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2025 Exam Block 4 > Exam 1: Lecture 2 - Principles of Orthopedic Surgery I > Flashcards

Exam 1: Lecture 2 - Principles of Orthopedic Surgery I Flashcards

1
Q

what are the 7 reasons for orthopedic sx

A
  1. stabilize fractured bones
  2. explore, debride, and stabilize injured joints
  3. replace damaged joints
  4. stabilize spinal column injuries
  5. decompress the spinal cord (IVDD)
  6. resect musculoskeletal tumors
  7. repair tendon and ligament injuries
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2
Q

what are the 2 goals of treat fractures, nonunions, or bone deformities

A
  1. bone union
  2. return to normal function
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3
Q

what are the 2 things we should do for surgical planning

A

choose implants and plan procedure and evaluate fracture, patient, and client

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4
Q

what are the specifics to evaluate fractures

A

identify which implants will achieve stability for the appropriate healing time and ensure selected fixation counteracts forces to bone

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5
Q

what is FAS in orthopedics

A

fracture assessment score

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6
Q

what are the things we should think about when we make a detailed plan for entire surgical procedure

A
  1. method of fracture reduction
  2. sequence of implant application
  3. possibilities for bone grafting
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7
Q

what can happen if we dont make a surgical plan

A
  1. prolonged operating times
  2. excessive soft tissue trauma
  3. technical errors
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8
Q

What are the 2 goals of fracture reduction

A
  1. reconstructing fractured bone fragments to normal anatomic configuration
    OR
  2. restoring normal limb function
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9
Q

what is the technique of fracture reduction

A

must overcome physiological processes like muscle contraction and fracture fragment overriding

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10
Q

what type of fracture reduction is this

A

anatomic reconstruction

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11
Q

what type of fracture reduction is this

A

normal alignment

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12
Q

what is closed reduction of a fracture

A

reducing fractures or aligning limbs without surgically exposing fractures bones

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13
Q

what is open reduction of a fracture

A

surgical approach to expose fractured bone segments and fragments (anatomically reconstructed and held in position with implants)

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14
Q

what are the advantages of closed reduction

A

enhances biological environment by preserving soft tissue & blood supply, decreases risk of infection (bc stays closed), and reducing operating time

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15
Q

what are the disadvantages of closed reduction

A

difficulty of accurate reconstruction of reducible fractures

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16
Q

what are the 2 ways open fracture reductions can be further classified as

A
  1. limited open reduction
  2. open but dont touch reduction
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17
Q

what is limited open reduction

A

lever transverse fracture into position or securing oblique fracture with lag screws or cerclage wire

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18
Q

what is an “open but dont touch” reduction

A

realigning bone and placing a plate but fracture fragments and hematoma are NOT manipulated

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19
Q

what are the 4 advantages of open reduction

A
  1. visualization and direct contact with bone fragments
  2. direct placement of implants possible
  3. bone reconstruction
  4. cancellous bone grafts can be used
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20
Q

why is visualization and direct contact with bone fragments an advantage of open reduction

A

facilitates anatomic fracture reconstruction

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21
Q

why is bone reconstruction an advantage of open reduction

A

allows bone and implant to share loads and results in stronger fracture fixation

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22
Q

why are cancellous bone grafts a good thing for open reduction of fractures

A

enhances bone healing

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23
Q

what are the 3 disadvantages of open reduction

A
  1. increased surgical trauma to soft tissue and blood supply
  2. diminished biologic environment
  3. greater opportunity for bacterial contamination
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24
Q

what are the indications for an open fracture reduction

A
  1. articular fractures
  2. simple fractures allowing anatomic reconstruction
  3. comminuted non-reducible diaphyseal fractures of long bones
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25
when is a closed reduction indiciated
1. greenstick and/or non-displaced fractures of long bones below elbow and stifle 2. comminuted non-reducible diaphyseal fractures of long bones treated with external fixations
26
what are the 2 ways of doing a direct reduction
1. counteracting muscle contraction 2. manual distraction of segments
27
what happens with counteracting muscle contraction
causes bone segments to override and major difficulty in anatomic reduction
28
what happens with manual distraction of segments
using bone-holding forceps to eventually fatigue muscles to allow reduction
29
explain when/how you do a direct reduction
for transverse fractures bone ends lifted and brought into contact, force slowly applied to reduce bones in normal position
30
how do you do direct reduction using a lever
reduce overriding bone segments of transverse fractures by placing a level between overriding bone segments and apply pressure gently
31
what type of reduction is this
direct reduction
32
what type of direct reduction is this
direct reduction using a lever
33
what type of direct reduction is this
direct reduction using bone holding forceps
34
35
how do we do a direct reduction with bone holding forceps
1. return bone segments of long oblique fracture into reduction with bone-holding forceps 2. place pointed reduction forceps at angle to fracture line 3. pointed reduction forceps gently closed
36
what is IMPORTANT to remember about direct reduction
1. rough bone handling of bone cause more fragmentation 2. bone must be inspected for fissure fracture lines
37
what is a direct reduction with butterfly fragment
anatomic reconstruction of fracture with a large butterfly fragment
38
what kind of direct reduction is this
direct reduction with butterfly fragment
39
when do we use indirect reduction
for non-reducible fractures
40
explain why non-reducible fractures are managed with indirect reductino
it preserves biology and bridging fixation provides mechanical support
41
what is indirect reduction
process of restoring fragment and limb alignment
42
explain how an indirect reduction using an IM pin
a pin is driven normograde thru proximal bone segment to fracture site
43
what type of indirect reduction is this
IM pin reduction
44
what type of indirect reduction is this
indirect reduction using animals weight in tibial/radial fractures
45
Briefly describe how to do an indirect reduction using animals weight
hang the leg, drop the sx table down and when fracture is stabilized you can raise the table
46
what are the 8 steps of fracture treatment planning
1. determine FAS 2. choose appropriate implant system 3. select technique for fracture reduction 4. develop plan for applying implants 5. decide about using bone grafts 6. surgical approach or approaches selected 7. check implant and instrument inventory 8. precontour plate (if needed)
47
T/F: When developing a plan for applying implants, we should make a drawing of fracture bone and the implant before sx
true! Helps ensure optimal results
48
what is important to do after sx when we use implants
evaluate postoperative radiographs to make sure the outcome you wanted is there
49
what are the 5 types of bone grafts
1. autograft 2. allograft 3. biomaterials 4. synthetic bone substitutes 5. composites of osteogenic cells
50
what is an autograft
bone transplanted from one sit to another in same animal
51
what is an allograft
bone transplanted from one animal to another of same species
52
what is a biomaterials graft
demineralized bone matrix, collagen
53
what is a synthetic bone substitute
tricalcium phosphate ceramics, bioglass and polymers
54
what is a composite of osteogenic cell graft
osteoinductive growth fractures and synthetic osteoconductive matrix
55
what are the "4 O's" of graphs
1. osteogenesis 2. osteoinduction 3. osteoconduction 4. osteopromotion
56
what is osteogenesis
ability of cells to survive transplantation and serve as source of osteoblasts
57
what is osteoinduction
ability of material to induce migration and differentiation of mesenchymal stem cells into osteoblasts (VIA BMP - bone morphogenetic protein)
58
what is osteoconduction
ability of material to provide scaffold for host bone invasion and determines speed of osteointegration
59
what is osteopromotion
material that enhances regeneration of bone (like PRP - platelet rich plasma)
60
what type of bone grafts are considered gold standard
cancellous bone autographs
61
what are the advantages of cancellous bone autografts
1. recommended when rapid bone formation is desired 2. assist healing when optimal healing not anticipated 3. promote bone formation in infected fractures
62
what are the disadvantages of cancellous bone autographs
1. additional surgical time required to harvest graft 2. potential for morbidity associated with donor site 3. limited availability of cancellous bone in small or elderly patients
63
where are the best sites for cancellous bone autografts
proximal humerus, proximal tibia, ilial wing, and distal femur
64
T/F: Cancellous bone autografts are harvested prior to fracture stabilization
FALSE! harvested after fracture stabilization but BEFORE primary ortho procedure
65
what is this image showing
how to take a graft of proximal humerus
66
what is this image showing
ilial wing bone graft
67
where are cortical bone autografts harvested
ribs, ilial wing, distal ulna, and fibula
68
what is a segmental graft
placed between fracture segments
69
what is a sliding onlay graft
paced over fracture site
70
what are the 3 advantages of cancellous bone allografts
1. reduced operating time 2. availability of graft 3. elimination of morbidity at donor site
71
what are the disadvantages of cancellous bone allografts
1. cost of grafts 2. lack of osteogenic properties in cancellous bone chips
72
T/F: Autogenous grafts are superior to allogenic grafts in promoting rapid new bone formation
true! Due to osteogenic properties
73
why are cortical bone allografts harvested and banked
to provide a ready source of cortical alloimplants
74
T/F: Cortical bone allografts are commonly used in fracture repairs
FALSE rarely used in fx repair......used for limb-sparing procedures
75
what is demineralized bone matrix
it is from processed allograft bone available for dogs and cats
76
what are the 4 types of fracture fixation systems
1. external coaptation 2. external skeletal fixators 3. intramedullary fixation 4. plate and screw fixation
77
what is the purpose of external coaptation
provides patient comfort before or after sx and can be used as primary repair in some conditions
78
what is important to remember about external coaptation as primary fixation
for bone to heal, MUST be at least 50% reduction of segments at fracture site on 2 radiographic views
79
what are the 3 types of external coaptation
1. bandages 2. splints 3. casts
80
what is important to remember about full leg casts
1. cant apply above midhumerus or midfemur 2. used ONLY for fractures of distal limb
81
what is important to remember about bivalve casts
1. supplements internal fixation devices 2. used for fxs of carpus, tarsus, metacarpal/metatarsal bones & digits, or carpal or tarsal arthrodesis
82

2025 Exam Block 4 (34 decks)

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