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Bone can heal to ____________ if... (5)
100%; special care if pain to alignment, growth disturbance, prevent joint disease, prevention of excessive motion, prevention of infection
What are the 4 principals of orthopedic treatment?
- anatomic reduction
- stable internal fixation
- preservation of the blood supply
- early, active, pain-free mobilization (avoid fracture disease)
What immediate care should be given to an orthopedic patient? (2)
- stabilize the limb above and below the fracture
- evaluate the entire animal (for shock, other injuries, etc)
What are the components of your orthopedic examination? (5)
- flexion tests
- drawer sign
- nerve blocks
What imaging modalities are used in orthopedic surgery? (5)
- ultrasound (tendons)
- nuclear scan
What are treat options for orthopedic patients?
- Medical management: external coaptation, joint medications
- Surgical management: principals of internal fixation
- Physical therapy: US, shock wave therapy, massage, water therapy, ice, range of motion, strengthening, swimming, rehab exercises
What are modes of external coaptation? (4)
- external fixators
External fixators work by...
off-loading the fracture site and keeping it aligned.
Topical DMSO gel function.
decreases LPS-induced joint inflammation in horses.
What is 1% diclofenac sodium?
and NSAID cream in liposomes, which will transfer it through the skin
Mechanism of action of NSAIDs.
arachadonic cascade; blocks cyclooxygenase
- intrarticular injection
- reduces joint inflammation and provide lubrication
PSGAGS (Adequan) function.
- [polysulfated glycosaminoglycans] given IM
- promotes cartilage repair and health for early DJD or early OA; must be used early on before cartilage is completely destroyed
What are nutraceuticals? (4)
- NOT A DRUG
- orally administered, required for normal body function, intent of improving health
Bone forms under _________, meaning...
compression; if you take the same cells and don't pressurize them, they will become cartilage or fibrous (don't have the same strength)
What is fracture disease?
loading stimulates bone formation; without loading, you get fracture disease, which is fusion and ankylosis of the joint, which will remain painful for life
What is the lag principal?
create compression across a fractured surface by over-drilling the near cortex and tapping the far cortex; when the screw tightens, compression at the fracture occurs [the screw threads and pulls the 2 cortices together]
What is the bone screw and lag technique? (3)
- countersink not necessary
- reduce and compress fracture
- counter traction of ligaments or muscles by using some level of compression
Describe a dynamic compression plate. (4)
- oval holes in plate
- fix plate to fracture
- eccentrically load screw on other side of fracture and away from fracture
- tighten screw [the screw wants to go in the center of the oval hole, so it pulls the plate up as it is tightened]
How is joint compression in arthrodesis achieved?
trans-articular screws (lock it with a lag screw in each sesamoid if fetlock) and DCP (dynamic compression plate)
Plates are not a good in _________ as they are in _________ because they can __________; THEREFORE,...
pressure; tension; they can bend; ALWAYS try to put the plate on the tension surface of the bone (convex surface)
How are wires used in transfixation?
use wires across a fracture in a box or figure 8 on the TENSION SIDE of the fracture b/c tension forces counteract distraction forces
What are disadvantages of using wire, and how can we address this?
wire is subject to failure on motion; must choose right gauge of wire, use multiple wires, and need some level of immobilization to prevent breaking of wire
What are the advantages of joint physical therapy? (5)
- Exercise: decreased inflammatory cytokines, improve joint mobility
- Massage: improve tissue fluid exchange
- Ice: decrease inflammation, reduce pain
Why do we countersink?
- to fit the head of the screw so that it does not bend when you put it in
- if you hit the opposite cortex and it's at an angle (not exactly perpendicular), the screw will bend at its weakest point, the junction of head and body
How can you keep a fracture reduced while you are working on getting the plate fitted and applied? (2)
- bone clamps
- muscle relaxation (neuromuscular blocking drugs, guaifenesin)