Fractures

Question 1

Forces that can act on a fracture

Answer 1

Bending
Torsion
Compression
Shearing
Tension

Question 2

Bending works by

Answer 2

Results in angulation of the bone
Breaks occurs opposite where force is applied
HBC, kicking, most common

Question 3

Torsion works by

Answer 3

Rotation of the bone
Tends to cause a spiral fracture
Caught on something

Question 4

Compression breaks bone by

Answer 4

Opposing forces acting on a bone
A fall

Question 5

Tension breaks bone by

Answer 5

Results in distraction (pulling apart)
Called avulsion fractures
Most often occurs at tendon or ligament attachments on bone

Question 6

Shearing breaks bone by

Answer 6

When a force is parallel to each other
Dragged by vehicle, an uncontrolled break

Question 7

Are bones always broken by one or more forces

Answer 7

Bone fractures are often caused by multiple forces
Need to know which force caused the fracture
This force needs to be controlled to promote healing

Question 8

How is Bone is viscoelastic

Answer 8

If a forces is applied slowly, bone has a greater ability to flex before breaking
If a force is applied quickly, less force is required to fracture the bone

Question 9

Classification of fractures Based on

Answer 9

Whether or not the bone has penetrated the skin
Appearance of or geometry of fracture
Positioning of fractured bone with respect to each other
Where on the bone the fracture is occurring
Whether or not there is underlying bone pathology

Question 10

Closed fracture

Answer 10

The fractured bone has not penetrated the skin

Question 11

Open fracture

Answer 11

Previously called compound
The fractured bone has gone through the skin
Always considered infected- considered an emergency

Question 12

Incomplete fractures are also known as

Answer 12

Cracks
Fissure fractures
Very good prognosis

Question 13

Greenstick fractures is

Answer 13

A type of incomplete fracture
Only occur in young animals due to elasticity of bone
Young animals heal quickly

Question 14

Comminuted fractures is

Answer 14

The bone has fractured into more than two pieces
Butterfly fragment
Comminuted fracture
A triangular or wedge shaped bone fragment

Question 15

Physeal fractures are

Answer 15

Fractures along the physeal plat (growth plate)

Question 16

Transverse fracture

Answer 16

The fracture occurs in a relatively straight line
Perpendicular to the (long axis) length of the bone

Question 17

Oblique factures are

Answer 17

The fracture line is not perpendicular to the long axis of the bone
Classified as
Short oblique
Long oblique

Question 18

Long oblique fracture is different form short by

Answer 18

• the fracture line is at least twice the diameter of the bone at that point

Question 19

Spiral fractures

Answer 19

Look like long obliques but hav a spiral patern

Question 20

Factors influencing how the bone fractures

Answer 20

How energy is applied
The type of force applied to the bone
The direction in which the force is applied to the bone
Which bone is affected
Bone maturity

Question 21

Why should you care how a bone breaks?

Answer 21

Knowing the type of fracture, what types of forces to avoid, and which forces work in your favour will matter to you when you are…
Assisting with bandage changes
Restraining an animals
Take radiographs
Providing nursing care

Question 22

Traumatic fractures occur because

Answer 22

These occur when too much force is applied to a healthy bone

Question 23

Pathological fractures occur when

Answer 23

These occur secondary to another disease process
Bone strength is impaired therefore less force is required to cause a fracture to occur

Question 24

Fracture repair needs formation of the bone by

Answer 24

Reduce fragments and immobilize the bone- need to understand how to minimize forces based on fracture types
Gap must be small enough for blood vessels to grow across- Blood vessels are required to bring other cells/healing factors to the repair site
Fibroblasts and chondrocytes enter gap and fill in with fibrocartilaginous tissue scaffold
Osteoblasts enter and fill with bone substance
Treat infection- INFECTED BONE DOES NOT HEAL

Question 25

Healing time for bone fractures and what needs to be done for it to work

Answer 25

Healthy adult: 8-12 weeks Puppy, kitten: 4-6 weeks The following conditions must be met The fracture must be reduced Immobilized- no motion or will cause sharing of newly formed blood vessels The bone must be healthy

Question 26

Methods of fracture repair

Answer 26

External coaptation Splints Casts Slings Braces Internal fixation Intramedullary (IM) pins Interlocking nails Bone plates Cerclage wire External fixation Fractures in certain bones present specific problems for repair

Question 27

External coaptation neutralizes what forces

Answer 27

Bending Torsion Shearing- maybe If the splint or cast is applied too loosely, forces will not be neutralized and healing will be impaired

Question 28

External coaptation advantages

Answer 28

Non-invasive Minimal disruption of the surrounding blood supply Minimal effects on growth in young animals Non Surgical placement- though may need to be sedated repeatedly during reassessments Moderate expense (maybe…) Can be performed in most clinics -specialized training is not required Good temp measure Before transporting the animal Before surgical repair is performed

Question 29

Limitations of external coapitation

Answer 29

Poor control of tensile, compressive and in some cases shearing forces Less rigid stabalization that with surgical repair It may not be possible to get good fracture reduction and alignment with a closed repair Especially true with fractures that have a lot of displacement or comminuted fractures

Question 30

Disadvantages of external coapitation

Answer 30

Rub sores and dermatitis are common Bandages that are too tight can lead to swelling necrosis

Question 31

Rules for using external coapitation

Answer 31

Include the joints proximal and distal to the fracture Don't apply the bandage too tight Ensure that the bandage is not too loose Apply extra padding to pressure points to minimize the risk of pressure sores Include the foot but leave the 2nd and 3rd digits exposed The leg should be splinted with the joints in slight flexion- normal standing position Splint changes will either require many people to help with restraint or sedation depending on the temperament/comfort level of the animal and staff support Frequent rechecks are required Take recheck radiographs with the splint on

Question 32

Follow up requirements with splinting

Answer 32

Recheck every 2-3 days initially, if things are going well, then increase to weekly rechecks The animal needs to be brought in immediately if The bandage has slipped The bandage is soiled or wet If the animal suddenly becomes more painful or starts trying to chew on the bandage where they had not previously The toes are swollen

Question 33

Why don't just put the splint on and see them back 6-8 weeks later

Answer 33

We need to evaluate the health of the tissues underneath the bandage and adjust management of the patient as necessary

Question 34

Internal fixation is and neutralizes what forces

Answer 34

Intramedullary pins Forces neutralized Bending Shearing IM pinning is often combined with some other form of fixation Cerclage wire Forces neutralized Bending Maybe torsion and shearing Can be used on long obliques, not short oblique fractures Also often combined with some other form of fixation

Question 35

External fixation is and neutralizes what forces

Answer 35

Can neutralize all forces External skeletal fixation This is hardware both inside and outside the body Screws and bone plates All forces are controlled by bone plates and screws

Question 36

Internal and external fixation advantages

Answer 36

Support of the fracture site External fixation > internal fixation> external coaptation Greater support means that the animal can use limb sooner Bandaging is not required with an internal and external fixation Don't use the pressure sores and dermatitis associated with external coaptation Wounds left uncovered if desired With surgical repair, fracture and alignment are often better Especially important with joint or growth plate involvement

Question 37

Disadvantages of external and internal fixations

Answer 37

The animal must have a general anesthetic Higher cost? Additional training and specialised equipment is required Risk of iatrogenic fracture during hardware implantation Disrupted blood supply- bone plates ESF required second procedure for hardware removal Hardware is often left in the animal when internal fixation is used Discomfort in cold Fracture at the ends of bone plates Pins can shift Infection risk

Question 38

Limitations of external and internal fixation

Answer 38

Need to monitor for infection Can be very difficult to treat due to hardware May require removal of hardware Still need post op care Recheck at 2 weeks, then q 2-4 weeks (earlier if concerns) Wound care Exercise restriction Analgesia PHYSICAL THERAPY

Question 39

Fracture complications

Answer 39

Tendon contracture Quadriceps contracture or quadriceps muscle tie down Osteomyelitis- an infection of the bone Malunion- the fracture heals out of alignment Non-union- the fracture does not heal

Question 40

Common Types of physical therapy

Answer 40

Warm packing cold packing passive range of motion Active motion

Question 41

How does warm pack therapy work

Answer 41

Will help to relax tight muscles Should be done before other exercise Heat causes peripheral vessels to dilate- can increase tissue swelling Avoid on joints, incisions and inflamed tissue 40-45oC for 15-20 min Works well in combination with massage

Question 42

How does passive range of motion work

Answer 42

Benefits Prevents contracture of tissues by maintaining mobility and flexibility of surrounding structures Muscles, ligaments, tendons or scar tissue Decrease muscle atrophy Increases blood flow to the area Strengthens innervation Ensure to provide support both proximal and distal to the joint 20x, 1-3 reps, minimum 3x/day

Question 43

Active motion- recumbent animals works by

Answer 43

Helps to maintain muscle mass Encourages nerve memory Support the animal- can be done with slings, harnesses Lifting the animal to a standing position and allowing them to support as much weight as they can If the animal can support some weight- progress to rocking and balancing exercises Recumbent patients must be flipped every 2-3 hours to prevent pressure sores

Question 44

Active motion- animals that are ambulatory can be done by

Answer 44

Slow walks Underwater treadmill Swimming Start on flat, non-slippery surface for 2-4 weeks Start with 5-10 minutes Gradual increase in duration, frequency and incline Must keep supported

Question 45

Cool packs for physical therapy help by

Answer 45

Decreases inflammation and swelling 10-15 minutes; 3x/day Ensure that you don't cause frostbite After active motion and PROM

Question 46

Uncommon modes of physical therapy

Answer 46

Cold compression-works better than icing alone Acupuncture Transcutaneous nerve stimulation (TENS)- well tolerated by dogs and cats Shockwave therapy Underwater treadmills Stem cell therapy Therapeutic laser Massage Chiropractic Assisi loop Therapeutic ultrasound Wobble boards, wobble balls, calvetti, underwater treadmills, etc