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Surgery 3 > Lecture 2: Principles of Ortho Surgery 1 (Exam 1) > Flashcards

Lecture 2: Principles of Ortho Surgery 1 (Exam 1) Flashcards

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1
Q

List the 7 reasons for Ortho Sx

A
  • Stabilize fractured bones
  • Explore, debride, & stabilize injured joints
  • Replace damaged joints
  • Stabilize spinal column injuries
  • Decompress the spinal cord (IVDD)
  • Resect musculoskeletal tumors
  • Repair tendon & ligament injuries
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2
Q

What are the two goals of treating fractures, nonunions, or bone deformities

A
  • Bone union
  • Return to norm function
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3
Q

What should be included in a surgical plan

A
  • Choose implants & plan procedure
  • Eval fracture, px, & client (use FAS)
  • Make a detailed plan for the entire sx procedure
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4
Q

What can occur if there is not a surgical plan

A
  • Prolonged operating times
  • Excessive soft tissue trauma
  • Technical errors
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5
Q

What are the two process for fracture reduction

A
  • Reconstructing fractured bone fragments to normal anatomic configuration (anatomic reduction)
  • Restoring normal limb alignment
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6
Q

Describe restoring normal limb alignment

A
  • Reestablishing norm limb length & joint alignment
  • Maintaining spatial orientation of the limb
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7
Q

What physio processes must fracture reduction techniques overcome

A
  • Muscle contractions
  • Fracture fragment overriding
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8
Q

What is a closed fracture reduction

A

Reducing of fractures or aligning limbs w/out surgically exposing fractured bone

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9
Q

What is a open reduction fracture

A
  • Surgical approach to expose fractured bone segments & fragments
  • Anatomically reconstructed & held in position w/ implants
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10
Q

What are the advantages of a closed reduction

A
  • Enhances bio envi
  • Preserves soft tissue & blood supply (speeds healing)
  • Decreases the risk of infection
  • Reduce operating time
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11
Q

What are the disadvantages of a closed reduction

A

Difficulty of accurate reconstruction of reducible fractures

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12
Q

What are the two classifications of an open reduction

A
  • Limited open reduction
  • “Open but don’t touch” reduction (OBDT)
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13
Q

Describe a limited open reduction

A
  • Small exposure
  • Lever transverse fracture into position OR
  • Secure oblique fracture w/ lag screws/cerclage (external fixator or interlocking nail)
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14
Q

Describe an OBDT reduction

A
  • Large exposure
  • Realigning bone & placing plate
  • Fracture fragments & hematoma are not manipulated
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15
Q

What are the advantages of open reduction

A
  • Visualization & direct contact w/ bone fragments (facilitates anatomic fracture reconstruction)
  • Direct placement of implants is possible
  • Bone reconstruction
  • Cancellous bone grafts can be used to help enhance healing
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16
Q

Describe bone reconstruction

A
  • Allows bone & implants to share loads
  • Results in stronger fracture fixation (improves mechanical envi)
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17
Q

What are the disadvantages of an open reduction

A
  • Increased sx trauma to soft tissue & blood supply
  • Diminished bio envir
  • Greater opportunity for bacterial contamination
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18
Q

What are the indications for an open reduction

A
  • Articular fractures
  • Simple fractures allowing anatomic reconstruction
  • Comminuted non reducible diaphyseal fractures of long bones (OBDT)
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19
Q

What are the indications of a closed reduction

A
  • Greenstick &/or non displaced fractures of long bones below the elbow & stifle
  • Comminuted non reducible diaphyseal fractures of long bones treated w/ external fixators
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20
Q

Describe a direct reduction

A
  • Counteracts muscle contraction
  • Manual distraction of segments
  • Transverse fractures
  • Bone ends lifted & brought into contact
  • Force slowly applied to reduce bones in norm position
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21
Q

What does counteracting muscle contraction cause

A
  • Bone segments to override
  • Major difficulty in anatomic reduction
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22
Q

What is manual distraction of segments

A
  • Using bone-holding forceps
  • Eventually fatigues muscles which will allow for reduction
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23
Q

Describe how a direct reduction is done on transverse fractures

A

Reduced by applying traction, countertraction & bending forces

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24
Q

Describe a direct reduction using a lever

A
  • Reduce overriding bone segments of transverse fracture by placing the lever btw/ overriding bone segments
  • Apply pressure gently to help distract & reduce bone segments
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25
Describe doing a direct reduction w/ bone holding forceps
* Return the bone segments of the long oblique fracture into reduction w/ bone hold forceps * Place pointed reduction forceps @ an angle to the fracture ling * The pointed reduction forceps are gently closed in a way where the bone ends are distracted & forceps manipulated to aid reduction & secured perpendicular to fracture (May need multiple attempts)
26
During a direct reduction what can cause more fragmentation
Rough handling
27
T/F: Bone should not be inspected for fissure fracture line
False; bone is inspected for fissure fracture lines
28
What should be done during a direct reduction if fissure fractures are present
The bone segment ends are secured w/ cerclage wire
29
What is a direct reduction w/ butterfly fragments
Anatomic reconstruction of a fracture w/ large butterfly fragments
30
What are the steps of a direct reduction w/ butterfly fragment
* Reduce fragment & securing to one segment * Creates 2 - piece fracture to reduce & stabilize
31
How & why are non reducible fractures reduced
* Managed w/ indirect reduction * Preserve bio * Bridge fixation provides mechanical support
32
What is indirect reduction
* Process of restoring fragment & limb alignment * Distracting major bone segments
33
Describe an indirect reduction using an IM Pin
* The pin is driven normograde thru the proximal bone segment to the fracture site * Centered in the distal segment & driven distally into the metaphyseal bone * Proximal segment held w/ bone holding forceps & the pin is advanced distally to distract to length * The fractured bone is aligned & a bone plate or external fixator applied * Stabilize the proximal segment w/ bone-holding forceps * Use the IM pin to push the distal segment away from the proximal segment
34
Why is a bone plate or external fixator applied during an indirect reduction using an IM pin
* Bridges fracture * maintains reduction
35
Describe an indirect reduction using the animal's weight in Tibial/radial fractures
* Animal is draped & sx procedure performed w/ limb suspended * Lower operating table so the animal's wt. distracts fracture * Used for closed & open reduction of fractures & is stabilized w/ external fixators * Can be done in open reduction of fractures are stabilized w/ plates (can be min invasive) * If the fracture is secured the operating table is raised to remove traction force
36
What are the 4 steps of fracture tx planning
1. Determine FAS score 2. Choose appropriate implant system (implants must counteract forces on the fractured bone) 3. Select a tech for fracture reduction 4. Dev a detailed plan for applying implants 5. Decide about using bone a bone graft (cancellous or allograft w/ demineralized bone) 6. Select surgical approach or approaches 7. Check implant & instrument inventory 8. Precontour plate (if appropriate)
37
What can be done to ensure optimal results when apply implants
Make a drawing of the fractured bone & implant & bone before sx
38
What should be done after sxx
Evaluate post op radiographs to make sure if pre op goals were met &/or decide if remedial steps are needed for the desired outcome
39
When is bone grafting standard practice
In fracture management & joint arthrodesis
40
Define autograft
Bone transplanted from one site to another in the same animal
41
Define allograft
Bon e transplanted from one animal to another of the same species
42
What is biomaterial bone grafting
* Demineralized bone matrix * Collagen
43
What is synthetic bone substitutes for bone graft
* Tricalcium phosphate ceramics * Bioglass & polymers
44
What are composites of osteogenic cells bone grafts
* Osteoinductive growth factors * Synthetic osteoconductive matrix
45
What is osteogenesis
Ability of cells to survive transplantation & serve as a source of osteoblasts
46
What is osteoinduction
* Ability of material to induce migration & differentiation of mesenchymal stem cells into osteblasts by bone morphogenetic protein (BMP) a TGF beta superfamily
47
What is osteoconduction
* Ability of material to provide scaffold for host bone invasion * Determines the speed of osteointegrations
48
What is osteopromotion
* Material that enhances regeneration of bone * Platelet rich plasma (PRP)
49
What is the considered gold standard of bone grafts
* Cancellous bone autografts * What all materials are compared to * Provides optimal osteogenic, osteoinductive, & osteoconductive properties & not immunogenic
50
When are autogenous cancellous bone grafts recommended
* When rapid bone formation is desired * To assist when optimal healing is not anticipated like in cortical defects after fracture repair or in adult/elderly animals w/ fractures, delayed unions, nonunions, osteotomies, joint arthrodesis, & cystic defects * To promote bone formation in infected fractures
51
What are the disadvantages of cancellous bone autografts
* Additional surgical time req to harvest graft * Potential for morbidity assoc w/ donor site * Limited ava of cancellous bone in small or elderly pxs
52
Where can cancellous bone be harvested
* Any lone bone metaphysis * Proximal humerus * Proximal tibia * Ilial wing * Distal femur
53
Why are the proximal humerus, prox tibia, & ilial wing the most often used harvesting sites
B/c they are accessible & contain large amounts of cancellous bone
54
How are graft sites selected
Based on accessibility when animal is positioned for fracture repair
55
When is bone usually harvested
* After fracture stabilization * Before primary orthopedic procedure (if the donor site could be contaminated w/ tumor cells or bacteria from recipient site)
56
How is bone grafted from the proximal humerus
1. Make round hole in near the cortex 2. Use bone curette to harvest cancellous bone 3. Place bone into stainless steel cup w/ whole blood for short term storage 4. Loosely pack cancellous bone in the fracture gap or along fracture lines
57
How is bone collected from the ileal wing
1. Make round hole in near cortex or osteotome 2. Use bone curette to harvest cancellous bone 3. Place bone in stainless steel cup w/ whole blood for short term storage 4. Loosely pack cancellous bone in the fracture gap or along the fracture lines
58
What is a cortical bone autografts
* Harvested where cortical bone is removed w/o affecting the function * Most common use is to transplant rib to form segmental strut for mandibular fractures * Done during fracture repair * incorporated as a segmental or sliding onlay graft * Hel in place w/ the same implant to stabilize fracture
59
What is a segemental graft
Placed btw/ fracture segments
60
What is a sliding onlay graft
Placed over the fracture site
61
What are the advantages of using allografts (VTS)
* Reduced operating time * Ava of graft * Elim of morbidity @ the done site
62
What is VTS
Frozen chips or chips mixed w/ demineralized bone powder
63
What are the disadvantages of allografts
* Cost of the graft * Lack of osteogenic prop in cancellous bone chips
64
What are the stages of cancellous bone incorporation into healing
* Graft placement * Vascularization of the graft * Osteoinduction * Osteoconduction * Remodeling
65
Compare autogenous v. allografts
Autogenous grafts are superior to allogenic graft in promoting rapid new bone formation due to osteogenic props
66
What are cortical bone allografts
* Cortical bone harvested & banked (VTS) which provides a ready source of cortical alloimplants * Frozen cortical allografts ava commercially * Used for limb-sparing procedures * Rarely used in fracture repair
67
Describe demineralized bone matrix
* From processed allograft bone * Ava for dogs & cats * 50:50 combo of DBM w/ varying sizes of allogeneic cancellous chips * Frozen or freeze dried * Has the same indications as for cancellous bone autograft * Can be mixed to extend cancellous autograft to fill large defects or mixed w/ autologous marrow to increase osteogenic props
68
What are some fracture fixation systems
* External coaptation * External skeletal fixators (ESF) * Intramedullary fixation * Plate & screw fixation
69
Describe external coaptation
* Provide px comfort before or after sx & decrease soft tissue damage * Used as primary repair in some conditions
70
What must there be for a bone to heal w/ external coaptation as primary fixation
There must be @ least 50% reduction of segments @ the fracture site on 2 radiographic views
71
What are some external coaptations
* Bandages * Splints * Casts
72
Describe a full leg casts
* Can't apply above midhumerus or midfemur * Only used for fractures of the distal limb (radial, ulnar, tibial, metacarpal, &/or metatarsal fxs)
73
Describe a bivalve casts
* Supplements internal fixation devices w/ +/- bone plate & screws * Fxs of carpus, tarsus, MC/MT bones, & digits * For carpal or tarsal arthrodesis

Surgery 3 (20 decks)

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