Fractures Flashcards by Kimberlee Ward

What is the etiology of condylar fractures?

High compressive load
Leads to osseous adaptation/sclerosis
Microtrauma/Microfracture
Condylar fracture

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Clinical signs of Non displaced incomplete fracture

Acute onset of severe lameness after intense exercise
Effusion of MCP/MTP joint
Pain on palpation

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Treatment of Condylar fracture

Internal fixation with transcortical screws in lag fashion
bandage
NSAIDs
Absolute stall rest

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Prognosis of Condylar fracture Return to Race

Favorable for non-displaced and incomplete
less for displaced (50%)
Less if joint comminution exists

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What is the most common long bone fracture of the equine?

Diaphyseal fracture of MCIII and MT III

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Prognosis of Diaphyseal fracture of MCIII and MT III

Dependent upon immediate 1st aid

External coaptation

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Optimal treatment of Diaphyseal fracture of MCIII and MT III

Double plate fixation

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Where are the plates placed on Diaphyseal fracture of MCIII and MT III?

tension side of the bone

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What is important to maintain in the treatment of Diaphyseal fracture of MCIII and MT III?

Inter-fragmentary compression

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Complications of Treatment of Diaphyseal fracture of MCIII and MT III

Infection 
Survive recovery 
Pain 
contralateral limb laminitis
colic

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What types of plates are used for the treatment of a Diaphyseal fracture of MCIII and MT III?

Dynamic compression plate
Limited contact - dynamic compression plate
Locking compression plate
Anatomic specialty plate

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What is the advantage of using the Limited contact - dynamic compression plate?

Continuity of bending stiffness

Improved blood supply under plate

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Compression

Maximum 2 screws on either side of fracture are placed under load

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Neutralization

Placed under anatomic reconstruction

screws inserted in neutral position

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Tension band

transforms tensile forces into compressive forces

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Buttressing

placed to bridge area of bone defect even after reconstruction

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Dynamic compression plate characteristics

Sell-compressing plate
Screws can be angled in many directions
Can be adapted to different internal fixation needs
Screws can be placed orthogonally or at an angle (up to 25 degrees)

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Limited contact -

Dynamic compression plate characteristics

Adaptable for different internal fixation needs
Limited contact/ grooved surface
Uniform stiffness
DCU hole for screws to be placed at 40 degrees

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Locking compression plate characteristics

Dynamic compression 
Limited contact/grooved under surface
Combi-holes permit the combination of conventional or locking screw
Minimally invasive 
locking or cortex screws used

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What is the advantage of using locking screws?

increase the stability and the fixation strength of the plate screw

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What are the challenges of using a fixation?

Large plates occupy space making skin closure difficult
implant failure
Post operative lameness
Contralateral limb lameness

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What inserts on the olecranon?

Triceps

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What is the cause if olecranon fracture in the equine?

Direct trauma - injury during halter training

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How do the animal present with ulnar fracture?

dropped elbow with carpus in flexion

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What is a complication of ulnar fracture in horses?

Disruption of the stay apparatus

How do you prepare an ulnar fracture for transportation?

Splint to fix carpus in extension | Apply the splint palmarly extending from the fetlock to the level of the elbow with adequate padding

What is the treatment for Salter Harris Type I minimal displacement in equine less than 250 kg ?

tension band technique repair

what is the treatment for Salter Harris Type I minimal displacement in equine that is greater than 250 kg?

apply a plate

What is the treatment of choice for olecranon fracture?

ORIF - Open Reduction Internal Fixation

What is important in horses less than 1 year with distal screws in the olecranon?

should not engage the radius

If you engage the radius in horse for olecranon fixation what will happen?

Subluxation of the elbow

What is the etiology of Femoral Physeal fracture?

Dystocia | Group housed juvenile cattle

Treatment of Femoral Physeal fracture

Stall rest | ORIF - pins/screws

Treatment for displaced proximal tibial physeal fracture with a large metapyseal fragment laterally in a ruminant

External coaptation | Thomas schroeder splint/cast

Why can you not use pins and screws in young ruminants?

Their bones are soft and not amenable to plates, screws or wires

Treatment of a Salter Harris Type II fracture of the proximal tibial physis in a foal

Bone Plate with cancellous screws fixation with tension band wiring

What are the complications of Bone plate and screw use?

Osteolytic lesions of the bone Osteopenia and lysis and sclerosis of the bone Loosening of screws due to screw osteolysis around the screw tracks

Treatment of Close comminuted mid-diaphyseal fracture of the humerus with displacement

Stall rest for 2-3 months | Nursing care

Potential complications of stall confinement

Non union and mal union breakdown or laminitis of the opposite limb Negative effect of the age and weight of the patient

What are the risks of humeral fracture with ORIF with plates?

injury to the radial nerve | irregular contour of the humerus

On what type of animal can you not use an interlocking nail?

Adult large animals

Treatment of Closed mid-diaphyseal short oblique tibial fracture

Transfixation pin cast placement Type 2 or 3 External fixator Pin removal at 6-8 weeks Stall rest for an additional 2 weeks

How do you treat pin tract sequestrum?

Debride and curette

Advantages of Transfixation Pin Casting in farm animals

Maintenance of reduction Early weight bearing Flexibility in pin positioning Availability of pins and casting material Comparable to side bar/clamp and plates/screws

Disadvantages of Transfixation Pin Casts in farm animals

no adjustment after application Restricted access to soft tissue Requires GA

What is the treatment for comminuted phalangeal fracture and MTIII/MCIII?

Transfixation Pin Casting

What are the possibilities for repair of a Closed transverse, mid diaphyseal fracture of the radius and ulna?

External fixator/TPC Double plating Thomas-schroeder cast/combo

Treatment of an oblique fracture of the distal tibia in a horse

Double plate fixation with DCP | Plates luted to increase stability

Plate luting

Bone cement applied between the plate and the bone after plate/screw placement Creates 100% plate-bone contact and increase strength of repair

Lute

a substance like cement for packing a joint or coating a porous surface

Treatment of Transverse fracture of the femoral distal diaphysis with severe displacement in a calf

Stack pinning and cerclage wire

Young ruminant fracture repair

Difficulties with plate and screw repair due to soft and thin bones Screw and plate loosening

How do you repair femur fractures in young ruminants?

``` 2 cerclage wires 3 IM threaded- end pins Skin closed with staples Drain ```

Femoral fracture repair in the adult large animal

Double plating

Femoral fracture repair in foals

Double plating on the cranial and lateral aspect of the cortex

Treatment of comminution and severe displacement

Double plating and cerclage wires for repair of femoral fracture

Surgical complications of ORIF with double plating

hemorrhage during reduction

Post op treatment of ORIF with double plating

Blood transfusion | Broad spectrum abx

Complications of fracture repair

``` Implant breakage Implant loosening infection sequestration delayed union/non-union contralateral limb laminitis contralateral angular limb deformity ```

Treatment of open/infected fracture

local debridement systemic and local abx: RLP and Abx impregnated PMMA beads cancellous bone graft

Treatment of open fracture distal radius of food animal

Trans-articular type 2 external fixator | 3 pins in radius, 3 pins in MCIII/IV

Treatment of open fracture distal radius in a heavier patient

Tubing with acrylic PMMA and external frames are not strong enough

Common cause of Mandibular fractures

Trauma

Treatment of Mandibular fractures

``` Loos teeth should never be removed until the fracture has healed Intraoral wiring Tension band wiring to cheek teeth External fixators plates ```

Indications for plating mandible

Fracture of body and vertical ramus of mandible Fracture of caudal aspect of horizontal ramus LCP

Disadvantages of mandibular plating

Can only place on compression side of the bone Screw placement is difficult due to tooth roots Exposure of caudal ventrolateral mandible difficult due to parotid duct Most fractures of mandible are open: infection or implant removal

Aftercare of mandibular fracture repair

``` No diet modification for incisor fractures Lavage Bute Abx implant removal after 6-8 weeks ```

Complications of mandibular fractures

``` Implant failure breakage of plates Loosening/breakage of wires Drainage Sequestra ```

What is contraindicated in patients with suspected head trauma and increased intracranial pressure?

Ketamine

Dacryocysto-Rhinography

Radiographic contract evaluation of the nasolacrimal duct

What does fracture of the zygomatic process cause in horses?

Chemosis

Treatment option for zygomatic process fracture

Cerclage - anchoring the tooth to the neighboring teeth screws plates fixateur extern

Treatment for vertical ramus fracture in equine

Plate

What is the strongest treatment for mandibular fracture?

Double plating

What are the causes of Neck vertebrae fractures?

Trauma | Electrocution

Treatment options for Neck vertebrae fractures

Screws Plates Fixateur extern

Causes of Static compressive spinal cord lesions

Degenerative joint disease (DJD) of diarthrodial articulations of caudal cervical vertebrae

Treatments for Static compressive spinal cord lesions in an animal less tahn 1 year of age

Treat symptomatically | surgery: ventral stabilization or dorsal decompression

What is the best surgical option for Static compressive spinal cord lesions?

Ventral stabilization

What is the best treatment option for Static compressive spinal cord lesions?

Dorsal laminectomy | Cervical ventral interbody fusion

Fractures Flashcards

(80 cards)