fracture assessment Flashcards
(20 cards)
What are the key components for describing a small animal fracture?
Bone affected, Location (articular, physeal, epiphyseal, metaphyseal, diaphyseal; proximal/middle/distal thirds), Configuration (severity: incomplete/complete; pattern: transverse, oblique, spiral, etc.), Displacement (of distal fragment relative to proximal), and whether the fracture is open or closed (Type I-IIIc).
What are the three categories considered in PFAS?
Biological factors (e.g., age, infection, trauma energy, blood supply, systemic disorders), Mechanical factors (size, weight, activity, limb load-sharing), and Clinical factors (surgeon experience, implant availability, owner compliance).
Why is it conceptually useful to apply PFAS even without numerical scoring?
Because radiographically identical fractures may require different treatments and prognoses depending on underlying biological, mechanical, and clinical factors.
List fractures that might be suitable for conservative management or external coaptation.
Maxillary/skull fractures without severe impairment, mandibular fractures with minimal malocclusion, minimally displaced spinal fractures without neurological issues, minor pelvic fractures not affecting weight-bearing axis, scapular body fractures, isolated ulnar/fibular fractures, minor metacarpal/metatarsal fractures, digit fractures, greenstick fractures in immature animals with strict rest.
Why are most fractures in dogs and cats not ideal for external coaptation?
Because casts/bandages can cause sores, impede early mobilisation, and hinder joint health and muscle maintenance; surgery is usually preferred if available.
What are the characteristics of fractures that are generally suitable for external coaptation?
Simple, transverse, relatively non-displaced fractures of the radius/ulna or tibia/fibula with minimal soft tissue cover allowing effective immobilisation.
Why should distal radius/ulna fractures in toy breeds not be managed with a cast?
Because they often result in atrophic non-union when casted and must always be surgically stabilised.
How should fractures distal to the elbow or stifle be temporarily stabilised?
With a splinted dressing (preferred) or a modified Robert Jones bandage, extending at least one major joint proximal to the fracture.
Why should humeral fractures not be bandaged?
Bandaging creates a pendulum effect across the fracture, which is painful. A spica splint may be used but is time-consuming and often not worthwhile.
Which fractures should not be bandaged for temporary stabilisation?
Scapular, femoral, and pelvic fractures.
What is the recommended initial treatment for open fractures?
Triage and stabilisation, intravenous broad-spectrum antibiotics (e.g., 20 mg/kg IV cefuroxime q6-8h), and a splinted dressing to immobilise and stabilise the limb.
Describe the Gustilo-Anderson classification for open fractures.
Type I: wound <1 cm, mild-moderate contusion; Type II: wound >1 cm, no major soft tissue damage; Type III: extensive soft tissue damage, subdivided into IIIA (adequate coverage), IIIB (soft tissue loss and bone exposure), IIIC (arterial injury needing repair).
What are the treatment goals for open fractures?
Prevent infection, promote bony union, repair soft tissue damage, and restore function.
What radiographic sign might suggest an open fracture?
Presence of gas opacity within tissues around the fracture.
What is the Orthopaedic Trauma Association Classification Scheme for open fractures?
Grades S1-3, M1-3, A1-3, B1-3, C1-3 for Skin defect, Muscle injury, Arterial injury, Bone loss, and Contamination, respectively.
What pelvic injuries often warrant surgical stabilisation?
Disruption of the weight-bearing axis, pelvic canal narrowing >50%, acetabular fractures, neurological compromise, and unmanageable pain.
How are minimally displaced sacroiliac luxations typically managed?
With four weeks of crate rest and analgesia, followed by repeat radiography after one week to monitor pelvic canal collapse.
What is the concern with sacrocaudal fracture/luxation (‘tail pull injury’)?
It may cause hind limb dysfunction, urinary and faecal incontinence due to tension on the sacral spinal cord and cauda equina.
What did Tatton et al. (2009) find regarding tail base sensation and urinary control recovery?
100% of cats with intact tail base sensation recovered urinary control within 3 days; 60% of those without sensation recovered control within 30 days.
What were Couper and De Decker’s (2020) findings on neurological injury and urinary control recovery?
90% of patients recovered voluntary urinary function; higher neurological grades correlated with reduced likelihood and longer recovery time for urinary function.
