Exam 3: Lecture 18: Fractures of the Thoracic Limb Flashcards
1
Q
What type of fracture account for approx. 0.5-2.4% of all fractures in dogs?
A
Scapular fractures
2
Q
What type of trauma is needed to produce scapular fractures
- due to extensive soft tissue protection
A
Substantial trauma
3
Q
56-70% of scapular fractures have concurrent injuries, most common 3 are?
A
- thoracic injury
- fractures of other bones
- neurological trauma
4
Q
How are scapular fractures classified?
A
- anatomic location
- articulated surface involvement
- stability
5
Q
What type of treatment for scapular fractures is classified as minimally displaced scapular body and spine fractures
A
Conservative treatment
6
Q
What type of treatment in scapular fractures is said to be for unstable extra-articulate + intra-articulate fractures
- displaced scapular neck fractures
- fractures of the acromion
- unstable, overriding body fractures
- +/- scapular body fractures with severe angulation
A
Surgical stabilization
7
Q
Signalment for scapular fractures is?
A
- any age, breed, sex of dog or cat
- young male dogs predisposed
8
Q
History in animals with scapular fractures include?
A
- trauma
- motor vehicle accidents
- gunshot
- falls
9
Q
Common PE findings in animals with scapular fractures include?
A
- usually NWB
- varying degrees of limb swelling
- pain and crepitus elicited on palpation
- proprioception may appear abnormal
10
Q
Why might proprioception appear abnormal for animals with scapular fractures
A
Animal may not lift paw when it is placed on the dorsum
- reluctant to move limb may be caused by pain
11
Q
What type of thoracic trauma may be concurrent with scapular fractures
A
- rib fractures
- pulmonary contusion
- pneumothorax
- diaphragmatic hernia
12
Q
What DI views are needed to diagnose scapular fractures
A
Craniocaudal
Lateral
13
Q
scapular fractures are painful, so what can be given to help with DI
A
Sedation or general anesthesia for proper positioning to obtain quality radiographs
14
Q
What is the problem with radiographs take under anesthesia just before surgery
A
Reduce amount of time available for planning surgical repair
15
Q
Lab finding for scapular fractures show?
A
- no specific abnormalities notes
- sufficient blood work done to determine appropriate anesthetic regimens and concurrent diseases
16
Q
In animals with scapular fractures, we should evaluate for concurrent nerve damage to rule out which 3 nerve issues
A
- brachial plexus
- Supra scapular nerve
- spinal cord trauma
17
Q
What is medical and surgical management of scapular fractures based on?
A
Classification criteria and FAS
18
Q
Conservative treatment for scapular fractures includes
- medical treatment with analgesics
- ________ sling
= used to close minimally displaced fractures - scapular body and spine
A
Velpeau sling
- keep on for 2-3 weeks (longer may result in carpus contracture)
19
Q
What type of treatment is shown in this image?
A
Velpeau sling
20
Q
Fracture assessment score is based on which 3 factors?
A
- mechanical
- biological
- clinical
21
Q
What type of treatment is used in unstable extra-articular and intra-articular fracture in animals with scapular fractures
A
Surgical treatment
22
Q
What are the 3 types of surgical treatment in animals with unstable extra-articulated and intra-articular fractures
A
- Orthopedic wire
= pin and tension band with K wire
= high FAS - Plates and screws
= low FAS - Lag screws
= Low FAS
23
Q
What is the primary problem in the image?
A
scapular body fractures
24
Q
How are the scapular body fractures fixed in this image?
A
- orthopedic wire
- plates and screws
25
What type of treatment is done in the image showing a scapular body fractures
Orthopedic wire
- high FAS
26
what type of fixation is done in this image showing scapular fractures
Supraglenoid tubercle
A. orthopedic wire
B. pin and tension band
C. Lag screw
27
What is the problem in this image?
Supraglenoid tubercle fracture
28
What is the main problem in this image?
Scapular neck fracture
29
How are the scapular neck fractures fixed in this image?
- crossed K-wire
- angle plate
- lag screw with plate
= low FAS
30
Diaphyseal + supracondylar fractures
- general consideration + clinically relevant pathophysiology
- Provide examples of how these fractures occur!
High velocity trauma
- blunt trauma
- motor vehicle accidents
- gunshots
31
What is the signalment in animals with humeral fractures
- any age, breed, or sex of dog or cat
- young male dogs
32
An animal presents with a humeral fracture, what can be a common history
- Trauma
- motor vehicle accidents
- gunshot
- falls
33
For humeral fractures we need to rule out concurrent injuries.
- what are the main 3 seen with humeral fractures
- thoracic injury
- fractures of other bones
- neurologic trauma
34
In animals with humeral fractures we have check for neurological trauma. Why is this important?
RADIAL NERVE
- fractures of distal humerus
- musculospiral groove of distal humerus
- Pinch dorsum of paw to check for superficial pain
35
How can you check for superficial pain (radial nerve intact) in animals with humeral fractures
Pinch the dorsum of paw
36
How do animals with humeral fractures present during a PE
- usually NWB
- varying degrees of limb swelling
- pain and crepitus may appear abnormal
- proprioception may appear abnormal
= animal may not lift paw when placed on its dorsum
= reluctant to move limb may be caused by pain
37
Animals with humeral fractures may have concurrent injuries, including thoracic trauma. What types of thoracic trauma can be noted?
- chest wall trauma
- pulmonary contusion
- pneumothorax
38
When should orthogonal radiographic views be taken?
When the animal is stable
39
For humeral fractures why is it important to radiograph the contralateral limb
- assess normal bone length and shape
- used to contour bone plate BEFORE surgery
(Reducing operative time)
- used as reference to select appropriately sized implants
40
In humeral fractures bridging plate fixation is done with craniocaudal radiographs of intact humerus, which is essential for?
Accurate plate contouring
41
Medical treatment of humeral fractures include?
- analgesics
- antibiotics for open fractures
42
What medical management is contradicted in humeral fractures due to
- inadequate stabilization (scapulohumeral joint can not be effectively stabilized)
Casts or splints
(External coaptation)
43
Which joint can not be effectively stabilized in animals with humeral fractures
Scapulohumoral joint
44
humeral fractures are not always immobilized. What type of splint can be placed on the animal to protect soft tissue and decrease pain from bone fragments
Spica splint
45
What type of surgical treatment techniques can be used on the humeral diaphysis fractures?
- IM pins
- interlocking nails
- IM pins plus ESFs
- ESF alone (linear or possibly hybrid)
- Bone plates and screws/plate-rod
46
What type of surgical treatment is shown in the image of a Humeral diaphysis fractures
Simple fracture
- IM pins with cerclage wire
- seated dismally in medial condyle / epicondyle
47
What type of surgical treatment is shown in the image of a Humeral diaphysis fractures
Simple fracture
- interlocking nails IM pins
- seated distally in MEDIAL EPICONDYLE
- also done for comminuted fractures
48
What type of surgical treatment is shown in the image of a Humeral diaphysis fractures
Simple fracture
- ESF modified type Ia with IM pin tie in
- seated distally in medial condyle/epicondyle
49
What type of surgical treatment is shown in the image of a Humeral diaphysis fractures
Comminuted fractures
- higher type ESF with IM pin tie in (modified type Ib)
- IM pin medial condyle / epicondyle
50
What type of surgical treatment is shown in the image of a Humeral diaphysis fractures
Bone plates and screws
- lateral
- cranial
- medial
51
What type of surgical treatment is shown in the image of a Humeral diaphysis fractures
Plate rod (plate pin)
- reduces cycling bending stress in the bone plate
52
Recommended methods for stabilizing _____ _____ humeral fractures based on FAS
Transverse or short oblique
53
Recommended methods for stabilizing _____ _____ humeral fractures (single large fragments) based on FAS
Long oblique or reducible comminuted
54
Recommended methods for stabilizing _____ _____ humeral fractures (multiple fragments) based on FAS
Non-reducingble comminuted fractures
55
How is the humeral diaphysis fracture fixed in this image
Post-op DI
A - stabilization of comminuted fracture with IM pin and plate
B - Fracture healing 12 weeks later
56
Recommended methods for stabilizing ______ fractures based on FAS
Supracondylar fractures
57
What type of fracture is A
Salter I fracture
- with two K-wire or small steinmann pins
58
What type of fracture is B
Salter III fracture with multiple K-wires or small steinmann pins
59
The image shows Type I and III salter Harris fractures of the proximal humerus. How are they stabilized
Multiple K-wires or small steinmann pins
60
The following image is of type____ salter Harris fractures
- Lateral condylar fractures
- T-Y fractures
Spaniels are predisposed
- IOHC
Type IV salter Harris’s fractures
61
The following image shows the Distal humeral / elbow fractures
- What type of surgical treatments is shown in the image?
T-Y fractures of the distal humerus
62
What type of fracture is shown in the image?
Salter IV Harris fractures
- later condylar fracture
- Post-op DI showing lag screws and pins
63
What is the difference between radial-ulnar fractures than other fractures on the thoracic limb?
- Greater chance of open fracture than the humerus or scapula
64
Which breed is known for distal radial-ulna fractures from minimal trauma after a jump or fall
Toy breed dogs
65
How do you diagnose radial-ulna fractures
DI and lab work
- same as for other fractures of thoracic limb
66
Differential diagnosis is important in animals with radial-ulna fractures because we have to determine if the fracture is traumatic or from underlying pathology, such as?
- neoplasia
- metabolic bone disease
67
Medical management of radial-ulna fractures include?
Analgesics
Antibiotics for open fractures
68
Splints and casts can immobilize _____ and _____
In radial-ulna fractures
- closed nondisplaced fractures
- Greenstick fractures in immature animals
Carpus + elbow
69
Splints and casts are contraindicated in which breed of dogs because of high incidence of nonunions
- poor blood supply
- limited soft tissue (extraossuous vasculature)
- Biomechanical instability
Miniature and toy-Breed dogs
70
For surgical treatment of animals with radial-ulna fractures pre-op management is the same as the scapula and humerus. But was is the important exception?
Always put temporary bandage / splint on radial-ulna fractures
71
Why should be always put temporary bandage / splint on animals with radial-ulna fractures
- comfort
- protection
- Prevent swelling until surgery
72
Does the following define an open of closed reduction in animals with radial-ulna fractures
- simple or moderately comminuted
= can be anatomically reconstructed
= stabilized with internal fixation or ESF
- Severely comminuted
= bridge plating + cancellous bone graft
Open reduction
73
Does the following define an open or closed reduction in animals with radial-ulna fractures
- severely comminuted fractures with ESF
Closed reduction
74
What type of surgical treatments is contraindicated for the radius?
- narrow medullary canal
- invasion of carpal joint to place pin
IM pinning and interlocking nail
75
During surgical treatment how is the ulna usually supported
Indirectly by radial stabilization
76
What are the indications for ulna stabilization
- need added support to comminuted radial fractures
- large dog needing more support
- reconstruction of radius + ulna needed for athletic performance
- Use IM pins, plates or ESF
77
What type of surgical treatments is indicated for the following simple fractures
- Type Ia and Ib external al fixators +/- cerclage wire
- high and moderate FAS
78
What type of surgical treatment is shown for comminuted fractures
Type II external fixators
- maximal
- minimal (modified)
= curve of radius
79
Bone plates and screws
- cranial
- medial
Bridge plate radius
- with ulnar IM pins
80
What type of fracture stabilization is shown in the image below
- based on FAS
Stabilizing transverse or short oblique radial fractures based on FAS
- bone plate and screws
- ESF
81
What type of fracture stabilization is shown in the image below
- based on FAS
Recommened for stabilizing long oblique or reducible comminuted radial fractures (single large fragments)
- neutralizing plate
- Type II or Ib ESF + cerclage wire
- Type Ia ESF ply’s cerclage wire
82
What type of fracture stabilization is shown in the image below
- based on FAS
Stabilizing nonreducible comminuted radial fractures (multiple fragments)
- bridging plate with maximal type II ESF
- Briding plate or minimal type II
- Type Ib ESF
83
In the image how is the ulna fracture treated and where is the fracture
- fracture (or osteotomies) of olecranon
- treated with Pin + tension band wire
84
How is the simple fracture treated in this image?
Treated with plate and screws
- tension band plate
85
How is the severely comminuted fracture treated in this image?
Bridging plating
- Buttress plate
86
How is the Styloid process fracture treated in this image?
Treated with pin + tension band wire
- high & moderate FAS
87
How is the intrarticular fracture treated in this image?
Anatomically reduced
Rigidly reduced
- lag screws with K-wire
- Moderate & low FAS
88
Where do the K-wires (cross pins) attach in the proximal radial physis
-Lateral proximal epiphysis
- lateral distal metaphysis
89
Where do the K-wires (cross pins) attach in the distal radial physis
- medial styloid process
- lateral aspect of distal radial epiphysis
90
How are nondisplaced radial fractures treated?
With a cast
91
In the physeal fracture A (premature closure) what is happening and where is it happening based on location
Distal ulnar physis
- shortening
- cranial bowing
- external rotation
- valgus angulation of radius
92
In the physeal fracture B (premature closure) what is happening and where is it happening based on location
Distal or proximal radius physis
- shortening of radius
- subluxation of radial numeral joint
93
In the physeal fracture C (premature closure) what is happening and where is it happening based on location
Partial closure of distal radial physis
- angular limb deformity of radius
94
Describe the post-op care for fractures of the thoracic limb
- basically same as pelvic limb
- some will splint every plated radius-ulna fracture
(3-4 weeks to provide more protection of repair)
95
What is the prognosis of radial-ulnar fractures (thoracic limb fractures)
Good with no complications
96
Complications for thoracic limb fractures are essentially the same as fractures of the pelvic limb, which can include?
- delayed union
- nonunion
- malunion
- angular limb deformity
- osteomyelitis
- pin tract infection (mostly ESF pins)
- Fixation failure
97
What type of fracture stabilization is shown in the image below
- based on FAS
Compression plate to stabilize transverse fractures of diaphysis
- T plate
- Lag screws + neutralization plate
- E: comminuted nonreducible
