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What is the definition of a fracture?

A complete or incomplete break in the continuity of bone and/ or cartilage


What are bone fractures usually accompanied by?

- Variable degree of soft tissue injury
- Locomotor dysfunction
- Maybe accompanied by significant injury to other body systems


What three aspects does the osseous blood supply have?



Describe the afferent blood supply of the bone...

- Principal nutrient artery
- Metaphyseal and Periosteal arteries are in association with muscle attachments
- Epiphyseal arteries separate the blood supply from the metaphysis


Describe the intermediate blood supply of the bone...

Fine system of little tiny vessels that run through the bone


Describe the Efferent blood supply of the bone...

Venous drainage at the periosteal surface


Where does the inside 2/3 of the bone get all of its blood supply from?

From the interior of the bone


In most significant injuries, which artery is damaged?

The Nutrient artery
- Less important than other vessels


What is the Secondary Bone healing sequence...

- Haemorrhage & clot formation
- Inflammation & Oedema
- Proliferation of cells
- Cartilage & Bone formation (callus)
- Remodelling


What are the two types of fracture healing?



Describe Primary Bone Healing...

Direct production of new bone with no precursor
- No callus
- Requires perfect anatomical reduction and rigid fixation
- Osteoblasts lay new lamellar bone if theres a gap
- Plates take the weight and load share with the bone


What is a bone callus?

When the body creates a whole lot of extra bone
- Stabilises the fragments to allow lamellar bone to grow and fill the fracture gap
- Size of callus is related to the stability of the fracture - more callus= less stable
- Not good within or around a joint - need primary healing here without callus production
- Initially stronger than primary
- Three types of callus


What do osteoblasts do in primary bone healing?

If there is a gap between bone, osteoblasts will lay lamellar bone perpendicular to the long axis followed by cutting cores


Describe the fracture vascular supply...

Afferent artery hypertrophies
Extraosseous vessels are the most important in repair.


What is the most important blood supply in fracture repair?

Extraosseous blood supply


What is the most important thing about fracture repair?

Preserving the blood supply!
Vascular response is imperative!


What will affects the vascular response to a fracture?

- Nature of the Trauma
- Surgical Handling
- Inadequate reduction
- Inadequate stabilisation


What are the three types of bone callus that can form?

- Periosteal
- Medullary
- Endosteal


What are 5 clinical signs seen in animals with fractures?

1. Dysfunction
2. Pain
3. Blood loss
4. Nerve Injury
5. Perforation of adjacent organs


What do we use to classify fractures?

- Location, direction & number of fracture lines
- Displacement of major bone fragments and stability
- Open or Closed
- Whether the fracture fragments can be reconstructed to provide load sharing


Why are fractures classified?

- Allows detailed & concise communication between vets
- Allows comparison of techniques when similar fractures are treated
- Allows assessment of the forces that lead to injury and affects the stability of repair
- Helps predict diagnosis, likelihood of infection & difficulty, complications of treatment


Describe a descriptive classification of fractures...

- Complete vs. Incomplete
- Displacement
- Single vs. Complex
- Open vs. Closed
- Bone involved
- Region of bone involved


What is a complete fracture?

Cortex fracture circumferentially


What is an incomplete fracture?

One cortex cracked, one bent
Fissure extending down the shaft, with the periosteum intact


What is a fissure?

A crack running down from the break


What does a wound over a fracture tend to mean?

- Contamination
- Soft tissue injury
- Devitalised tissue
- Dead space/ foreign matter
= risk of infection


What is important in preventing infection of an open wound from a fracture?

Aggressive early internal fixation
- granulation tissue resists infection but is disturbed by motion


What type of urgency is an open fracture?

A Surgical Emergency!


How do you classify open fractures?

Grade I: skin penetrated inside to out. Wound 1cm diameter without extensive st damage or flaps. In to out or out to in. Foreign material may be carried into the wound

Grade III: wounding from the outside with extensive skin, subcutaneous and muscle injury with neo-vascular injury


What is the prognosis for the three grades of open fractures?

Grade I and II: good prognosis

Grade III: require extensive and expensive treatment. Risk of infected nonunion is high.
Alternative is amputation but should attempt repair