Smallies External Coaptation (LaFuente) Flashcards Preview

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Flashcards in Smallies External Coaptation (LaFuente) Deck (26):

What 4 mechanical force can act on a fx?

- bending
- rotation
- compression/shear
- distraction


Which types of fx are stable? Which are unstable?

> stable
- transverse
- green sick (buckling)
> unstable
- oblique
- spiral
- comminuted
- segmental??
- avulsion
- compression??


Which forces are neutralised by a cast? Which are not?

- bending
- rotation
> as long as joints above and below are immobilised
> compression/shear difficult to neutralise with a cast


What are distraction forces?

- muscle tension
- poorly neutralised by external coaptation
- eg. olecranon fx, greater trochanter fx
> sling to v weight bearing?
> reduces muscle tension
> reeduces tension force


1. When is external coaptation indicated?

- closed
- minimally displaced (20% in contact minimal)
- stable
- pair of bones (ie. tibia and fibula)
- young animals high healing potential
> 50% contact rule


HOw long do fx take to heal in pupppies?



What are the 5 basic guidelines for coaptation?

1. When?
2. Reduction
3. ALignment
4. Standing positino
5. Join above and below


2. how is reduction carried out? How much reduction is needed?

> heavy sedation/GA
- repeatras to ensure apposiiton remains throughout healing
> adequate reduction 50% contact rule
- juveniles tolerate greater displacement without developing non-union cf. older


3. aims for aligment? Consequences of malalignement?

- perfect reduction rare
- proper joint alignment must be maintained
- failure to align major bone fragments to joints of limb -> angular/rotational malunion
- functional gait abnormality
- painful lamenss d/t 2* OA


4. What position should the leg be fixed in?

- normal standing position
- unless joint extension/flexion needed d/t soft tissue


5. How many joints are immobbiised with a fx?

> one above and one below
- most conventional splints cannot be used above the stifle/elbow so need surgical correction
- spica splints can eb constructed to immobilise hip/shoulder


See lecture for diagram on immoobilising fx



How often is external coaptation used?

> infrequently
- hard to manage, severe complications, often better ways
> commonly used for support after surgery esp arthrodesis (for 6 weeks)


Types of external coaptation?

> Robert JOnes
- thick
- modified RJ thinner
> spinted
> bilvalved cast
- allowws frequent changes without ...
> Spica spint
- immobilise shoulder/hip
> Schroeder-Thomas??
> Walking bar
- aluminium bar at end of cast
- for digit fx


What is external coaptation dressing made up with?

1. primary layer
- cover and protect, absorb discharge, wet to dry debriding
- eg. melolin, allevyn
2. secondary layer
- absorption, support and pressure
- cotton wool (do not let it contact skin!!)
- cast padding (less bulky, conforms better)
- conforming gauze wrapped over to provide stability and occasionally compression
+- casting tape for fx
3. tertiary layer
- holds inner layers, barrier against physical abrasion and environmental contaminantss
- elastic conforming bandage most common
- if this layer appears wet with discharge bacterial infection is possible - change the bandage!!
4. +- stirrups


Advantages of external coaptation?

- cheap (providing no complications)
- avoids surgery


Disadvantages of external coaptation?

- stable, min displaced fx
- can -> bone/limb malalignment
- can cause serious complications
- complications more expensive /difficult to tx than original fx!
- difficult to manage (slip, wet)


Potential complications d/t external coaptation?

- distal limb oedema/swelling (leave toes exposed to check)
- skin rubbing, ulcers, necrosis (can use 'donuts')
- soft tissue necorsis
- cast slippage
> amputation may be only option


How can risks associated with external coaptation bandages eb minimised?

- only use if necessary
- plenty of padding esp bony prominence
- change q1week initially then q2weeks
- owner check daily for swelling and smell


How regularly do casts need to be changed in puppies?

Weekly to compensate foro bone growth


Outline the slater-harrie classification system. Which type of fx is this applicable to? LOOK UP

- Fx across a growth plate (physis) = SALT pnumonic
> type I: Slipped
fracture plane passes all the way through the growth plate, not involving bone, cannot occur if the growth plate is fused reference required -good prognosis
> type II: Above
fracture passes across most of the growth plate and up through the metaphysis, good prognosis
> type III: Lower
fracture plane passes some distance along the growth plate and down through the epiphysis, poorer prognosis as the proliferative and reserve zones are interrupted
> type IV: Through or transverse or together
fracture plane passes directly through the metaphysis, growth plate and down through the epiphysis, poor prognosis as the proliferative and reserve zones are interrupted
> type V: Ruined or rammed
crushing type injury does not displace the growth plate but damages it by direct compression, worst prognosis


If a fx came in as an emergency and could not be reduced until the next day, how would you manage the patient while waiting?

- rest
- restricted activity
- opioids
+- cold compress
+- sling


What causes carpal hyperextension and how can it be treated?

rupture of palmar carpal ligaments and fibrocartilage, usually 2* to trauma
> Tx: pancarpal arthrodesis
- castless plate applied (special one for carpal arthrodesis with differnet sized screws


Which side of a fx are splints usually placed? Exception? What effect does this have and how can these problems be overcome? What risks might occour 2* to this!?

- usually on tension side
- for carpal arthrodesis must go on dorsal aspect (compressive side)
> ^ risk bend and breakage
- to compensate, use external coaptation to protect implant and reduce the forces
> risk of cast sores and cast slippage
- do not place immediately postop, place RJ for 3-5d then cast when swelling educed
- monitor 24hrs before sending home
- change weekly d remove @6weeks


How can distal limb integrity be assessed?

Needle in foot pad - if frank blood comes out then tissue is still viable


Potential roles of external coaptation ?

- temporary first aid
- 2* support after surgical intervention
- 1* support and stabilisation of selected fx