Lecture 18: Fractures of the thoracic Limb (Exam 3) Flashcards by Shelby Rainbolt

56-70% of scapular fractures have concurrent injuries because it requires substantial trauma, what are the most common

thoracic injuries
other fractures
neurologic

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What are the 3 classifications of scapular fractures

anatomic location
articular surface involvement
stability

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For minimally displaced scapular body and spine fractures should you use conservative treatment or surgical stabilization

conservative treatment

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For unstable extra-articular and intraarticular fractures should you use conservative treatment or surgical stabilization?

**surgical stabilization: **
* Displaced scapular neck fractures
* Fractures of the acromion
* Unstable, overriding scapular body fractures
* +/-Scapular body fractures w/ severe angulation

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What animals are predisposed to scapular fractures

young male dogs

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Why might a patient with a scapular fracture have abnormal proprioception

pain

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What are some common thoracic injuries that occur alongside scapular fractures that you should rule out

rib fractures
pulmonary contusion
pneumothorax
diaphragmatic hernia

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In patients with scapular fractures you should evaluate for concurrent nerve damage to rule out involvement of: (3)

brachial plexus
suprascapular nerve
spinal cord trauma

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Closed minimally displaced fractures like scapular body and spine can be treated with conservative management such as:

velpea sling (2-3 weeks & no longer)

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Mechanical, biological, and clinical factors all contribute to a baseline score that you use to guide the type of implant you chose: what is this scale?

Fracture assessment score

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Unstable extraarticular and intraarticular fractures with a high FAS can be repaired with

Orthopedic wire- pin
tension band with K wire

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unstable extraarticular and intraarticular fractures with a low FAS can be fixated with what

plates and screws
lag screw

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Scapular body fractures should be fixated with what

orthopedic wires or plates and screws

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Scapular body fractures with a high FAS should be fixated with what

orthopedic wire

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Scapular fractures at the supraglenoid tubercle should be fixated with what

orthopedic wire (pin and tension band)
lag screws

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Scapular neck fractures should be fixated with what

Crossed K wires
angle plate
lag screw with plate

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Scapular neck fractures with low FAS should be fixated with

lag screw and plate

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In order to rule out neurological trauma associated with humeral fractures you pinch the dorsum of the paw, (rule out superficial pain first): what nerve are you checking?

radial n

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FYI scapular and humeral PE finding can be the same: I listed them all out in answer

Usually non-wt. bearing
Varying degrees of limb swelling
Pain & crepitus elicited on palpation
Proprioception may appear abnormal
Animal may not lift paw when placed on its dorsum
Reluctance to move limb may be caused by pain

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What thoracic trauma may be associated with humeral fractures

chest wall trauma
pulmonary contusion
pneumothorax

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When radiographing a fractured humerus you should ALWAYS radiograph the contralateral limb, why?

assess normal bone length and shape
used to contour bone plate before surgery (reduces operative time)
used as a reference to select appropriate sized implants

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What view of the contralateral humerus is necessary for accurate plate contouring

craniocaudal radiograph

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Can you use external coaptation (cast or splints) on humeral fractures?

NO (contraindicated inadequate stabilization, not proper stabilization of scapulohumeral joint )

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What can you do pre-operatively with patients with fractured humerus to reduce pain from bone fragments and protect soft tissue

Spica splint

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Surgical treatment of humeral diaphyseal fracture includes fixation what can you use? (5)

* intramedullary pins * interlocking nails * IM pins plus ESF * ESF alone (linear or hybrid) * bone plate and screws/plate-rod

# **Fill in the ?s** Simple fractures of the humeral diaphysis should be fixated with **?** seated distally in the **?** OR **?** seated in the **?**

* intramedullary pin and cerclage wire seated distally in the medial condyle/epicondyle * interlocking nail seated in the medial epicondyle (comminuted fractures as well)

What type of external fixator can be used on simple fractures of the humerus

modified type Ia with intramedullary pins (seated distally in the medial condyle/epicondyle)

What type of external fixation can you use on comminuted fractures

modified type Ib with IM pin(medial condyle/epicondyle)

What fixation method is used for transverse diaphyseal fractures of the humerus

bone plates and screws (lateral, cranial, and medial)

What combination of fixation methods can work for stabilization of comminuted fracture, one part decreases the cyclic bending load of the other

Plate-rod (plate pin)

# **What should be used for correction/fixation** * Transverse or short oblique humeral fractures are fixated based on their FAS Score of 0 to 3

compression plate external skeletal fixator plus IM pins or interlocking nails

# **What should be used for correction/fixation** Transverse or short oblique humeral fractures are fixated based on their FAS Score of a 4-7

interlocking nail ESF with IM pins

# **What should be used for correction/fixation** Transverse or short oblique humeral fractures are fixated based on their FAS Score of a 8-10

ESF with IM pins

# **What should be used for correction/fixation** long oblique or reducible comminuted humeral fractures are fixated based on their FAS Score of a 0-3

* neutralization plate * interlocking nail * four pin ESF plus IM pins and cerclage wire

# **What should be used for correction/fixation** long oblique or reducible comminuted humeral fractures are fixated based on their FAS Score of a 4-7

two pin ESF with IM pin and cerclage wire

# **What should be used for correction/fixation** long oblique or reducible comminuted humeral fractures are fixated based on their FAS Score of a 8-10:

IM pin plus cerclage wire

# **What should be used for correction/fixation** **nonreducible** comminuted humeral fractures are fixated based on their FAS Score of a 0-3:

* plate-rod combination * Interlocking nails * an ESF plus IM pin

# **What should be used for correction/fixation** **nonreducible** comminuted humeral fractures are fixated based on their FAS Score of a 4-7:

bridging plate or ESF with IM pins

# **What should be used for correction/fixation** **nonreducible** comminuted humeral fractures are fixated based on their FAS Score of a 8-10:

two pin ESF plus IM pin

What fixation method was used here on this comminuted fracture

Plate and IM pin

# **What should be used for correction/fixation** **supracondylar** humeral fractures are fixated based on their FAS Score of a 0-3:

two plates or a plate-rod combination

# **What should be used for correction/fixation** supracondylar humeral fractures are fixated based on their FAS Score of a 4-7

medial compression plate or a two pin ESF plus IM pin

# **What should be used for correction/fixation** supracondylar humeral fractures are fixated based on their FAS Score of a 8-10:

IM pin seated in medial condyle and a lateral placed crossed pin (stabilize transverse fracture)

A Salter I fracture of the proximal humerus should be stabilized with what

two K wires or small Steinmann pins

A Salter III fracture of the proximal humerus should be stabilized with what

multiple K wires or small Steinmann pins

Type IV Satler harris fracture of distal humerus should be stabilized with what

* lag screws and K wires * Older dogs = lag screws & plates

What breed are predisposed to type IV Salter harris fractures of distal humerus

Spaniels (IOHC)

T-Y fractures of the distal humerus should be surgical prepared with what

* lag screw * IM pin though medial condyle and plate on lateral side (or plate medial side)

What was used here to correct a type IV Salter harris fracture

lag screw and pin

Radial-ulnar fractures have (less/more) of a risk of open fractures than others in the thoracic limb

What dogs are susceptible to distal radial ulnar fractures

toy breeds (jump or falls)

The diagnosis of all the limb fractures are the same, but what should you always make sure to do with any fracture

rule out underlying pathology

closed non-displaced fractures of the radius and ulna and greenstick fractures of radius and ulna in young animals can be treated how?

splint or cast

What is contraindicated in miniature and toy-breed dogs with radial and ulnar fractures

**splints and cast ** * high incidence of nonunion * poor blood supply * limited soft tissue * biomechanical instability

What should ALWAYS be done pre-operatively to Radial ulnar fracture repairs

temporarily bandage/splint

simple or moderately comminuted open radial/ulnar fractures should be fixated with what

internal fixation or ESF

Severely comminuted open radius/ulnar fractures should be fixated with what

bridging plates and cancellous bone graft

Closed severely comminuted radial and ulnar fractures should be fixated with what

external skeletal fracture

What fixation method is **CONTRAINDICATED FOR THE RADIUS**

**IM PINNING AND INTERLOCKING NAIL** (narrow medullary cavity and invasion of carpal joint)

What can be used to fixate radial fractures

plate and screws or ESF

What patients is fixation of the ulna indicated

* added support to comminuted radial fractures * large dogs * athletic performance dogs

What three fixator methods are used in ulnar fractures

* IM pins * plates * ESF

Radial fractures with high or moderate FAS can be fixated with what

type Ia and Ib external fixator(with cerclage wires)

What type of fixation method is used on comminuted fractures

Type II external fixator (maximal or minimal bc of curve of radius)

What can be used to stabilize transverse fractures of radial diaphysis

Compression plate

What can be used to stabilize small distal diaphyseal radial bone segment

T plate

What can be used to stabilize long oblique fractures of the radius

lag screws and neutralization plate

comminuted nonreducible diaphyseal fractures of the radius can be stabilized with what

bridging with a plate (IM pin in ulna)

Recommended methods of stabilizing transverse or short oblique radial fractures based on FAS of 0 to 3

bone plate and screw (esf can be used)

Recommended methods of stabilizing transverse or short oblique radial fractures based on FAS of 4 - 7

bone plate and screw (or esf)

Recommended methods of stabilizing transverse or short oblique radial fractures based on FAS of 8 to 10

ESF (if not displaced can cast)

Recommended methods for stabilizing long oblique or reducible comminuted radial fractures based on FAS 0 to 3

neutralization plate

Recommended methods for stabilizing long oblique or reducible comminuted radial fractures based on FAS of 4 to 7

type II or Ib ESF and cerclage wire

Recommended methods for stabilizing long oblique or reducible comminuted radial fractures based on FAS 8 to 10

type Ia ESF plus cerclage wire

Recommended methods for stabilizing non reducible comminuted radial fractures based on FAS 0-3, 4 to 7, & 8 to 10:

* 0 to 3: bridging plate or maximal type II ESF * 4 to 7: bridging plate or minimal type II * 8 to 10: type Ib ESF

Fractures of the olecranon should be fixated with

pin and tension band wires

Ulnar simple fractures should be fixated with

plates(tension band plate) and screws

Severely comminuted fractures of the ulna should be fixated with

bridging plate (buttress plate)

Styloid process fractures of the ulna should be treated with

pin and tension band wires

Intraarticular fractures of the ulna should be rigidly stabilized with

lag screws and K wires

Radial physeal fractures should be stabilized with

K wires (cross pins)

Nondisplaced ulnar fractures are treated how

cast

Physeal fractures can cause premature closure of a physis and lead to deformities which physis fracture can cause * Shortening * cranial bowing * external rotation * valgus angulation of the radius

Distal ulnar physis

Physeal fractures can cause premature closure of a physis and lead to deformities which physis fracture can cause * shortening of radius * subluxation of radial and humeral joint

distal or proximal radial physis

Physeal fractures can cause premature closure of a physis and lead to deformities which physis fracture can cause angular limb deformity of radius

partial closure of distal radial physis

Prognosis after surgical repair of radial and ulnar fractures

good