Fractures- Sparks Lecture

Question 1

what is the clinical approach to fracture management?

Answer 1

what is it, is treatment required, is external coaptation suitable or does it require other forms of fixation or reduction, should i even try to fix it, and how can I give my treatment the best chance of success?

Question 2

list all the treatment options for fractures

Answer 2

euthanasia, stall confinement, external coaptation (splint or cast), ex fix, internal fix

Question 3

splints are more commonly indicated for______. proper way to put one on?

Answer 3

temporary emergency coaptation or as a follow up to other forms of fixation

stabilize the joint above and below, place at 90 degrees, and extend them to the ground

Question 4

when are casts commonly indicated?

Answer 4

• in metacarpal/tarsal fractures
• in closed fractures with good blood supply
• prognosis is GOOD!

Question 5

prinicples for proper cast application

Answer 5

• include joint above and below
• the most proximal portion should end at the end of a long bone
• include the foot
• allow limb to be in a neutral position
• overlap with 50%

Question 6

how to prepare a limb for a cast

Answer 6

make sure its clean and dry, make sure no circumfrential tape

Question 7

what should you consider if you need to do fracture reduction?

Answer 7

will probs need heavy sedation since its so painful, use a heavy guage wire through the tip of the hoof, ideally you should have radiographs

Question 8

easy way to get cast off?

Answer 8

when putting it on, use OB wire threaded through old IV lines

Question 9

when should you remove a cast?

Answer 9

rapidly growing calves: q 2-4 weeks
adults: q 6-8 weeks

ideally based on radiographs

Question 10

signs that a cast needs to come off asap

Answer 10

swelling above cast, worse lameness, drainage visible, smell

Question 11

pros and cons of a cast

Answer 11

pros: cheaper, can be done in the field, good prognosis with some fractures

cons: cast sores, no protection against compression, malalignment of fracture possibly, tendon/ligamrnt laxity

Question 12

thomas splints are sort of like what in humans? how do they work? when are they indicated?

Answer 12

crutches!

specialized splints, idea is to distribute forces with the leg not actually touching the ground i honestly dont know leave me alone fam

mostly for RADIAL & TIBIAL fractures!!

Question 13

how high can you get a full limb cast?

Answer 13

to the olecranon

Question 14

pros and cons to thomas splints

Answer 14

pros: cheaper than surgery, can be applied in the field

cons: issues with alignment, what if the fracture opens, can cause prolonged recumbency, pressure sores, contralteral varus

Question 15

ex fix can be used on what fracture types?

Answer 15

long obliques or comminuted fractures or spiral

Question 16

what is transfixation?

Answer 16

a cast + external fixator

idea is to suspend the limb in the cast and take weight off the cast tip (idk what this means)

good for fractures that will collapse like long boliques, comminuted, or spiral fractures

Question 17

what anatomical location can be fixed with transfixation pin casting?

Answer 17

metacarpals and metatarsals, occasionally the distal radius and distal tibia

DO NOT work for fractures proximal to the radius or tibia

Question 18

pros and cons of transfix

Answer 18

pros: can do in GP

cons: pin complications, more technically involved, cast sores, imperfect reduction and alignment, infection,

Question 19

when is external fixation useful?

Answer 19

when youre attempting to repair an open fracture–>because you can provide wound care!

Question 20

whaat are some indications for using internal fixation?

Answer 20

• if you want a cosmetic outcome
• when near perfect reduction is possible
• in LIGHT animals
• in an articular fracture?
• in areas that you can’t reach with other methods (like a femur fracture)

Question 21

pros and cons to internal fixation

Answer 21

pros: early return to WB, accurate alignment

cons: expense, referral, implant failure, infection

Question 22

list best way to treat the following fractures:

MC/MT

tibia

radius/ulna

femur

Answer 22

MC/MT: cast, transfix if communitied, oblique, ir spiral, and ex fix if open

tibia: thomas splint, cast if distal tibia

radius ulna: thomas splint

femur: ex fix or int fix