer 121

**Debridement**

Question 122

**Screws** with these Characteristics: _Largest Core Diameter_ _Self Tapping_ _Threaded Head Locks into Threaded Hole in Locking Plate_

Answer 122

**Locking Screw** _**\***Only for use with Locking Plates_

Question 123

Type of **Biological Osteosynthesis** Approach: _Implants are Placed through Incisions distant to the Fracture_ _Fracture is Not Approached_ _Intra-Operative Fluroscopy is used to Guide Placement of Implants and to Confirm Fracture Reduction and Alignment_

Answer 123

**Minimally Invasive Osteosynthesis** _**\***Not Making an Incision over the Fracture or Touching the Fracture Ends_ \*Difficult to Do- Steep Learning Curve

Question 124

**Skin Flap** Characterized by: _Three-Sided Flap that can be used when Donor Skin is Available in the Same Plane as the Wound_ _One Side of the Wound becomes the Leading Edge of the Flap_

Answer 124

**Single Pedicle Advancement Flap** **\***Very common in the _reconstruction of Upper Eyelids_

Question 125

When Cutting **Cerclage Wire**, cut the Wire leaving ____ Twists in Place on the Bone

Answer 125

**2-3** _**\***Don't bend the Twist over- Loosens the Wire_

Question 126

A **Permanent Change in Shape**, where Material Does NOT return to Original Shape when Load is Removed

Answer 126

**Plastic Deformation**

Question 127

**Topical Wound Medication** that Provides the Following:

Answer 127

**Sugar** **\***Effect is due to Osmolality

Question 128

This is a Radiograph of a _____ Fracture

Answer 128

**Incomplete (Greenstick)** **\***One Cortices is still Intact

Question 129

Which Two Types of **External skeletal Fixators** can be used on the _Humerus and Femur_?

Answer 129

**Type 1A and Type 1B**

Question 130

**Chemical Debridement** Agent that contains:

Answer 130

**Granulex**

Question 131

If **Fracture Ends** do not Line up then Fracture is Considered \_\_\_\_\_

Answer 131

**Displaced** _**\***Displacement is Described based on the Location of the DISTAL Segment_

Question 132

When Blood Supply is Considered, **Skin Flaps** in small animals are classified as \_\_\_\_Flaps, if a _Direct Cutaneous Artery and Vein are NOT Included_

Answer 132

**Subdermal Plexus Flap**

Question 133

\_\_\_\_\_ Grafts contain all Adnexal Component making them: _More Likely to Resemble Normal Skin_ _Grow Hair Better_ _Able to Withstand Trauma as well as Surrounding Skin_

Answer 133

**Full Thickness** **\***Full Thickness Grafts have several Advantages over Split Thickness Grafts \*_Generally Recommends use to Full Thickness Grafts_

Question 134

**Secondary Implants** that are: _Small Steinmann Pins_ _Easily Bent_ _Come in Various Lengths_

Answer 134

**Kirschner Wires (K Wires)**

Question 135

Sling worn for 2-4 Weeks Post Op after Medial Glenohumeral Ligament Reconstruction for Repair of **Shoulder Instability**

Answer 135

**Velpaeu Sling**

Question 136

Signalment for which **Bone Disease**?

Answer 136

**Osteochondrosis/Osteochondritis Dissecans**

Question 137

In Patients with **Plant Fiber Foreign Bodies**, Many Times ______ are initially treated with Antibiotics with apparent success but Frequently the Draining Tract re-develops when the Antibiotics are Discontinued

Answer 137

**Sinus Tracts** _**\***Sinus Tracts will heal Rapidly when Foreign Body is Removed_ _\*_Common Presentation- Animal came in with a wound and was treated with Antibiotics and the wound healed. Antibiotics were discontinued and weeks later a new wound has opened up- Plant Fiber Foreign Body

Question 138

\_\_\_\_\_ **Drains** Depend on _Gravity and Capillary Action_ to Move Fluid

Answer 138

**Passive** **\***Ex. Penrose

Question 139

\_\_\_\_\_ Flaps can be Constructed without the Length Limitations of Subdermal Plexus Based Flaps

Answer 139

**Axial Pattern**

Question 140

\_\_\_\_\_\_ Implants Include: _Bone Plates_ _Interlocking Nails_ _External Skeletal Fixators_

Answer 140

**Primary** \*Primary Implants**-** Fixation that Maintains Bone Length and Provides Rigid Support while the Bone is Healing

Question 141

**Degloving Injury** where Skin Surface remains Intact but the Blood Supply is Destroyed, where skin typically becomes Black, Hard, and Cool to the touch and begin to slough away within a few days

Answer 141

**Physiologic**

Question 142

Technique that is useful in managing open wounds and prior to excising masses on the _distal part of the limbs_ where skin is Limited. This Technique takes advanged of **Creep and Stress Relaxation**. The Skin is typically stretched over a _24 hour period_

Answer 142

**Presuturing** **\***Mattress Sutures placed prior to Surgery to Distribute the Tension. _Creates more Loose Skin_ for Closing during Surgery \*The limb should be bandaged until the sutures are removed just prior to surgery

Question 143

With Regards to **Orthopedic Wire**, the Thicker the Wire, the ____ the Gauge

Answer 143

**Lower** _**\***The Thicker the Wire, the Stronger the Wire_ _\*We generally are using 18-24 Gauge Wire_

Question 144

**Two Axial Pattern Flaps** that have the Most Clinical Application

Answer 144

**Thoracodorsal** **Caudal Superficial Epigastric** _**\***Thoracodorsal and Caudal Superficial Epigastric Flaps are the most Useful for Closing Wounds on the Limbs_

Question 145

When Placing **Intramedullary Pins**, DO NOT Penetrate the ____ Surface

Answer 145

**Joint** **\***End point for Positioning the Pin is always going to be the Distal Metaphysis. _Do not Drive Pin into Joint because it will Damage the Joint and the Animal will be in Pain and not want to Bear Weight_

Question 146

When Placing Pins for **External Skeletal Fixation** (Transfixation), the Pins should be placed ____ Bone Diameter away from Fracture and Each Other

Answer 146

**1/2**

Question 147

**Topical Wound Medication** that provides the Following:

Answer 147

**Honey** **\***Ex. Manuka Honey \*_Main Advantage of Honey- Produces agents that have Antibacterial Effect_

Question 148

Physical Exam Findings for which **Shoulder Disease**

Answer 148

**Congenital Shoulder Luxation** **\***Typically NOT very Painful

Question 149

How does the Healing of **Superficial Wounds** Differ in _Dogs and Cats?_

Answer 149

**In Cats with Traumatic Wounds, if the _Subcutaneous Tissue_ is gone it will take longer for Granulation tissue to Form and Longer for the Wound to Heal** **\***In a Dog with the Same wound, the Healing process would not Take as Long

Question 150

How to Perform a _____ Flap: _Toes to the Shoulder and Lateral Abdomen must Be Clipped and Prepped_ _Place Sterile Glover over the Foot helps to Reduce Contamination to the Surgical Site_ _Leg is Placed along the Side to determine best Location and Size of Flap Necessary to Cover Defect_ _Edges of Flap are Oriented in the Dorsoventral Direction_ _Leg is Inserted through Pouch and Edges are Sutured to the Edge of the Wound_

Answer 150

**Pouch Flap**

Question 151

**Topical Wound Medication** with the Following Indications:

Answer 151

**Calcium Alginate**

Question 152

**Antiseptic** used for Wound Lavage that has:

Answer 152

**Povidone Iodine** **\***Residual Activity- 4-6 Hours, so _repeated doses are necessary to maintain maximum Activity_ _\*Needs to be Diluted to 1:10 or Less_

Question 153

Always place AT LEAST ___ **Cerclage Wires** to Stabilize Fracture

Answer 153

**2** **\***Used to Hold Fragments in Position

Question 154

Methods to _____ **External Skeletal Fixator** Rigidity: _Frame Type (II-III)_ _Double Bar_ _Interconnecting Bars_ _Reduce Bone-Connecting Bar Distance_ _Pins Close to Ends of Bone and Fracture_ _Increased Number of Pins_ _Larger Diameter Pins and Connecting Bar_

Answer 154

**Increase** _**\***Pins Closer to Ends of Bone and Fracture = More Stable_

Question 155

The **Passive Drain** ____ Site must be Kept Clean and Dry to Minimize Maceration of Surrounding Skin

Answer 155

**Exit**

Question 156

True/False: In Patients with **Arrow Wounds** and Impailment Injuries, you should Initially pull the object out of the Patient

Answer 156

**False** **\***First Inclination is often to pull the object out but this should be avoided. The Object may be Tamponading off larger blood vessels so bleeding may become Uncontrollable if it is not removed in a surgical environment

Question 157

Treatment for ACUTE Cases of **Biceps Brachii Tendinopathy**

Answer 157

**Confinement for 4-6 weeks** **Non Steroidal Anti-Inflammatory Drugs** **+/- Physical Therapy**

Question 158

Technique for Removing \_\_\_\_\_: 1. Incision is Extended through the Middle of the ___ to the End of the Puckered Skin 2. The Triangle of Tissue formed on each Side is Excised at the Base 3. The Skin is Sutured

Answer 158

**Dog Ears**

Question 159

Advantages of \_\_\_\_\_\_\_: _Keep Wound Moist_ _Allow Excess Fluid to Drain_ _Do not Damage Newly Formed Reparative Tissue when Bandage is Changed_

Answer 159

**Nonadherent Dressings**

Question 160

**Screws** that are Preferred when Fixing _Diaphyseal Bone Fractures (Hard Bone)_

Answer 160

**Cortical Screws** _**\***Wider Core Diameter_

Question 161

Treatment for Recurrent/Persistent **Biceps Brachii Tendinopathy**

Answer 161

**Intraarticular Corticosteroid Injection** **Strict Confinement- 4-6 weeks** **Physical Therapy**

Question 162

Incision that Connects Base of Flap and Recipient Site that is used to Avoid having to Tube Flap over Intact Skin

Answer 162

**Bridging Incision** _**\***Always use the Bridging Incision technique rather than Tubing the Flap_

Question 163

**Rectangular Flaps** that _Turn on a Pivot Point to Reach the Defect._ These Flaps are Created within _90 Degrees of the Long Axis of the Defect_ and are Generally 3x's the Width of the Defect

Answer 163

**Transposition Flap** _\*Transposition Flaps- Donor Skin in Different Axis from Wound!!!!_ \*In most Instances this Flap is Generated 60-90 Degrees from the Plane of the Wound

Question 164

Method of **Debridement** that is Accomplished by the application of Enzymatic Agents in Animals that are Poor Surgical Risks or when Surgical Debridement may damage vital Structures

Answer 164

**Chemical Debridement (Ezymatic)** **\***Common Chemical Debridment Solution- Granulex

Question 165

When Placing Pins for **External Skeletal Fixators**, at least ___ Pins in Bone Segments are required

Answer 165

**Two** _**\*Three** Pins per Bone segment is Ideal_

Question 166

Administration of **Antibiotics** PRIOR to Wound Contamination

Answer 166

**Prophylactic** **\***Use of Antibiotics to Prevent Infection \*The Lower the Experience of the Surgeon, the Higher the Likelyhood that Prophylactic Antibiotics should be used

Question 167

Which Suture Material would be most Appropriate for this Wound? \***Bite Wound** to the Thorax

Answer 167

**Absorbable Monofilament** \*_Absorbable Suture_- Short Lasting: 7-10 days Intermediate Lasting: 10 days - 3 weeks Long Lasting: \> 1 Month

Question 168

In Patients with **Gunshot Wounds**, Lead Fragments in ____ should be removed because they can be dissolved by Synovial Fluid Causing Periarticular Fibrosis and Hypertrophic Arthritis

Answer 168

**Joints**

Question 169

**Screw Type** that has a Wider Core Diameter and is: _Less Likely to Bend_ _More Likely to Pull out_

Answer 169

**Cortical Screw**

Question 170

\_\_\_\_\_ Drains must Exit _Dependent Area_ of Wound. A Single Exit Site if Preferred over Two Exit Wounds to Decrease the Risk of Ascending Infection

Answer 170

**Passive**

Question 171

\_\_\_\_\_ **Strain**: When Force is Applied Laterally on Either Side of a Column Leads to _Widening of the Material_

Answer 171

**Shear**

Question 172

True/False: Disadvantage of **Surgical Drains** is the Increased Risk of Secondary Infection

Answer 172

**True** **\***There is a Risk of Ascending Infection associated with the Drain

Question 173

Knowledge of the Normal Skin _____ Lines is important when planning Surgical Procedures. By choosing the Correct Direction for making a Skin Incision or Closing a Wound, the Surgeon can produce a wound that will Heal Better and Faster with Less Risk of Complications.

Answer 173

**Tension**

Question 174

\_\_\_\_\_**Strain**: Combination of _Compressive, Tensile and Shear Loading Forces_

Answer 174

**Torsion**

Question 175

In Patients with **Gunshot Wounds,** Extenstive searching for Lead Fragments is unnecessary unless they lie within or close to a \_\_\_\_. Lead Fragments in soft tissue are relatively inert and usually become walled off

Answer 175

**Joint**

Question 176

Up to 90% of Surface Bacteria on a **Traumatic Wound** can be removed by _____ when _Large volumes are Delivered Under Moderate Pressure_

Answer 176

**Wound Lavage** **\***Wound Lavage is Done with Saline or Balanced Electrolyte Solution

Question 177

True/False: **Prophylactic Antibiotics** should be Administered After Induction

Answer 177

**False** _**\***Prophylactic Antibiotics should be Administered PRIOR to Induction (30-60 minutes prior to skin incision). If the Patient has an Anaphylactic reaction to the Antibiotic it will be more apparent if the Patient is not Induced yet_

Question 178

Type of Non Surgical **Fracture Fixation**

Answer 178

**External Coaptation (Ex. Splint/Cast)**

Question 179

**Axial Pattern Flap** with these Characteristics: _Anatomical Landmarks- Abdominal Midline, Mammary Thelia, Base of Prepuce (Males)_ _Can Reliably Extend into Caudal Thoracic Glands of Female_ (# 4 in Diagram)

Answer 179

**Caudal Superficial Epigastric Axial Pattern Flap** \*Much more Reliable Flap in _Female Dogs_

Question 180

Preparing the _____ for **Grafting**: Lightly Scape Surface of the Granulation tissue with Scalpel Blade to Remove any Surface Debris and Expose Capillary Ends All Epithelium Migrating from the Wound should be Removed Apply Sponges moistened with the anitseptic Solution to the Surface to keep it Moist

Answer 180

**Recipient Site/Bed**

Question 181

Goal of which type of **Internal Fracture Fixation**: _Goal is to Return Limb Alignment and Length to normal without Disruption of Fracture_

Answer 181

**Biological Osteosynthesis**

Question 182

During Evaluation of an **Open Traumatic Wound** we should Temporarily Close or Pack the Wound, Clip and Prep Surrounding Skin while wearing Caps, Masks and Gloves in Hopes of using Complete _____ Technique

Answer 182

**Aseptic**

Question 183

Signalment for which **Shoulder Disease**

Answer 183

**Traumatic Shoulder Luxation**

Question 184

Medical Treatment for **Arthritis** Described Below: _Reduces Signs of Arthritis_ _Calorie Restriction Reduces Prevalence_ _Delays or Prevents Radiographic Osteoarthritis_ _Reduces Need for Medication/Surgery_ _Good to Excellent EBM Support_

Answer 184

**Weght Management** **\***Reducing Obesity in Dogs with OA improves Lameness, and Decreases the Need for Surgery. Long Term Calorie Restriction also Delays or Prevents the Development of Hip Dysplasia

Question 185

In Cases of **Open Fractures**, once you have Cleaned the Wound Appropriately, Start Treatment with \_\_\_\_\_

Answer 185

**Cefazolin** (Antibiotic)

Question 186

Signalment and History of which **Shoulder Disease**?

Answer 186

**Congenital Shoulder Luxation** _**\***SMALL AND TOY BREED with no History of Trauma_

Question 187

**Shoulder Disease** characterized by the Following: _Abnormally Increased range of Motion_ _Laxity in Support Structures of Shoulder_ _Repetitive Microtrauma ("Overuse Injury")_

Answer 187

**Shoulder Instability** _**\***80% Medial Shoulder Instability_

Question 188

During **Secondary Wound Closures,** Lightly scrape the Surface of the Granulation bed with a Scalpel Blade and thoroughly Lavage the Wound to remove Surface Debris and Reduce _____ Counts

Answer 188

**Bacterial**

Question 189

\_\_\_\_\_\_ **Strain**: Forces Applied in a Pulling Fashion that Leads to _Lengthening_ of Bone

Answer 189

**Tensile**

Question 190

Wound Classification used for **Traumatic Wounds**

Answer 190

**Contaminated**

Question 191

True/False: The Potential for Pneumo/Hemo Thorax and the Necessity for Controlled Ventilation during Surgical Intervention should be considered when managing **Bite Wounds** on the Thorax

Answer 191

**True**

Question 192

**Disease Modifying Agents** are Heparin Analongues and should not be used in Animals that have \_\_\_\_\_

Answer 192

**Coagulopathies**

Question 193

Diagnoses Based on Radiograph

Answer 193

**Osteochondrosis**

Question 194

The goal of ____ Technique is to Minimize the Incidence of Surgical Wound Infection

Answer 194

**Aseptic**

Question 195

Which of the Following is _False_ Regarding **Active Drains:** A. Active Drains are More Efficient than Passive Drains B. Decreased Risk of Drainage Macerating Surrounding Skin C. Risk of Infection is Lower than with Passive Drains D. Active Drains Enhance Healing E. All of the Above are True

Answer 195

**E. All of the Above are True** **\***Much more efficient than Gravity Drains in Removing Fluid Accumulations \*Risk of Ascending infection is Significantly Less than with Gravity Drains because the Surrouding Skin stays Drier creating a Less Hospitable Environment for Bacterial Growth

Question 196

**Adherent Dressing** that is Primarily Indicated for Wounds producing a _Low Viscous Exudate_ and for Wounds Containing Loose Necrotic Tissue and Foreign Materials

Answer 196

**Dry-to-Dry Dressings**

Question 197

Property of Bone, where Elastic Modulus is Dependent Upon the _Direction of Loading_ (Stress Application)

Answer 197

**Anisotropic** **\***Ex. Bone is Stronger and Stiffer in Compression. Bone is Weakest when Shear Stress is Applied

Question 198

Main Advantage of **Moisture Retentive Wound Dressings**

Answer 198

**Autolytic Wound Debridement**

Question 199

Two Types of Surgical **Fracture Fixation**

Answer 199

**External Skeletal Fixator** **Internal Fracture Fixation (Pins, Wire, Plate/Screws)** **\***External Fixatory- Secures Bone to an External Rigid Fixator _Internal Fracture Fixation is used more Commonly_

Question 200

**External Skeletal Fractures** are very Useful with ____ Fractures

Answer 200

**Open** _**\***Open Fractures- One of the most useful Applications of External Skeletal Fixators_

Question 201

**Conservative Treatment** for which Bone Disease: _Small Lesions_ _Young Patient (_ _Clinically Silent or Mild Lameness_ _Diet/Exercise Restriction (Cage Rest)_ _Weight Control_ _+/- NSAID or other Therapies_

Answer 201

**Osteochondrosis** _**\***Conservative Treatment is Suitable if you have a very small Lesion in a Young Patient that isn't too sore as a Result_

Question 202

Best **Prophylactic Antibiotic** to use for Surgeries _Involving the GI Tract, Particularly Colon or when Obstruction is Present_

Answer 202

**Cefoxitin** **\***_Used for Procedures where a wider range of coverage to Include Anaerobes is Desired_

Question 203

Three Components that Make up the Construct of **External Skeletal Fixators**

Answer 203

**Connecting Clamp-** Secure Pins and Connecting Bars **Connecting Bar** **Transfixation Pin-** Inserted through the Near (Cis) and Far (Trans) Cortex

Question 204

Radiograph of _____ **Arthritis**

Answer 204

**Rheumatoid** \*Non Infectious

Question 205

**Passive Drains** should be Covered by a _____ to Absorb Exudate.

Answer 205

**Bandage** _**\***Bandaging also Reduces Soiling and Irritation of the Surrounding Skin by the Exudate_

Question 206

In ______ Plates, Tighetning the Screw generates Friction between the Bone and Plate. Loading of the Limb results in _Forces shared between the Bone and Plate_

Answer 206

**Conventional Plates**

Question 207

Three Surgical Treatments for **Biceps Brachii Tendinopathy**

Answer 207

**Arthroscopic Evaluation of the Joint** **Tenotomy of Biceps Tendon-** Cut Tendon **Tenodesis of Bicipital Tendon**

Question 208

Wounds converted to Clean or Clean-Contaminated status in 2-5 days by repeated lavage, debridement, and activation of host defense mechanisms can still be closed primarily but the closer is called a ______ Closure

Answer 208

**Delayed Primary Closure** _**\***Wound Left open for 2-5 Days_ \*Closed Prior to Visible formation of Granulation tissue

Question 209

**Plant Material Foriegn Bodies** (Ex. Grass awns, Sticks) can Migrate significant Distances causing a _____ that is lined by Granulation Tissue

Answer 209

**Draining Tract**

Question 210

Postoperative Care needed in ______ Includes: _Immediately After Surgery, Cover with Nonadherent Pad_ _**Apply Broad Spectrum Antibiotic Ointment** on Pad First_ _Apply Several Layers of Absorbent Material_ _Cover Bandage with Porous Adhesive or Elastic Tape_

Answer 210

**Skin Grafts** _**\***If the Graft Crosses a Joint, immobilize the Leg with a Splint, Half Cast or Bi-valve Cast_

Question 211

After Performing **Distant Flaps (Pouch Flap and Single Pedicle Direct Flaps)**, both of these Techniques necessitate Immobilization of the Leg along the Side for Approximately ____ Days

Answer 211

**14** _**\***The Temperament and the ability of the animal to walk on Three Legs should be considered before performing these Procedures_

Question 212

Signalment and History for which **Shoulder Disease**?

Answer 212

**Shoulder Instability** _**\***Poor Response to Medical Managment- NSAIDs!!!!!- Know this_ \*NSAIDs cannot Fix the Unstable Joint

Question 213

Indications for Surgery in Cases of **Traumatic Shoulder Luxation**

Answer 213

**Chronic/Recurrent/Unstable Luxation** **Accompanying Fractures**

Question 214

**Surgical Treatment** for which Bone Disease: **_Arthroscopic Fragment Removal and Subchondral Bone Debridement_** _Replacement of Articular Cartilage with Fibrocartilage_

Answer 214

**Osteochondrosis** _**\***Surgery is the Recommended Method of Treatment in almost All Cases of Osteochondrosis/Osteochondritis Dissecans_ **_Surgery is the Standard of Care-_** _Debridment of Bone with Curette or Shaver_

Question 215

Three most Commonly used **Skin Flaps** in Small Animal Medicine

Answer 215

**Single Pedicle Advancement Flap** **Rotation Flap** **Transposition Flap**

Question 216

\_\_\_\_ Dissection is the most Easily performed by inserting Closed Scissors under the Skin and then Spreading the points to Separate the Tissues. ____ Dissection has the Advantage of **_Preserving the Direct Cutaneous Arteries and Veins_** so that large amounts of Skin can be undermined without affecting the blood supply to the skin edges

Answer 216

**Blunt**

Question 217

Most Common **Passive Drain,** which is a Soft Latex Tubing that Collapses Easy and Conforms well to the Wound

Answer 217

**Penrose Drain**

Question 218

Technique for Correcting **Dog-Ears:** A. the Dog-ear is forming at the end of the suture line B. The Incision is Extended through the Middle of the Dog-Ear to the end of the Puckered Skin C. The _____ of Tissue formed on each side is excised at the base D. The Skin is Sutured

Answer 218

**Triangle**

Question 219

Three **Infection Potentiating Factors (IPF**) that interfere with Normal Host Defense mechanisms and _Reduce the Number of Bacteria required to Cause Infection to as Few as 100_

Answer 219

**Montmorillinite** **Kaolinite** **Illite** **\***If you introduce any of these three components to a wound, the wound will become Infected

Question 220

Post Op Fracture Assessment that Asks: ## Footnote **Are the Joints Above and Below the Fracture Aligned to Promote Normal Limb Use?**

Answer 220

**Alignment** _**\***Remember to Include the Joints in all Radiographs_

Question 221

What are the Arrows pointing at in this Radiograph?

Answer 221

**Osteophytes**

Question 222

Classification of **Wound**: _Surgically Created Wound_ _No Infections Encountered_ _Aseptic Technique Maintained during Surgery_ _No Structure normally Containing Bacteria Opened_

Answer 222

**Clean Wound** **\***This wound is NOT free of Bacteria- all wounds will have bacteria. In Clean Wounds the number of bacteria is very small. The risk of Infection after this type of procedure is very low

Question 223

Place **Cerclage Wire** ___ cm from Fracture Ends

Answer 223

**0.5** _**\***Spaced 0.5-1x Bone Diameter Apart_

Question 224

Most Common Source of **Operative Wound Infections**

Answer 224

**Patients Endogenous Flora** **\***Ex. Skin, GI Tract, Fur

Question 225

Advantages of _____ Fixation: _Can be Placed with Minimal Disruption of the Fracture_ _Variety of Construct Options_ _All Implants are Removed once the Fracture is Healed_ **_Useful for Treatment of Grade II and III Open Fractures_** _Implants can be Removed in Stages to Slowely Increase the Loading on Bone_

Answer 225

**External Skeletal Fixators**

Question 226

Type of **Open Fracture** Characterized by: _Open Wound \> 1cm in Size_ _Wound from External Source_ _Mild Soft Tissue Trauma without Extensive Soft Tissue Damage_ _No Flaps or Avulsions_

Answer 226

**Type II** **\***Typically from an External Source

Question 227

Therapy used to Seal Wounds after Surgical Debridement where _Constant or Intermittent Suction is applied to the Wound_ that leads to Accelerated Granulation Tissue formation

Answer 227

**Negative Wound Pressure Therapy (Vacuum Assisted Closure)** **\***These wounds tend to Progress More Rapidly towards Healing- Very commonly used in Acute wound Managment _\*Adequate wound debridement and removal of forign bodies must be accomplished BEFORE utilizing this technique_ _\*This Technique is primarily indicated for open wounds that contain little or no devitalized tissue for foreign material but are not yet ready for closure_

Question 228

After Physical Examination, what are the Next Two Steps in Initial Managment of **Traumatic Wounds**?

Answer 228

**Debridement** **Wound Lavage**

Question 229

Approach for **Internal Fracture Fixation** characterized by: _Avoid Disruption of Fracture Hematoma_ _Less Rigid Fixation_ _Secondary Healing_

Answer 229

**Biological Osteosynthesis** **\***_Relies on Secondary Healing_

Question 230

True/False: The ability to Close Wounds by the **Local Movement of Tissues** is Controlled by the availability of Surrounding Skin for Movement and the Tension produced by that Movement

Answer 230

**True**

Question 231

Special Kind of Subcutaneous **Suture** used to advance skin that has been undermined across the Surface of a Wound. These Sutures are used to help Close Skin Defects when Direct Apposition of the Skin Edges Results in Excessive Tension

Answer 231

**Walking Sutures** **\***Tensions Distributed over Surface of wound rather than Being Concentrated at Primary Suture Line

Question 232

The Following are Considered _____ Implants: _Orthopedic Wire_ _Kirschner Wires_ _Intramedullar Pins_

Answer 232

**Secondary** **\***Most often, these Materials are being used adjuctively with Plates or other types of Fixation Devices

Question 233

The Blood Supply to ____ **Flaps** comes through the Extenisve Interconnection of _Blood Vessels in the Dermis_ and _Superficial Subcutaneous Tissue just below the Dermis_

Answer 233

**Subdermal Plexus Flap** **\***Direct Cutaneous Artery is NOT Included, so perfusion of the Flap is Dependent on the Driving Force (Blood Pressure) in Smaller Vessels

Question 234

Etiology for which **Elbow Disease:** _Shortened Ulna Displaces Humerus Proximally leading to Radioulnar Incongruity_

Answer 234

**Ununited Anconeal Process**

Question 235

**Drains** are Indicated if \_\_\_\_cannot be sufficiently obliterated as a Wound is Closed

Answer 235

**Dead Space** **\***Dead Space- the Potential Space created when tissue planes are separated or when Tissues have been Removed

Question 236

Type _____ **External Skeletal Fixator**: **_Unilateral-Uniplanar-_** Bar is Only on One side of the Bone and all of the Pins are in one Plane

Answer 236

**Type IA** **\***Most Basic Type of External Fixator- _Least Rigid of all the Constructs_

Question 237

When Performing a **Single Pedicle Advancement Flap**, Triangles of Skin are Removed at the Base of the Flap to prevent ____ from Forming when Flap is Advanced

Answer 237

**Dog Ears**

Question 238

Transposition Flap that _Incorporates a Direct Cutaneous Artery and Vein._ Inclusion of these Vessels allows Large Flaps to be Elevated and Transferred in a Single Procedure

Answer 238

**Axial Pattern Flaps** **\***Can make this flap much longer and expect it to survive because we are bringing a dominant blood supply with it

Question 239

When using ____ Dressings, The Wet Dressings help _Liquefy Viscous Exudates enhancing their absorption_

Answer 239

**Wet-to-Dry Dressings**

Question 240

Risks of \_\_\_\_\_\_: _Implant Failure- Loosening, Breakage, Migration_ _Osteomyelitis (Bone Infection)_ _Impingement of Nerves_ _Osteopenia (Bone Loss)_

Answer 240

**Internal Fixation**

Question 241

Method of **Debridement** performed by applying Adherent Dressings to a Wound. The Devitalized Tissue sticks to the Dressing Material and is Removed when the bandages are changed

Answer 241

**Mechanical Debridement**

Question 242

\_\_\_\_\_ Bone has a **High Porosity** of 75-95% characterized by: _Long Elastic Phase-_ Maintain its shape for a Long Time _Lower Yield Point-_ Low Stress to Hit Yield Point

Answer 242

**Cancellous**

Question 243

Granulation Tissue may be Slow to Cover Exposed \_\_\_\_. This is a Frequent Problem in Degloving Injuries. If ___ is Devitaized, Granulation Tissue will Rarely Cover it. If this Happens the ____ will usually _have to be Removed_ unless it is Essential for Providing Stability or Function

Answer 243

**Bone**

Question 244

**Plate Function** Described Below: _Used in Metaphyseal Fractures to Prevent Collapse of the Adjacent Articular Surface_ _Plate is subject to Full Loading_ _Most or all Screw Holes should be Filled_

Answer 244

**Buttress Mode** \*Not used very Often

Question 245

Indications for which type of **Adherent Dressing**

Answer 245

**Dry-to-Dry Dressings** **\***Ex. Keralix Sponges

Question 246

Three Methods of **Wound Lavage**

Answer 246

**Bulb Syringe**- Used for Keeping Tissue Moist Ineffective for Removing Bacteria and Foreign Bodies **Water Pik**- Can Produce Pressure high Enough to Damage Tissue and Drive Bacteria Deeper into Wound **Syringe and Needle-** Can achieve the Goal of Reduing the Number of Bacteria in the wound and flushing away foreign bodies without causing Significant damage to surrounding tissue (Best Method)

Question 247

**Shoulder Disease** with the Following Presentation:

Answer 247

**Biceps Brachii Tendinopathy** _Unilateral Disease!!!- Traumatic_ _**\***Chronic Lowgrade Lameness at first, which Progresses and Worsens with Exercise_

Question 248

Disadvantages of ______ Fixators _Frequent Rechecks Required ($$)_ _Morbidity associated with Skin-Pin Interface_ _Pin Loosening- Implant Failure_ _Requires High Level of Owner Compliance_ _Additional Procedures required for Destabilization and Implant Removal_

Answer 248

**External Skeletal Fixation**

Question 249

Perferred Dilutent for **Chlorhexidine**

Answer 249

**Sterile Irrigating Water** **\***Chlorhexidine diluted with Polyionic Solutions (Sodium Chloride) can form a Percipitate (Chlorhexidine Chloride Salt). _Preference is to use Sterile Irrigating Water as the Dilutent to avoid getting percipitate in the Wound_

Question 250

Post Op Fracture Assessment that Asks: ## Footnote **Is there Evidence of Bone Healing, Infection, Osteopenia, or Malunion?**

Answer 250

**Activity**

Question 251

True/False: There is Evidence that Continuation of **Prophylactic Antibiotics** beyond 24 hours has added Benefit for Prophylaxis

Answer 251

**False**

Question 252

Skin ____ retain a Blood Supply throughout the Healing Process, While Skin \_\_\_\_\_are Segments of Skin that are Completely Detached from the donor, prepared, and the placed on the Recipient Site

Answer 252

**Flaps** **Grafts**

Question 253

Almost any Geometry of Wound will Heal well, except for _____ Wounds

Answer 253

**Circular** **\***Avoid creating Circular Wounds and Avoid leaving wounds with a Circular Configurations

Question 254

**Biological Dressing** that contains natural components, such as Collagen (Types I, II, an V) and Transforming Growth Factor Beta and Beta Fibroblast Growth Factor

Answer 254

**PSIS** Porcine Small Intestinal Submucosa \*Conducive to smart tissue remodeling of organ augmentation and reconstruction with reduced scar formation

Question 255

Surgical Treatment for **Arthritis** Described Below: _Complete Removal of ALL Articular Cartilage_ _Cancellous Bone Graft_ _Rigid Fixation (Usually DCP)_ _Standing Angle_

Answer 255

**Arthrodesis**

Question 256

Type of **Biological Osteosynthesis** Approach: _Fracture is Surgically Approached and Visualized_ _Fracture Ends are NOT Manipulated during Placement of Implants_ _Fracture Reduced via Traction or Manipulation of Bone Away from Fracture_ _Minimal Distrubance of Fracture Hamatoma, Periosteum and Blood Supply_

Answer 256

**Open but do Not Touch** **\***Don't Manipulate Pieces of the Fracture or Hamatoma

Question 257

Surgical Treatment for **Arthritis** characterized below: _Technically Challenging_ _Highly Specialized Instrumentation/Training_ _Hip, Elbow, Stifle, Shoulder_ _Expected Outcome dependent upon Joint_ **_Intent is to Allow/Preserve Normal Joint Function_**

Answer 257

**Joint Replacement Arthroplasty**

Question 258

Etiology of which **Bone Disease**: _Most common in **Larger Breed Dogs (**Great Danes)_ **_Rapidly Growing Breeds_** _Males Predisposed_ _Hereditary- Within Blood Line (Animals with OCD- Do NOT Breed)_ _Nutritional- Rapid Growth, Calcium/Vitamin D_

Answer 258

**Osteochondrosis** _\*By Far most Common in Large Breed Dogs, including Great Danes_ _Nutrition influences Manifestations of Osteochondrosis- Breeds Predisposed to OCD have Rapid Growth. Oversupplying with Energy during the Rapid Growth phase has been shown to Predipose to OCD_

Question 259

If **Recipient Bed** has Irregular Edges, a \_\_\_\_\_can be made to make sure the Graft will cover the Defect. To make a \_\_\_\_\_: _Place Absorbent Material (Gauze or Towel) on the Surface to Obtain Blood Imprint of the Recipient Site_ _Transer the Pattern to Donor Site_

Answer 259

**Pattern**

Question 260

Most Common Type of **Bone Plate** that are _Very Stiff and Fail by Bending_

Answer 260

**Stainless Steel** **\***Stainless Steel Bone Plates tend to _Fail by Bending_

Question 261

Type of **Orthopedic Wire** that is: _Placed like "Sutures" Holding Bone Fragments Together_ _Indicated in Simple Fractures of Flat, Non Weight Bearing Bones that Interdigitate Well_ _Most Commonly used for **Mandibular and Maxillary Fractures**_

Answer 261

**Interfragmentary Wire**

Question 262

Flaps that are used to **Reconstruct Distal Limb Wounds** when Axial Pattern Flaps cannot be extended Far enough to cover the Defect and when Skin Grafting is not Deemed a Viable Option

Answer 262

**Distant Flaps**

Question 263

When Constructing an **Axial Pattern Flap**, If the edge of the Defect is not Adjacent to the Donor Site, and Incision can be Made between the Donor Site and the Wound (Bridging Incision) or the Flap passing over Intact Skin can be sutured into a \_\_\_\_\_

Answer 263

**Tube** **\***Tubing the Flap has the Disadvantages of Requiring a Second Surgery to excise the Tube portion of the Flap \*_His Preference is to make Briding Incisions in almost all instances_ \*Picture Below- Thoracodorsal Artery Axial Pattern Flap

Question 264

List Three _Neutraceuticals_- Food or part of Food that Provies Medical Benefit in Treatment of **Arthritis**

Answer 264

**Glucosamine** **Omega 3 Fatty Acids** **Avocado**

Question 265

For **Degloving Injuries**, Devitalized Tissue and Foreign Material are Debrided but an Effort should be made to conserve as much skin as possible to aid in the reconstruction. _____ Adherent Dressings are often used Early to help Debride the Wound

Answer 265

**Wet-to-Dry**

Question 266

Cartilage is always being Broken Down or Synthesized. In **Arthritis** the Balance is Shifted towards Destruction. The point of ______ agents are to Slow Down, Stop or Reverse the Breakdown of Cartilage as much as possible

Answer 266

**Disease Modifying Agents** **\***_Building Blocks for Articular Cartilage and Joint Fluid- Promote Synthesis over Breakdown_

Question 267

Name these **Fracture Configurations** from Left to Right

Answer 267

**Transverse-** Straight Line Across **Oblique** **Spiral** **Comminuted/Reducible** **Comminuted/Nonreducible** **\***Comminuted- More than 2 Bone Segments

Question 268

The Time Between Wounding and the Development of Infection

Answer 268

**Golden Period (4-6 Hours)** **\***Number of Organisms are Low enogh that Primary Closure can still be Performed

Question 269

Indications for \_\_\_\_\_\_: _Fracture Fixation of **Appendicular Skeleton- Below the Stifle or Elbow**_ _Spinal Fractures/Luxation_ _Mandibular Fractures_ _Correction of Angular Limb Deformities_ _Limb Lengthening_

Answer 269

**External Skeletal Fixator**

Question 270

True/False: For **Active Drains**, Continuous Suction should be Maintained by Emptying the Container before it is completely full and Retrograde Flow back into the wound should be Prevented by Temporarily Occluding the Drain while the Container is being Emptied, unless the Canister has a One-way Valve to Prevent Backflow

Answer 270

**True**

Question 271

\_\_\_\_\_ Sutures help to **eliminate Dead Space** and **Distribute Tension over the Entire Surface of the Wound** rather than Concentrating it at the Wound Edges

Answer 271

**Walking Sutures**

Question 272

In Patients with **Degloving** and Crush Injuries, when you _initially evaluate_ these Patients, you need to check _____ Sensation prior to Analgesic Administration

Answer 272

**Pain** **\***When Initially evaluating, check Pain (Neurologic) Sensation. Once you start Analgesics, it becomes harder to assess Pain Sensation _If the Patient has Deep pain sensation- Neuronal Sheath is Intact_

Question 273

Complications of _____ Flaps Include: _Flap Edema_ _Seroma_ _Infection_ _Partial Dehiscence_ _Vessel Thrombosis with Flap Loss_

Answer 273

**Axial Pattern Flaps** _**\***Most Worrisome- Vessel Thrombosis leading to Loss of Flap_

Question 274

**NSAIDs** reduce pro Inflammtory Mediators by Inhibiting \_\_\_\_\_\_

Answer 274

**Cyclooxygenase** _**\***COX2- Responsible for creating all the Inflammatory Mediators. Most NSAIDs used for the Treatment of Arthritis are selectively Suppressing COX2_ **_\*All NSAIDs have Side Effects!_**

Question 275

Fractures and Unstable Joints resulting from **Degloving Injuries** are best stabilized by an External Fixator (Ex. Kirschner-Ehmer Apparatus). External Fixators allow some \_\_\_\_\_

Answer 275

**Joint Motion** **\***_Use an external fixature that allows a small amount of joint movement_

Question 276

Noninflammatory ____ **Osteoarthritis**: _No Underlying Cause_ _Highly Unusual in Dogs_ _More common in Cats_

Answer 276

**Primary** _**\***Dogs will Almost always have Secondary Osteoarthritis- Secondary to Something Else_

Question 277

\_\_\_\_ **Strain**: Forces Applied that lead to _Shortening_ of Bones

Answer 277

**Compressive**

Question 278

When Blood Supply is Considered, **Skin Flaps** in small animals are classified as \_\_\_\_Flaps, if a _Direct Cutaneous Artery and Vein ARE Included_

Answer 278

**Axial Pattern Flap**

Question 279

Treatment/Managment for **Burn Wounds**

Answer 279

**Fluid Resuscitation-** Important (Ex. Hydrotherapy) Initial Burn Managment- **Aloe Vera, Silver Sulfadiazine** **Cool Injured Tissue** **Surgical Debridment** **\***Burn Wounds are very likely to become Infected- Therefore need to use Topical Antibiotic such as Silver Sulfadiazine. _Aloe Vera and Silver Sulfadiazine work Synergystically_

Question 280

Two **Distant Flaps** most Applicable to Small Animal Medicine

Answer 280

**Pouch Flap** **Single Pedicle Direct Flap**

Question 281

**Review Card**: Anatomy of Bone

Question 282

Characteristic Posture for patients with **Elbow Dysplasia**

Answer 282

**MCD** **"Toed Out"** **\***Foot Turned out to the Side and Elbow is Abducted

Question 283

\_\_\_\_\_ Implants Include: _Kirshner Wire (K Wires)_ _Cerclage Wire_ _Interfragmentary Screws_

Answer 283

**Secondary** **\***Secondary Implants- Devices that we use to help maintain Reduction while you are Putting on Primary Implants

Question 284

Best type of **Bone Plate** to use on: _Geriatric Patients_ _Very Comminuted Fractures_ _Osteoporotic Bone_ _MIPO- Minimally Invasive Plate Osteosynthesis_

Answer 284

**Locking Plate (LCP)** _**\***Used on Fractures that will take a Long time to Heal_ \*Would NOT use LCP on Young Animals who Heal Faster

Question 285

Treatment for **Congenital Shoulder Luxation** with Normal Glenoid

Answer 285

**Open Reduction/Capsulorrhaphy Only** **Glenohumeral Ligament Reconstruction**

Question 286

How to Perform a ____ **Skin Flap**: _Intial Incision is Made 2-2.5 Times the Width of the Defect_ _Skin is Undermined Deeply to Perserve Blood Supply_ _Arcing Incision is Incrementally lengthened and Undermined until the Flap can be Advanced with little Tension_

Answer 286

**Rotation Flap** **\***Back Cut Incision- Increases mobility of the Flap but also _Increases the Risk of Vascular Compromise_

Question 287

Pros and Cons of which Type of **Fracture Fixation**:

Answer 287

**External Coaptation (Ex. Splint/Cast)** **\***Cons- _Require Frequent Rechecks_, which Drives up the Cost _Immobilization of Joints_

Question 288

Methods to _____ **External Skeletal Fixator** Rigidity: _Decrease Frame Type_ _Decrease Number of Pins_ _Smaller Diameter of Pins and Connecting Bar_

Answer 288

**Decrease** _**\***As a patient begins to heal, we Choose to Decrease Rigidity to let that bone bear more Weight and Forces to Promote Healing- Wolfes Law: The more Forces that a Bone experiences, the more likely that it is to Heal and create new Bone_

Question 289

**Bone Disease** Described Below: _Necrotic Cartilage Induces Repair_ _Inflammation is the First Stage of Repair_ _Defect in Joint Surface Accelerated Degenerative Joint Disease_ _Pain of Clinical Disease is a result of Inflammation_

Answer 289

**Osteochondritis Dissecans**

Question 290

**Topical Wound Medication** that is Produced from Kelp (Seaweed) that is very good for Wounds in the Early Stages of Wound Healing that do Not need Further Debridement but are _Producing a lot of Exudate._ This Topical Medicine is Exteremely Hydrophilic and will absorb a lot of Fluid from the Wound

Answer 290

**Calcium Alginate** **\***Promotes Autolytic Wound Debridement and wound Healing

Question 291

True/False: To be Effective, **Prophylactic Antibiotics** should be Administered at least 30 minutes but no more than One hour before the Skin Incision

Answer 291

**True**

Question 292

Physical Exam findings with which **Should Disease**?

Answer 292

**Biceps Brachii Tendinopathy**

Question 293

Prognosis with **Osteochondrosis/Osteochondritis Dissecans**

Answer 293

**Expect Near Normal to Normal Function with Surgery**

Question 294

**Biological Dressing** that is a Natural, Resorbable, Biocompatible Scaffold which potentiates appropriate tissue remodeling, Reinforces Wound Tissue, and is absorbed by the body as it is replaced by Host Tissue

Answer 294

**Porcine Small Intestinal Submucosa (Vet BioSISI)** **\***Takes on the characteristics of the tissue that you put it in

Question 295

**Bite Wounds** that extend into the _____ should be Explored when the Patient is Stabilized because of the High Risk of Penetrating Injuries to the GI Tract

Answer 295

**Abdominal Cavity**

Question 296

Developmental Orthopedic Disease, such as **Osteochondrosis**, almost always have what is referred to as a \_\_\_\_\_\_age Distribution, when you talk about Age of Onset

Answer 296

**Biphasic** _**\***Immature- Inflammatory Arthritis_ _Mature- Secondary Degenerative Arthritis_

Question 297

**Bone Plate** with the Following Characteristics: _Fixed Angle Implants_ _Threaded Lock Screw Head Locks Into Threaded Screw Hole on Plate_ _Prevents need for Plate-Bone Contact_ _Little to No Contouring Required_

Answer 297

**Locking Plates (LCP)**

Question 298

Once the **Graft** is Placed on the Recipient Bed, the Graft should be Manipulated as little as possible to Avoid Disrupting the \_\_\_\_seal that begins to form soon after the graft is placed on the Recipient Bed

Answer 298

**Fibrin**

Question 299

Mainstay Drugs used for the Treament of **Arthritis**

Answer 299

**NSAIDs (Tramadol, Gabapentin)** _**\***These Drugs are not Treating the Underlying Cause of the Disease, Rather they are Diminishing the Signs of it_

Question 300

Easiest way to Assess the Extent of **Burn Injuries**

Answer 300

**Rule of 9s**

Question 301

A **Reversible Change in Shape**, where Material Returns to Original Shape when Load is Removed

Answer 301

**Elastic Deformation**

Question 302

\_\_\_\_ can be Successfully Placed on: _Freshly Created Surgical Wounds with Sufficient Blood Supply to Produce Granulation Tissue_ _Healthy Granulation Beds_

Answer 302

**Skin Grafts** _**\***Prefer to Allow Healthy Granulation Bed form before Grafting_

Question 303

A Patient has **Bite Wounds** to the Thorax and a Positive Test for Hemothorax (Blood within the Thorax). What is the Significance in seeing if this Blood has Clotted or Not?

Answer 303

**Ongoing Bleeding- Blood will Clot** **Old Bleeding- Blood will Not Clot** **\***If the Blood does Not Clot then the blood is old and you don't have to be worried about current bleeding in the Thorax

Question 304

If Reconstruction of the Wound is Delayed for Prolonged Period, the _____ Granulation Tissue is not Conducive to Successful **Grafting**

Answer 304

**Chronic** _**\***Chornic Granulation tissue should be Excised to its Base, and Fresh Granulation bed allowed to form before any Skin-Grafting Procedure is Performed_

Question 305

True/False: Intraoperative Administration of Antibiotics has NOT been shown to Decrease Incidence of Infection

Answer 305

**True**

Question 306

**Incremental Destabilization of the Construct** of an External Skeletal Fixator, that Allows Increased Axial Loading of the Fracture to Enhance Callus Hypertrophy and Remodeling of the Fracture

Answer 306

**Dynamization**

Question 307

If Bone is Viable, Granulation Tissue coverage of the Bone can be Encouraged by performing \_\_\_\_\_. Multiple Holes are Drilled through the Cortex of the Bone into the Medullary Cavity. Blood Clots that form will act as Scaffold for Granulation Tissue Formation

Answer 307

**Cortical Fenestration**

Question 308

**Retraction** of Skin Edges after Tissue is cut

Answer 308

**Primary Contraction**

Question 309

**Bone Plate** in which the Plate Surfaces are Flat, where _Friction Between Bone and Plate Creates Stability_

Answer 309

**Dynamic Compression Plate (DCP)** **\***By Creating Friction between the Bone and the Plate, the Plate is Stabilizing the Bone

Question 310

**Axial Flap** that is Made based on the Following Landmarks: _Patient in Lateral Recumbancy with Limb in Relaxed Extension_ _Spine of the Scapula_ _Caudal Border of the Scapula_ _Vessel Originates at the Caudal Shoulder Depression_ (Flap #3 in Diagram)

Answer 310

**Thoracodorsal Artery Axial Pattern** **\***Origin of Vessel in Caudal Shoulder Depression

Question 311

If Wounds are left Open for Longer than 5 Days, Granulation Tissue will begin to fill the wound. Closure of wounds after Granulation tissue has Formed is called \_\_\_\_\_\_

Answer 311

**Secondary Closure** **\***Secondary Closures are easies to perform when the Wound is Deep and Narrow

Question 312

\_\_\_\_\_\_\_ System can be used with _Both Active and Passive Drains_ to perform **Wound Lavage** or Injections into wounds

Answer 312

**Ingress/Egress System** **\***Ingress- Fluids go into the Wound Site Egress- Fluids come out of the Wound Site _One way System- Do NOT Inject into Egress Drain_

Question 313

True/False: Glass, Gravel, Pellets, and Carbon Material **Foriegn Bodies** are commonly Inert (Immobile)

Answer 313

**True**

Question 314

**Bone Disease** characterized by: **_Aberrant Repair that Leads to Degradation of Articular Cartilage_** _Altered Subchondral Bone Metabolism_ _Periarticular Osteophytosis_ _Synovial Inflammation_

Answer 314

**Osteoarthritis**

Question 315

**Screws** with these Characteristics: _Best for use in **Metaphyseal and Epiphyseal Bone (Trabecular Bone)**_ **_Increased Outer Diameter_** _Deeper Thread_ _Larger Pitch_

Answer 315

**Cancellous Screws** _**\***Cancellous Screws have a Smaller Core Diameter- More likely to Bend_ _Cancellous Screws- Better in Bone that is Softer/Less Dense (Ex. Metaphyseal Bone)_

Question 316

In Patients with **Plant Material Foreign Bodies,** Instilling Dilute _____ into the Tract prior to surgery stains the tissue and can make following the tract easier

Answer 316

**Methylene Blue**

Question 317

_Planned Decrease of the Stability_ of an **External Skeletal Fixator** is Termed \_\_\_\_\_\_\_

Answer 317

**Dynamization**

Question 318

True/False: Since **Drains** are Foriegn Bodies, Drainage will Rarely Completely Cease until it is Removed

Answer 318

**True**

Question 319

Fractures that Only occur in **Skeletally Immature Animals**

Answer 319

**Physeal Fractures** \*Physis (Growth Plate) is only Present in Young Animals _\*Salter Harris Fractures- Physeal Fractures in YOUNG Immature Animals_ \*Physis- Area of Weakness in Young Animals

Question 320

Most Common Area of the Body that Leads to **Clean-Contamined Wounds** during Surgery

Answer 320

**GIT**

Question 321

In _____ Plates, Tightening the Screws Locks the Screw into the Plate Creating a Construct that Converts Shear and Bending Stress into Compressive Forces at Bone-Screw Interface

Answer 321

**Locking** **\***The Plate is locked into the Screw and the Screw is very Well Seeded within the bone. The Force is able to go up through the Screw and go across the plate at the Area of the Fracture _\*No Load sharing at the Level of the Fracture_

Question 322

Full-Thickness Skin Grafts may Develop \_\_\_\_\_\_, especially if Revascularization is Delayed. This is generally the Result of the Overgrowth of Normal Skin Flora on an abnormal skin and does NOT Markedly affect Graft take

Answer 322

**Superficial Infection**

Question 323

**Screw** Diameter should Not Exceed \_\_\_\_\_% of Bone Diameter when Used in Diaphyseal Bone

Answer 323

**40%** **\***Most of the time use screws that are closer to 25-30% of the Bone Diameter

Question 324

Initial Event in **Osteochondrosis** is Related to ____ to the Developing Epiphyseal Cartilage as it Ossifies

Answer 324

**Blood Supply**

Question 325

**Mobile Fragment** within a Joint

Answer 325

**Joint Mouse** **\***Loose Osteophyte

Question 326

_Type of **Orthopedic Wire** Placed Circumferentially Around Bone_ Column that Causes Compression across Fracture ends

Answer 326

**Cerclage Wire** **\***Place Circumfrentially around Bone to Restore the Bone Column

Question 327

What Strain Types can **External Skeletal Fixators** Counteract?

Answer 327

**Axial Compression** **Rotation** **Bending** **Tension**

Question 328

If you are Concerned about Infection at a **Drain** Site, a sample can be Collected on a ____ swab. If Bacteria are seen on Cytology, the Swab can be Submitted for Sensitivity Testing

Answer 328

**Culture** _**\***Cut off/Swab end of Drain from Deepest part of Wound after Removal_

Question 329

**Intramedullary Pins** Resist ____ Forces Only

Answer 329

**Bending**

Question 330

True/False: Open Traumatic Wounds should Initially be Considered **Clean-Contaminated** at Best

Answer 330

**False** **\***Traumatic Wounds = Contaminated at Best

Question 331

_Negatively Charged Particles_ with Large Surface Area that are a **Clay and Organic Soil Component** that Inhibit Phagocytosis and Bacterial Killing

Answer 331

**Infection Potentiating Factors (IPF)** **\***IPF- Increases the Risk of Infection within a Wound. If Clays or Organic Soils are within the Wound you want to do a good job trying to flush them out

Question 332

Physical Exam results for which Disease of the Elbow?

Answer 332

**Elbow Dysplasia**

Question 333

After **Axial Pattern Flaps** are Placed, ____ in the Flap is common during the First week after Surgery because of the Change in Orientation of the Venous Return and Disruption of the Lymphatics

Answer 333

**Edema**

Question 334

Most Common Cause of **Degloving Injuries**

Answer 334

**Hit by Car** **\***Combined Degloving and Crush Injuries are More common in Dogs and Cats

Question 335

Classification of **Wound**: _Surgically Created Wound_ _Hollow Viscus is Opened with Gross Spillage_ _Major Break in Technique- Ex. Scratch Nose or Adjust Glasses_

Answer 335

**Contaminated** \*Ex. _Obstruction_- More fluid contained in the GIT and greater Likelyhood that you will spill some of those contents \*Major Break in Technique- _Scratch Nose or Adjusting Glasses_

Question 336

If you are using **Intramedullary Pins** in Combination with a Plate, you was the Intramedullary Pin to Fill \_\_\_\_\_% of Medullary Canal

Answer 336

**30-40%**

Question 337

**Neutraceutical** that Competes with Arachidonic Acid as a Substrate for COX that Leads to Production of Less Proinflmmatory Mediators

Answer 337

**Omega 3 Fatty Acids**

Question 338

Best Diagnostic Test for Diagnosing **Plant Material Foreign Bodies**

Answer 338

**Ultrasound** **\***Plant-Based Foreign Bodies are Commonly Nonradioopaque and hard to diagnose on Radiographs \*Ultrasound can be used during surgery to help locate the Foreign Body- Intraoperative Ultrasoundography

Question 339

Administration of **Antibiotics** after Infection is Present

Answer 339

**Therapeutic**

Question 340

True/False: **Orthopedic Wire** can be used as Sole Method of Fracture Fixation

Answer 340

**False** \*You NEVER use Wire as a Sole means of Fraxture Fixation- Except on some Mandibular Fractures

Question 341

Post Op Fracture Repair Assessment that asks: ## Footnote **Are Fracture Fragments Well Apposed?**

Answer 341

**Apposition** **\***Make sure the Fracture Fragments are Touching/Near Eachother

Question 342

Granulation Tissue is Ready for _____ when: _Granulation Tissue is Pink and Glistening_ _Surface is Smooth_ _Wound is Contracting and Epithelial Migration is visible at Wound Margin_

Answer 342

**Grafting**

Question 343

In Patients with **Gunshot Wounds,** the Tissue Damaged Produced is greatly Influenced by the\_\_\_\_\_of the Projectile.

Answer 343

**Velocity** \*Low Velocity bullets generates Smaller amounts of Kinetic Energy so damage is usually confined to an area immediately around the path of the bullet

Question 344

Possible Complications of _____ Fixators: **_Pin Tract Drainage- Infection of Soft Tissues_** _Loosening of Pins/Wires- May Result in Bone Resorption_ **_Osteomyelitis_** _Ring Sequestrum_ _Nerve or Vascular Damage_

Answer 344

**External Skeletal Fixators**

Question 345

\_\_\_\_\_\_ Therapy helps animals to Move their Limbs through a Greater Range of Motion. Bouyancy Allows Activity while Reducing Stress on Joints

Answer 345

**Underwater Treadmills**

Question 346

Prognosis for **Traumatic Shoulder Luxation**

Answer 346

**Good to Excellent**

Question 347

**Neutraceutical** that Stimulates Proteoglycan Synthesis of Hyaline Cartilage and has Antiinflammatory Effects

Answer 347

**Glucosamine**

Question 348

Deep Partial Thickenss **Burn Wound.** What is the Significance if the Hair does NOT Epilate (Pull Out) Easily?

Answer 348

**Hair Follicle is Intact and Tissue will Survive** \*Epilate- Pulling Hair Out \*Intact Hair Follicles provide more Epithelialization to the Wound Healing Process

Question 349

Disadvantages of \_\_\_\_\_: _Bacteria can Flourish in Moist Environments_ _Wet Dressings can cause Maceration of Surrounding Skin_ _If Bandage soaks through, Bacteria can Move into or Out of Bandage (Strike-Through)_

Answer 349

**Adherent Dressings**

Question 350

\_\_\_\_\_\_\_ has been Found Helpful in the Treatment of **Arthritis**, Inlcuding Techniques such as: _Cold/Heat Therapy_ _Passive Range of Motion Exercise_ _Massage_ _Swimming_ _Treadmill Exercise_ _Acupuncuture_

Answer 350

**Physical Therapy/Rehabilitation** _**\***Passive Range of Motion- Non Weight bearing Flexion and Extension of a Joint. The Joints are moves through as much of a Range of Motion as can be accomplished Comfortably. Helps Mantain and Improve Range of Motion and Promote Blood and Lymphatic Flow_

Question 351

\_\_\_\_\_ The Graft has the Following Advantages: _Allows Expansion of Graft to Cover Larger Defects_ _Allows Drainage of Blood and Serum from Under Graft_ _Allows Graft to conform bettern to Uneven Surfaces_

Answer 351

**Meshing** _**\***The Degree to which a Mesh graft can be expanded is determined by the number of rows and slits and the length of each Slit. Increasing Either or Both Increases the Degree of which the Graft can be Expanded_

Question 352

Fixation that Uses _Percutaneous Pins or Wires Attached to External Construct_ to Stabilize Fracture Fragments

Answer 352

**External Skeletal Fixation**

Question 353

Radiograph of ____ **Arthritis**

Answer 353

**Septic** \*Infectious Arthritis

Question 354

**Adherent Dressings** that are used on Wounds containing Necrotic Tissue and Foreign Material and are particularly useful on Wounds producing a _High Viscous Exudate_

Answer 354

**Wet-to-Dry Dressings** **\***Wet-to-Dry Dressings should be Discontinued once the wound bed is Healthy

Question 355

Only use **Cerclage Wire** on Which Two types of Fractures?

Answer 355

**Long Oblique** **Spiral Fracture**

Question 356

Single Most Important Element in the Treatment of **Osteoarthritis**

Answer 356

**Weight Managment**

Question 357

**Steinmann Pin** Technique characterized by: _**Use of 2 or More Smaller Diameter Pins** rather than One Larger Pin_ _Higher Incidence of Pin Migration_ _Increased Damage to Medullary Blood Supply_ _Rarely Practiced_

Answer 357

**Stack Pinning**

Question 358

If your Patient has a **Congenital Shoulder Luxation with Glenoid Dysplasia**, which Treatment is Best?

Answer 358

**Salvage Procedures** _**\***Ex. Arthrodesis, Glenoid Excision, Amputation_

Question 359

The Risk of Infection _____ with Every **70-90 Minutes** of Surgery

Answer 359

**Doubles** _**\***Rule of Thumb- Risk of Infection Doubles every Hour_

Question 360

Gold Standard of Diagnoses for **Elbow Dysplasia**

Answer 360

**Arthroscopy**

Question 361

**Review Card**: **Salter Harris Fractures** Type 1: Separation at the Level of the Physis _Type II: Fracture across Physis and Metaphysis (Above)_ _Type III- Physis and Epiphysis are Fractured (Lower)_ Type IV: Fracture through the Metaphysis, Physis, and Epiphysis Type V: Crushing Injury at Physis

Answer 361

_\*The Physis will be Involved in every Type of Salter Harris Fracture_ **Type II and Type III are Most Common** Prison (Physis) Makes (Metaphysis) Every (Epiphysis) Boy (Both) Crazy (Crush)

Question 362

Removal of the _____ is Facilitated by suturing the **Graft** Subcutaneous Side up to a Piece of Sterile Cardboard to Stretch it back to its normal Dimensions

Answer 362

**Subcutaneous Tissue** **\***The base of the Hair Follicles will be Visible when the Subcutaneous Tissue is Removed, giving the Graft a "cobblestone Appearance"

Question 363

True/False: When Placing a **Conventional Plate**, you NEVER want to place a Screw through the Fracture

Answer 363

**True** _**\***Ideally you want the Screw to be a minimum of 5mm Away from the Fracture_

Question 364

When Placing **External Skeletal Fixtures,** the Connecting Rod should be as Close to the Bone as Possible, and the Clamps connecting the Pins and Rods should be at least \_\_\_cm away from the Skin

Answer 364

**1 cm**

Question 365

Physical Exam findings for which **Shoulder Disease**?

Answer 365

**Traumatic Shoulder Luxation** _**\***Make Diagnosis based on- Malpositioning of Greater Tubercle_ _**\*Greater Tubercle** will be more Prominant than Normal and the Limb will be Abducted_

Question 366

**External Skeletal Fixator** with the Following Characteristics: _Use of Small Diameter Fixation Wires and Transfixation pins- Optimized Bone Purchases in Small Fracture Fragments_ _Wires Connect to Rings_ _Rings are Connected by Rods_

Answer 366

**Circular External Skeletal Fixators (CERF's)**

Question 367

\_\_\_\_\_ **Strain**: Combination of Tensile (Lengthening) and Compressive (Shortening) Loading Forces

Answer 367

**Bending**

Question 368

Common Causes of **Nonhealing Wounds** Include all of the Following, Except: A. Foriegn Bodies B. Immunodeficiency C. Hard to Culture Pathogens (Actinomyces, Sporotrichosis) D. Concurrent Disease E. Nutritional Status F. Drugs (Chemotherapy)

Answer 368

**All of the Above are Causes of Nonhealing Wounds**

Question 369

Easiest Method for Harvesting \_\_\_\_\_: _Dissect from Donor Site deep to Cutaneous Trunci Muscle_ _Remove Cutaneous Trunci Muscle and Superficial Subcutaneous Tissue Prior to Applying Graft_

Answer 369

**Skin Grafts** _**\***Harvest Graft at the Level of the Subcutaneous Tissue below the Cutaneous Trunci Muscle with Scissors_

Question 370

Most Commonly used Method of **Surgical Debridement,** where you begin with Superficial Layers (Skin) and Progress to the Deepest Extent of the Wound

Answer 370

**Layered** **\***All Devitalized Skin, Muscle and Fat should be sharply Excised. Blood Vessels, Tendons, Ligaments and Nerves should be Spared unless Obviously Severed

Question 371

Indications for \_\_\_\_\_: **_Complicated Fractures of the Tibia and Radius_** _Distraction Osteogenesis- Bone Lengthening Procedures_ _Correction of Angular Limb Deformities_

Answer 371

**Circular External Skeletal Fixators (CERFs)** _**\***Great for more Complicated Fractures of the Tibia and Radius_

Question 372

Classification of **Wound**: _Infected Wounds Containing Pus_ _Contain Contents of Perforated Hollow Viscus_

Answer 372

**Dirty**

Question 373

**Topical Wound Medication** that is a Hydrophilic Powder used to Cleanse Wounds and Promote Healing because it is: _Chemotactic for PMNs and Macrophages_ _Provides Energy for Cells_ _Stimulates more Rapid Granulation Tissue Formation_ _Antibacerial Properties_

Answer 373

**Maltodextrin**

Question 374

\_\_\_\_\_\_ Tracking Suture should be used with **Penrose Drains** to Maintain the Position of the Drain

Answer 374

**Percutaneous** _\*If Tracking Sutures are used to Maintain the Position of a Drain, they should be Passed Percutaneously so that the suture can be cut and Removed before the Drain is Pulled_ **\***Do NOT use Buried Sutures

Question 375

_Moderate_ \_\_\_\_, such as Walking and Swimming, is Indicated in Patients with **Osteoarthritis** in order to Maintain Muscle Strength and Joint Flexibility without Increasing Pain

Answer 375

**Exercise** _**\***Exercise Reduces Pain_

Question 376

We only use **Cerclage Wire** on _Long Oblique or Spiral Fractures_. The Fracture line must be \>/= \_\_\_x's the Diameter of the Bone and you must be able to Reconstruct the Bone Column

Answer 376

**2x's**

Question 377

Technique where you Use a Cortical or Partially Threaded Screw as a \_\_\_\_Screw: _Used for **Oblique Fractures**_ **_Screw Positioned PERPENDICULAR to the Fracture Line_** _Glide Hole Drilled in near Cis Cortex_ _Trans Cortex is Drilled to the Core for the Core Diameter of the Screw_ _Tightening of the Screw pulls the Trans Cortex Closer to the Cis Cortex Causing Compression across the Fracture_

Answer 377

**Lag** Drill One Wider hole through One Cortex (Cis Cortex) Drill a Smaller Hole through the Other Cortex (Trans Cortex)

Question 378

Physical Exam Findings common with which Bone Disease?

Answer 378

**Osteochondrosis/Osteochondritis Dissecans** _**\***Pain on Hyperextension of Shoulder Joint_ _Pain on Flexion of Shoulder Joint_

Question 379

**Dressings** that contain various _Growth Factors_ and some also Inhibit Bacterial Growth, that actually contribute to the Wound Healing Process rather than just covering the Wound

Answer 379

**Biological Dressings** **\***Ex. Equine Amnion

Question 380

True/False: **Fenestrating Penrose Drains** Increase the Effectiveness by Reducing Surface Area

Answer 380

**False** \*Fenestrating Penrose Drains DO NOT Increase their Effectiveness and in fact, may decrease their Effectiveness by reducing Surface Area

Question 381

How to Perform a _____ **Skin Flap**: _Parallel Incision are Made from the Corners of the Leading Edge_ _Incisions are made 1.5 times as Long as the Defect_ _Skin is Underminded to the Cutaneous Trunci_ _Advance Flap across the Defect_ _Suture the Skin Flap in Place_

Answer 381

**Single Pedicle Advancement Flap** \*If Flap will not Reach Across Defect, the Incisions are Lengthened Incrementally.

Question 382

Pathophysiology of which Bone Disease: _Focally Thicker Cartilage due to Failed Endochondral Ossification_ _Cleft between Calcified and Non Calcified Tissue_ _Force of Normal Activity Fractures Cartilage_

Answer 382

**Osteochondrosis**

Question 383

**Shoulder Disease** characterized by:

Answer 383

**Congenital Shoulder Luxation**

Question 384

Goal with ____ is to Achieve as much Contact with Bone with a Sufficiently stable Implant of Minimal Size

Answer 384

**Screws** \*Goal of Screws- Sufficiently Stabilize the bone while using an Implant of Minimal Size_- Don't want to Oversize Screw. If Screw is Oversized then you can Damage the Bone_

Question 385

**Change in Shape** due to Application of a Force (Stress)

Answer 385

**Deformation** **\***Change in Shape

Question 386

Goals of \_\_\_\_\_\_: _**Restore Length and Alignment** to Promote Normal Bone Healing_ _Minimize Motion at Fracture Ends_ _Permit Early Ambulation with Use of as many Joints Possible during Healing Period_ _Balance the Forces that Promote Bone Healing vs. Those that Promote Bone Resorption_

Answer 386

**Fracture Fixation (Immobilization)** **\***_Alignment does NOT mean Alignment of Fracture Fragments, but Rather Alignment of the Limb. Alignment = Normal Limb Alignment_

Question 387

**Intramedullary Pins** can be used in Humerus, Femur, Tibia, Ulna, Ect, but is CONTRAINDICATED in the \_\_\_\_\_

Answer 387

**Radius** **\***Radius has a Cranial Bowing and if you try to pass the pin down the Medullary Canal, you will end up coming out of the Cranial Aspect of the Articular Surface

Question 388

In Patients with **Bite Wounds,** Devitalized tissue should be extensively debrided and the wound thoroughly Lavaged. In Most cases _____ are Placed prior to wound Closure

Answer 388

**Drains** **\***Drains are used to assess the character of the fluid coming from the wound

Question 389

Clinical Applications for _____ Wiring: _Olecranon Fractures_ _Greater Tuberosity Fractures_ _Lateral Malleolus Fractures_ _Patella Fractures_ _Greater Trochanter Fractures_

Answer 389

**Tension Band Wiring** | (Avulsion Fractures)

Question 390

Most Common use of **Skin Grafts**

Answer 390

**Reconstructing Degloving Injuries on Extermities** **\***Distal Limb wounds are often difficult to reconstruct with Local Flaps because of Limited Size of Flaps available Locally

Question 391

In Patients with **Degloving** and Crush Injuries, If we know Implants will be needed, we should treat _____ wounds first in order to decrease the risk of Infection

Answer 391

**Skin** _**\***Treat Soft Tissue Injuries First_ \*_Degloving combined with Crush Injury is more Common in Small Animals than just Degloving when the Distal Limb is Affected_

Question 392

True/False: An Assessment of the Severity of **Bite Wounds** can be assessed via a Good History and Physical Exam including Examining the Skin for Puncture Wounds, Bruising, and _Probing the Wounds after Administrating Sedatives_

Answer 392

**True**

Question 393

Type \_\_\_\_\_**External Skeletal Fixator**: **_Bilateral-Uniplanar_** with Combination of Full and Half Pins

Answer 393

**Type 2B** _\*Only difference between 2A and 2B is that some Half Pins are Included in the 2B Fixator_

Question 394

Prefer ____ Skin Grafts for the Following Reasons: _Consists of Epidermis and Dermis_ _Includes Hair Follicles and Adnexal Structures_ _Best Cosmetic Apperance and Function_

Answer 394

**Full-Thickness**

Question 395

In many **Degloving Injuries,** Tendons, Ligaments and Joint Capsules are damaged beyond repair. In this Situation the Wound is left ____ because the Greater amount of Fibrous Connective Tissue formed during second Intention wound healing helps to stabilize the joint

Answer 395

**Open** _**\***If the Skin is closed, less fibrous connective tissue is formed so joint instability and pain are more likely to persist. Wound Closure can be Performed after healthy Granulation Tissue Covers the Wound_

Question 396

Technique with Steinmann Pins that is used most Commonly with **Salter Harris Fractures**

Answer 396

**Cross Pinning**

Question 397

When Placing **Pins** for \_\_\_\_\_, the Pins are _Placed Percutaneous through Small Incisions_ in Areas with Little Soft Tissue Coverage

Answer 397

**External Skeletal Fixators** **\***Avoid Important Neurovascular Structures

Question 398

Rank these Procedures from _Least to Greatest_ Risk of **Surgical Wound Infection** 1. Contaminated 2. Clean-Contaminated 3. Clean Procedures 4. Dirty

Answer 398

**Clean Procedures**- Least Risk of Infection **Clean-Contaminated** **Contaminated** **Dirty**- Greatest Risk of Infection \*Dirty- Implies Infection

Question 399

**Graft** with the Following Characteristics: _Full-Thickness Plugs of Skin Placed in Granulation Bed_ _Not used often in Small Animals_ _Enhance Epithelialization_ _Poor Cosmetic Appearance_

Answer 399

**Punch (Seed) Grafts**

Question 400

**Secondary Implant** that is Often Referred to as _Intramedullary Pins_ that come in a Variety of Lengths

Answer 400

**Steinmann Pins**

Question 401

How to Apply _____ **Graft**: _Skin Biopsy Punch is used to Remove Plugs of Granulation Tissue at 5-7 mm Intervals over the Surface of the Wound_ _Grafts are Harvested using the Skin Biopsy Punch and placed into the Plug Holes_ _Fibrin Seal Forms between the Graft and Recipient Bed_

Answer 401

**Punch Graft** **\***Grafts are Press fit into Granulation Bed but not Secured otherwise

Question 402

Key Points in Designing a ______ Flap: 1. The Edge of the Defect should be Incorporated into One Side of Flap 2. The Width of the Flap should be Equal to the Width of the Defect 3. The Legth of the Flap is determined by measuring the distance from the Pivot Point to the Most Distant Point of the Defect (A-B = B-C)

Answer 402

**Transposition Flaps** **\***Creating a Flap that is too short will create a Line of Tension across the Flap which can Interfere with Circulation and Result in Necrosis of the Flap Distal to this Point \*If the Flap is designed properly, there should be minimal Tension on the Closure

Question 403

**Screw** Placed Across a Fracture line to Hold a Fragment in Place, where No Compression across the Fracture is Achieved

Answer 403

**Position Screw** **\***Weaker repair compared to Lag Screw

Question 404

Pros and Cons of which type of **Fracture Fixation**?

Answer 404

**Internal Fixation** _**\***By Placing something Internally and making the Fracture as Secure as Possible, you will Create More Stability and Promote Normal Muscle and Joint Function_ **_Internal FIxation leaves the Joints Free to be Mobile_** Cons- May have to Remove Implants due to Pain/Discomfort to Patient or Infection (Biofilm)

Question 405

4 Diseases that lead to **Elbow Dysplasia**

Answer 405

**Ununited Anconeal Process** **Fragmented Medial Coronoid Process** **Osteochondrosis Dissecans (OCD)** **Joint Incongruity**

Question 406

Technique used to relieve tension on Primary Suture Line and to Facilitate Closure of defects on the _Distal Aspects of Limbs._ Typically make a complete Row of Incisions leaving 1-2 cm between each Incision. The Second Row of Incisions should be Staggered with those in the First Row.

Answer 406

**Multiple Punctate Relaxing Incisions** **\***Primary Indication- Facilitate Closure of defects on the distal aspect of the Limbs \*The Smal secondary defects created heal more Rapidly by second intention then when one large wound is left to heal by second intention

Question 407

**Spontaneous Fusion of Joint** which Signifies _End Stage of Joint Disease_

Answer 407

**Ankylosis**

Question 408

True/False: In Order for Fractures to Heal, they should have _Very Little/No Motion_ at the Fracture Ends

Answer 408

**True** **\***Motion will cause Bone Absorption of Fracture Ends

Question 409

Internal Fixation that Combines _Benefits of a Intermedullary Rod and a Plate_: Used to Treat **Diaphyseal Comminuted Fractures** Can be Placed to Adhere to Principles of Biological Osteosynthesis Cannot be used for Fractures of the Radius

Answer 409

**Interlocking Nail**

Question 410

**Burn Wounds** with \_\_\_\_\_\_% Coverage of the Patient are Often Associated with Significant Complications and Prolonged Treatment

Answer 410

**\> 50%** **\*** \< 15% Burn Coverage- Good Prognosis \* 15-50% Burn Coverage- Patient will be Okay, but Will take a Lot of Work- Reconstruction Procedures

Question 411

Type ____ **External Skeletal Fixator:** **_Bilateral-Uniplanar_**- Pin goes through the Both Cortices and Out through the Skin so that we can Place a Connecting Bar Medially and Laterally _Uses Full Pins_ _Stiffer than Type 1_

Answer 411

**Type 2A**

Question 412

Type of **Orthopedic Wire** that is used to: **_Neutralize the Pull of Muscles/Tendons on the Fracture Fragment_** _Distractive Forces of Tendon or Ligament are Converted into Compressive Forces_ _Indicated for Avulsion Fractures and Some Osteotomies_

Answer 412

**Tension Band Wire**

Question 413

**Mismatch in Articular Surfaces**

Answer 413

**Incongruity**

Question 414

\_\_\_\_\_ **Drains** Actively Remove Exudate by applying _Suction_

Answer 414

**Active** **\***Much More Efficient than Gravity Drains in Removing Fluid Accumulations

Question 415

When Placing a Pin for **External Skeletal Fixator,** The Pin Diameter should be no more than \_\_\_\_% of the Bone Diameter

Answer 415

**25%**

Question 416

During Perioperative Preparation of a **Traumatic Wound**, if Sufficient skin is Present, the Wound can be Temporarity Closed with skin Staples or Suture before Clipping the Hair and Prepping the Skin. Otherwise, further contamination of the wound is prevented by packing it with saline moistened sponges or by covering it with ______ followed by sponges while the surrounding skin is Prepared

Answer 416

**Lubricating Jelly (K-Y Jelly)**

Question 417

\_\_\_\_\_ a Skin Flap avoids making Bridge Incisions, but will require a Second Surgery to Cut the Flap free after it has Healed in the Wound Bed

Answer 417

**Tubing**

Question 418

Treatment for Mild, Moderate and Severe **Shoulder Instability**

Answer 418

**Mild- Rest, Physical Therapy** **Moderate- Arthroscopic Thermal "Capsulorrhaphy"-** Thermal Insult Induces Repair **Severe- Medial Glenohumeral Ligment Reconstruction**

Question 419

Type _____ **External Skeletal Fixator:** **_Bilateral-Biplanar-_** Full Pins that go Through both Cortices of the Bone, in Addition to Half Pins coming in from a different Plane _Stiffer than Type I or Type II_

Answer 419

**Type 3**

Question 420

Which Two Components can be used as a Biological Bandage for Patients with Physiologic **Degloving Injuries**

Answer 420

**Aloe Vera** **Silver Sulfadiazine** (Antibiotic Cream)

Question 421

**Grafts** Transferred between Individuals of _Different Species_

Answer 421

**Xenografts**

Question 422

True/False: **Drains** should NEVER Exit through the Incision Line

Answer 422

**True** _**\***Drains should ALWAYS Exit through a Separate Stab Incision, not the Primary Suture Line_ \*Drains that Lie Directly under Suture lines or Exit through them can Interefere with Wound Healing and Result in Wound Dehiscence

Question 423

Point when Material _begins to Deform Plastically_. Strain Exceeds the Materials ability to Recover rendering it **Permanently Deformed**

Answer 423

**Yield Point** **\***Occurs between Elastic and Plastic Deformation

Question 424

Type of **Open Fracture** Characterized by: _Wound Smaller than 1cm (Very Small)_ _Typically Created by Bone Fragment from Inside that Retracts back Through Skin_ _Mild/Moderate Soft Tissue Contusion_

Answer 424

**Type I**

Question 425

**Moisture Retentive Dressing** that have become Popular in Wound Management because they create a more Ideal Environment for Wound Healing to occur. These Dressings contain Hydrophilic Materials attached to a water Impermeable Adhesive Backing

Answer 425

**Hydrocolloid Dressings** **\***_Dressing can be Maintained for up to One Week_

Question 426

In **Shoulder Disease**, if the Etiology is _Repetitive Trauma or Overuse_, it is Probably seen _____ in Adult Dogs

Answer 426

**Unilaterally** **\***Ex. Biceps Brachii Tendinopathy

Question 427

Allografts and Xenografts can be Temorparily used as \_\_\_\_\_in Patients with Extensive Burns or Denuded Areas, but they are Eventually lost due to the Rejection Phenomenon, _unless Immunosuppressive Drugs are Administered_

Answer 427

**Biological Bandages**

Question 428

**Shoulder Disease** Characterized by: _Injury with Tendon Fiber Disruption_ _Acute to Chronic Inflammation of Tendon and Associated Synovial Tissues_ _Imperfect Correlation between Signs and Gross Appearance_

Answer 428

**Biceps Brachii Tendinopathy** _**\***Repetative Strain on the Tendon_

Question 429

**Grafts** Transfered from a Donor Site to a Recipient Site on the _Same Animal_

Answer 429

**Autograft** _**\***Most Successful type of Graft since the Graft and Host are Immunologically Identical_