Fracture Disease And Complicaitons Flashcards by Corinne Perra

What are complications of fracture immobilization?

Quadriceps contracture 
Disuse osteoporosis 
Muscle atrophy 
Ligamentous laxity 
Cartilage atrophy 
Fracture associated sarcoma

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Most common complication after distal femor fractures that are improperly immobilized>

Quadraceps contracture

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Predisposing factors to quadriceps contracture?

Young patient <6months

Poor use of limb during healing

Immobilization of limb

Extensive muscle trauma

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Clinical presentation of quadriceps contracture?

Muscle replaced by fribrotic tissue
Forms adhesions between muscle and bone

Tight band at quadriceps 
Difficulty ambulatory 
Muscle atrophy 
Hock/stifle locked in extension 
Toe excoriation

Dorsally raised patella

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Radiographs show..
patella drawn proximally

Genu recurvatum
Ankylosis and DJD

Quadripceps contracture

Genu recurvatumm = knee bent backwards

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How do you prevent quadriceps contracture?

Early return to function 
Physical therapy 
No immobilization 
Ice packs 
NSAIDS

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Treatment of quadriceps contracture?

Salvage
-release of quadriceps
Arthrodesis (last ditch)
Amputation (toes abraded)

Dynamic flexor brace

Prognosis

poor for full fxn
guarded for partial fxn

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What do you call loss of bone due to reduction of mechanical stress?

Disuse/secondary osteoporosis

Wolfs law - osteoclasts

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If disuse osteoporosis is longer than ______ the damage can be permanent

12 weeks

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If you have muscle atrophy due to immobilization after fracture, how much longer does recovery take?

2-4x longer

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How is ligamentous laxity resolved?

Improved muscle tone

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How does cartilage atrophy occur?

Joint use stimulates glycosaminoglycans

Immobilization decreased GAG —> cartilage erosion and ankylosis

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Cartilage atrophy is reversible if under ____ weeks

Can be permanent over 7weeks

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Digital flexor contracture is seen following what cases?

Small dogs with fracture of elbow/antebractum

Walks on 3 legs with carpus flexed

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Prevention and treatment of digital flexor contracture?

Encourage limb use
Spoon splint
Passive range of motion

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Fracture assoicated sarcoma is seen in what breeds more commonaly

Large

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Fracture associated sarcoma is usually seen with what type of fracture?

Comminuted femoral fracture

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etiologies of fracture assoicated sarcoma?

Implant corrosion at fracture site

Jonas pin
TPO plate

Dissimilar metals

Complicaitons( inflammation or infection)

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What do you call a slower than expected healing

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Delayed union fracture

What do you call a fracture that the progression of healing has ceased?

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Non union fractures

What are the two types of non union fractures?

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Viable — abundant callus formation (elephant foot)

Non viable — lack blood supply

T/F: non union fractures are unlikely to heal without some form of intervention

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True

What are mechanical factors that can cause non union fracture/ delayed union?

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Fracture segment proximity — avoid gaps larger than bone diameter

Motion at fracture site

some motion can trigger stem cell proliferation
too much motion damages cells and prevents callus formation

What factors can alter the biological environment affecting bone healing?

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Decreased blood supply of periosteum

Decreased surrounding soft tissue

Increased age

Open reduction/fixation method (extrinsic factors)

What cells are found in the periosteum and medullary cavity, decrease in aging patients and will proliferate when exposed to growth factors ?

Cellular environment

Causes of delayed and non union fractures?

Fracture instability Damage to vascular supply Bone affected - radius and ulna (blood) - femur (most commonly broken) - humerus - tibia Local infection Large fracture gaps Fixation Metabolic conditions

How does local infection alter bone healing?

Alter pH and release enzyme that prevent neovascularization

What metabolic conditions can impair bone healing?

Renal disease Cushings Hypothyroid glucocorticoids

What is the treatment for delayed union fractures?

Additional time to heal Replace or add implant if failure Infection - culture and treat Reduce patient activity

If you have treated a delayed union fracture and it has no improvement in 2-4weeks, it is then what kind of fracture?

Non union

Treatment of non-infected viable non union fractures

Fracture stabilization Bone graft External fixator to preserve blood supply

How do you treat a non infected, non viable, non union fracture?

Stabilized Removed fibrous tissue from fracture site Removed loose implants Ream medullary cavity to reestablish blood supply Bone graft Roger bone ends until bleeding

How do you manage open fractures?

Manage patient first Limb viability? Debridement - sterile lube over wound - cover wound - clip hair - clean surrounding with 4%CGS - debride non viable tissue Vigorous irritation of would -7-8psi sterile saline of 0.05% Chlorhexidine Cover with sterile dressing Stable bandage

T/F: antibiotics are always indicated for open fractures

True

What antibiotics do you give in case of open fractures?

Culture Combo of gram pos and neg, anaerobic, aerobic Most effective if <3 hours from injury Change based on culture results Cephalosporins and fluroroquinolones

T/F: fractures can heal with coexisting infection

True But they will not heal is there is also instability

Why do most open fractures have increased healing times?

More necrotic tissue Disruption of blood supply Cancellous atuografts are indicated

What is the best open fracture stabilization method that allows bone access to the wound and doesnt spread contamination ?

External fixator Bone plate

Etiologies of osteomyelitis?

Open fracture repair | Hematogenous

Most common causative organisms of osteomyelitis ?

Staphylococcus intermedius E.coli Pseudomonas

Pathophysiology of osteomyelitis?

Damage to bone Vascular compromise and ischemia Bacterial contamination Necrotic tissue, instability Lack of blood supply—> perpetuate infection Surgical implants - biofilm, adherence, colonization - antimicrobal resistance

Clinical signs of osteomyelitis ?

Excessive local pain Excessive swelling Fever Lethargy

Osteomyelitis appears how on radiographs?

Loose or broken implant Lucency around implant Periosteal proliferation Sequestrum Can confirm with biopsy and culture

How do you manage osteomyelitis ?

If fracture healed - remove implant and give long term antibiotics Not healed but implant is stable— leave in Fracture not healed and not stable e— replace with stable fixation method ``` Large amount of discharge —> treat as open wound, direct culture Debride and lavage Pack IV abs for 3-5days then oral for 6-8wks When discharge stops, close or heal by second intention ```

How do you manage a sequestrum ?

Dead bone from osteomyelitis Involcrum — bone formed around sequestrum Use rongeurs or bur to remove Treat infection If weakens bone — provide stabilization

Fracture Disease And Complicaitons Flashcards

(45 cards)