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Fracture Assessment Flashcards

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1
Q

What is an open fracture?

A

Fractured bone exposed to environmental contamination via disrupted soft tissue covering.

Open fractures can lead to severe complications due to contamination.

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2
Q

What are the grades of the Gustilo-Anderson Open fracture classification System? (6)

A
  • Grade 1: open fracture with wound < 1cm
  • Grade 2: open fracture with wound >1cm with minimal soft tissue damage/flaps/avulsions
  • Grade 3: open fracture with extensive soft tissue damage
    • 3a: adequate soft tissue covering despite extensive soft tissue injury
    • 3b: extensive soft tissue loss, periosteal stripping, bone exposure, often massive contamination
    • 3c: open fracture with arterial injury requiring repair

This classification helps in determining treatment and prognosis.

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3
Q

What are the types of incomplete cortical disruption fractures? (3)

A
  • Fissure
  • Greenstick
  • Depression (skull/nasal cavity)

Incomplete fractures are characterized by partial breaks in the bone.

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4
Q

What are the types of complete cortical disruption fractures? (3)

A
  • Simple (2 fragments)
  • Comminuted (3+ fragments, fracture lines will interconnect)
  • Segmental (3+ fragments, intact column in between the 2 fractures)

Complete fractures can significantly impact bone stability and require different treatment strategies.

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5
Q

What are the types of displacements in fractures? (3)

A
  • Medial/Lateral
  • Cranial/Caudal
  • Proximal/Distal

Displacement describes the position of the distal fragment relative to the proximal fragment.

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6
Q

What does the Fracture Assessment Score (FAS) evaluate? (x2)

A
  • Biological assessment
  • Biomechanical assessment

FAS helps in determining the ideal type of fracture repair.

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7
Q

What are the types of plates used in fracture repair?

A
  • DCP (Dynamic Compression Plate)
  • LC-DCP (Limited Contact Dynamic Compression Plate)
  • LCP (Locking Compression Plate)

Each type of plate has specific advantages and disadvantages regarding soft tissue preservation and stability.

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8
Q

What is the purpose of Open Reduction?

A

Open reduction allows for direct visualization and alignment of fracture fragments.

  • Articular fractures
  • Anatomically reconstructable fractures
  • Comminuted fractures treated by major segment alignment and cancellous bone graft
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9
Q

What is the purpose of Closed Reduction?

A

Closed reduction is less invasive and is used when fractures are not displaced.

  • Nondisplaced or incomplete fractures
  • Comminuted fractures treated by major segment alignment using bridging osteosynthesis
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10
Q

What is Anatomic Reconstruction?

A

Anatomic reconstruction aims to restore the original anatomy of the bone for optimal function.

  • Articular fractures
  • Single fractures
  • Fractures with one to three large fragments
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11
Q

Grade open fracture, wound <1cm

A

Grade 1

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12
Q

Name of grading system for open fractures

A

Gustilo-Anderson Open Fracture Classification system

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13
Q

Grade open fracture 10cm wound with major soft tissue damage, bone exposure

A

grade 3b

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14
Q

Grade open fracture 10cm wound, arterial bleeding

A

Grade 3c

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15
Q

Grade open fracture 2cm wound, minimal soft tissue damage

A

Grade 2

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16
Q

Grade open fracture, wound 10cm but no big flaps or arterial bleeds

A

Grade 3a

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17
Q

Types of Complete Simple Fractures (3)

A

Transverse
Oblique (2x)
Spiral

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18
Q

Differentiating between short and long oblique

A

Long oblique length is 2 x diameter of bone at that level

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19
Q

Long obliques can be treated with…

A

cerclage wires or lag screws (may need multiple + neutralisation plate)

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20
Q

Definition of comminuted fracture

A

3 or more fragments, interconnected fracture lines

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21
Q

Grade open fracture 10cm wound, bone exposed, artery bleeding

A

grade 3c

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22
Q

name of open fracture grading system

A

Gustilo-Anderson Open Fracture classification system

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23
Q

Grade open fracture <1cm open wound

A

Grade 1

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24
Q

Grade open fracture soft tissue flap 10cm no arterial bleeding

A

Grade 3b

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25
Grade open fracture wound 3cm wound minimal damage to soft tissue
Grade 2
26
types of complete fractures (x3)
Simple Comminuted Segmental
27
Simple fracture - # fragments
2
28
Difference between Comminuted vs. Segmental fracture
Both have 3+ fragments, however comminuted will have interconnected fracture lines, and segmental fractures have atleast 1 intact column between the 2 fragments.
29
Types of simple complete fractures
Transverse Oblique (x2) Spiral
30
Difference between short and long oblique fracture
Long oblique has a fracture line 2 x diameter of bone at level of fracture.
31
Long obliques can be fixed using:
Cerclage wires or lag screws (+ additional neutralisation plates) due to the long segments.
32
Types of comminuted fractures
Butterfly (triangular piece) Mildly comminuted Highly comminuted
33
what contributes to Fracture Assessment Score? (FAS)
1. Biological assessment: 2. Biomechanical assessment 3. Clinical factors
34
What contributes to Biological assessmnet? (6)
1. Severity of tissue injury 2. Age of patient 3. Health of patient 4. Intensity of trauma 5. Time of action of trauma 6. Surgical approach required - open/closed
35
Biomechanical factors to consider (3)
1. Patient size 2. Is load sharing possible? 3. Are other limbs involved/general disability of patient
36
What to consider when assessing fracture apparatus?
Plate screws type of repair Compression used? signs of lucency, infetion, movement, breaks,
37
what should be assessed with Alignment?
Is torsion, varus or valgus present?
38
Apposition - what are you looking at?
Are the cortices overlapping? Is there compression?
39
Activity - what is being assessed?
Expectation of fracture repair may need to be assessed over time
40
DCP plates - types of screws used, and consequence of that, including downside
only cortical screws - need good plate contouring to achieve contact and load sharing. Downside is more soft tissue damage required to place them.
41
42
43
44
45
46
Types of Simple fractures
1. Transverse 2. Oblique (long/short) 3. Spiral
47
How would you define a long oblique fracture
Length of fracture line is 2 x diameter of bone at the fracture level
48
define butterfly fracture, what kind is it?
its a type of ca type of comminuted fracture where two oblique fracture lines create a wedge-shaped, triangular fragment between the two main bone fragments.
49
Types of comminuted fractures
1. butterfly 2. mildly comminuted 3. highly comminuted.
50
definition segmental fracture
3 or more fragments, with an intact bony column between 2 fragments
51
grade open wound 4cm, large flap avulsed, no arterial bleeding
3b
52
open fracture grading <1cm
grade 1
53
open fracture grading 1-10cm, minimal soft tissue damage
grade 2
54
grade open fracture, 10cm + , adequate soft tissue covering
Grade 3a
55
grading system for open fractures
Gustilo Anderson Open fracture grading system
56
57
What factors are considered as Clinical factors
1. Patient/client compliance 2. Patient comfort level required
58
When assessing fracture Apparatus - what things are you considering?
Type of plate type of screws - is there compression Signs of implant issues - lucency, infection, movement, breaks
59
Whats the benefit of Biological reconstruction?
it will allow load sharing while direct healing takes place
60
What type of fixation best for fractures where anatomical reconstruction is not possible?
Bridging fixator - will carry the full load
61
what kind of fracture are typically able to be reconstructed
Simple, or Minimally comminuted (with LARGE FRACTURE FRAGMENTS, no more than 3 pieces) | The biomechanical benefit outweights the surgical biological damage from ## Footnote From AO blog - Glyde/Tan
61
If multiple limbs are affected - how does that affect your choice of fracture fixation?
Increased need for much more robust fixation - needs to be able to withstand weight bearing because wont be able to take weight off using other 'good' legs.
62
Required xray views for a fracture: important to include:
1. 2 orthogonal views 2. include proximal and distal joints 3. orthogonal views of contralateral bone/joints.
63
why is it important to take contralateral limb xrays in fracture planning?
Can use that limb for fracture planning and measurement/implant templating.
64
What are the 2 main benefits of anatomical reconstruction and primary bone healing?
1. bony column can share the load with the implant, reducing the stress on the implant, increasing force required to cause failure to the implant. 2. abscence of a callus in healing is more ideal for articular (joint) fractures and those of the vertebral column.
65
Main source of blood supply to bones normally, and then when there is a fracture?
1. normally medullary artery 2. Fractures: periosteal/extraosseus blood vessels
66
what kind of fractures dont require fixaton and why?
Greenstick - they are already relatively stable, with little/no damage to peristeum or medullary artery, or surrounding muscle.
67
consequence of ongoing time on fracture fixation implants
cyclic or fatigue failure
68
which is better method of healing for non articular fractures?
In non-articular fractures, indirect healing through callus formation carries no inherent negative effect when compared to direct or non-callus healing.
69
default preference for fracture repair of 3 fragments, esp if unsure
Bridging fixation
69
why is primary'/direct bone healing without a callus in a joint important?
causes significant arhritis and can impair function
70
what does bridging fixation require in terms of implant features
Threaded screws/bolts/pins
71
types of bridging fixation
1. Bone plate 2. Augmented bone plates 3. Interlocking nails 4. ESF with threaded pins
72
how do you augment bone plating for a stronger outcome? (4)
1. plate/rod 2. double plating 3. orthogonal plates 4. dual bone fixation)
73
which bone are IM pins contraindicated in and why?
The radius - 1. it has a small medullary canal and 2. lacks prominent extra-articular areas for safe pin entry/exit, 3. Risk of joint damage 4. limited bending stability
74
Type of fixation - ESF
Bridging
75
how long will effectively placed threaded ESFs last with effective stability and lack of complications
up to 12 weeks
76
ESF ok for up to 12 week healing, but if likely to have prolonged healing time...better to use...?
plates or Interlocking nails
77
Categories of biological time frames of bone healing (3)
good - up to 8wks healing moderate - 8-16wks poor - 16-24weeks
78
5 most common factors that influence healing time
1. Age 2. blood supply to fracture site 3. fracture gap 4. infection 5. concurrent injuries/disease
79
how long does it take for medullary artery to repair?
a few weeks
80
consequence of high energy injury and comminuted fracture? and likely healing time required?
quite a lot of damage to surrounding soft tissue whcih reduces amt of blood supply up to 24wks = 6mths
81
how long will fracture likley take to heal in a young animal with low energy simple fracture?
up to 8wks
82
time expected fracture to heal old animal with distal limb fracture?
16-24wks (4-6mths)
83
6 main factors that affect the stability of fracture repair | (biomechanical assessment)
1. type of fracture 2. can it be anatomically reconstructed/load sharing achieved? 3. method of repair 4. single or multi limb? 5. patient size 6. expected activity level
84
length of time before complications are expected for casts, splints, slings
4wks
85
how long will cerclage wires and IM pins last?
up to 12wks
86
types of "lightweight fixation" choices
casts, splits, slings, IM pin/cerclage wire
87
heavy weight fixation choices,
Bone plates interlocking nails ESFs with threaded pins
88
how long will heavyweight fixations last for? (except for...)
6mths Except for threaded ESF's - 12wks
89
why are smooth pins not advised for ESFs anymore?
they only last about half the amt of time that threaded pins last
90
appropriate use of cast ie. biological/biomechical situation - and Bones best suited -
good/good Distal limbs, radius, tibia
91
92
IM pins (+ wires/Kwires) best for -
simple long obliques or spiral fractures of humerus, femus, or tibia with good biomechnical assessment
93
what is the importance of assessing biology of fracture?
tells you how long it will take to heal
94
what does mechanical assessment tell us?
how strong the fixation needs to be
95
downside of casting in a young growing dog on bones
decreased bone density
96
longest time you'd want to cast/splint a limb for due to osteopenia
4 weeks
97
requirement of casting/splinting (x 4)
1. need to immobilise the joint above and below the fracture 2. fast healing anticipated 3. Good alignment (intact periosteum) 4. Resistance to compression
98
# ``` ``` Reconstructing boney fractures is hugely preferred to bridging reconstruction - it can sustain forces approx x higher
8 x higher (bridging =100kg force ) (reconstructing= 800kg force)
99
main source of strength ESF's
connecting bars
100
downside of ESF- relating to type of fixation
cant compress the bones, type of bridging fixation
101
how are plate sizes organised
1. screw size/diameter 2. locking vs. non locking 3. design and application
102
What is a (uber)Schwinger artifact?
Metallic screws cause a "streak" or "halo" artifact due to the high attenuation of X-rays by the metal. This artifact can obscure surrounding bone and soft tissue, making it difficult to accurately assess bone fractures or other abnormalities.
103
Benefit of LCP plates?
Can use for both locking screws as bridging fixation as well as cortical screws for compression

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