Post Op Managment Flashcards
What 3 things do we look at in a post fracture repair radiological assessment?
- Alignment >50% ESF
- Assess for any rotation that has occurred as implants tightened
- Implant positioning avoiding joints, fracture site and on occasions growth plates (unless you have lag screwed it)
What is the allignment in “open but do not touch” fractures?
At least 50% overlap
in both planes. Doesn’t have to be perfectly aligned.
Do you deserve cereal in melted chocolate?
Yes.
What is the allignment in ‘ORIF’ (open reduction, internal fixation)?
Must be near 100%
What can be seen in relation to the fracture on a radiograph of a fracture repair with an external fixator?
the fracture lines
What are the 3 major causes of inappropriate fixation?
- Implants too small or too large
- Fail to address forces applied
- Too rigid, especially external fixator
What is the consensus about using casts in veterinary?
- Many complications, e.g. pressure sores and loss of digits
- Avoid this method of immobilization
Where are pressure sores most common with robert Jones dressings?
- Accessory carpal bone
- Calcaneus
Post fracture repair what rrestrictions should we give tto dogs in general?
Garden on lead for 3 weeks and then to lead for another 8 weeks
How long should we restrict cats
8 weeks
When are antibiotics recommended on fracture discharge?
60-90mins + surgery
What instructions do we give to owners for dressing management?
- Keep dry. Heavy duty polythene protected with sock only when outside
- Check toes and top of dressing twice daily
- Any smell to bring to surgery
- If off colour, bring to surgery
- If veterinary surgeon in any doubt remove dressing or cast
What fixation failure do we have with pins?
Fracture rotates or collapses
What fixation failure do we have with cerclage wires?
Loosen and fail to maintain reduction of fragments resulting in instability
What fixation failure do we have with a plate?
- Loss of trans cortex with cyclical loading results in plate breaking
- If too strong, stress protection of the bone
- Stress riser – rigid piece of bone next to area of bone not plated and can break
What fixation failure do we have with an ESF?
- Pin tract infection common
- Fracture through pin tract
- If too strong get delayed healing of fracture
What is a common IM pin failure in a cat femur?
Damages sciatic nerve especially in the cat
•an affected animal will show a great degree of pain – you have to do something straight away otherwise you get neuropathy
What failure is common if there is a retrograde placement of an IM Pin?
Can enter a joint
What happens if there is eccentric loading of bones during weight bearing + muscle contraction?
Bending
What happens if there is a defect in compression surface +/- weak implants with the plates and screws?
Angulation of bone
When are plates weak against bending?
If cyclically loaded
What are the threee options for a buttress fixation?
- Very strong broad DCP plate
- Bridging plate – strong central section without screw holes
- Combination fixation; pin-plate
What are problems with placing an external skeletal fixator?
- Failing to place pins within safe corridors
- Pin tract sepsis and premature pin loosening
- Iatrogenic bone fracture (pins > 25-30% of bone diameter, or close to fracture lines)
- Placing clamps / bars too close to skin = pressure necrosis
- Using too weak / strong a frame
How do we know this is loosening?
Start to see radiolucency
