SAOP1- Fracture Planning

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  1. A dog presents with a single long bone fracture. What should you first ensure?
    • that the dog can walk/ ambulate
    • 3-legged animals can still walk/ run
    • if not, probably neurologic damage/ spinal fracture
  2. Before fracture planning after a traumatic event, you must first...
    identify LIFE-THREATENING problems (CNS trauma, shock, respiratory collapse)
  3. What are complications that can arise from thoracic trauma? (5)
    • pulmonary contusions
    • pneumothorax
    • rib fractures/ flail chest
    • diaphragmatic rupture
    • pleural effusion
  4. What is flail chest?
    • multiple segmental fractures of the ribs; negative intrapleural pressure sucks flail segment into chest and air is blown out of chest on expiration
    • manage conservatively in a chest bandage
    • do not put this animal under anesthesia
  5. What complications can aries from abdominal trauma? (3)
    • uroabdomen- dx w/ retrograde urethrocystogram, intravenous urogram, bloodwork/ belly tap
    • hemoabdomen- sometimes no blod in abdomen until you open it up and relieve pressure on ruptured vessels
    • septic peritonitis- dx with belly tap
  6. Describe the examination for orthopedic trauma (after you have evaluated CNS, CVS, respiratory).
    • use analgesia
    • radiographic examination- look for multiple fractures; good quality orthogonal views, stressed views
    • temperature, pulse, color of extremities- can the limb be salvaged? or is amputation the best option
  7. What injury is commonly seen in large breed dogs that jump from a height?
    • Carpal hyperextension injury, often bilateral
    • present with carpal swelling and pain
    • with this presentation, be sure to take stressed extension view on radiographs and look for displacement of metacarpal V (this is where the palmar carpal¬†ligament inserts) [in a non-stressed orthogonal view, it make look normal]
  8. What fracture factors affect treatment and healing prognosis? (6)
    • bone biology
    • delay to repair- did the owner wait 2 weeks to get the animal seen
    • fracture configuration- if there enough bone proximal and distal to the fracture to plate it? is an ex fix a viable option? is it comminuted?
    • location- what bone(s) are affected? is there growth plate involvement?
    • multiple fractures- all on one limb? in multiple limbs?
    • open versus closed fractures- severe soft tissue trauma delays healing
  9. Describe the classification scheme for open fractures.
    • Grade I: bone penetrates skin, dermal barrier is compromised
    • Grade II: penetration of skin from the outside, little loss of bone or soft tissue
    • Grade III: a- soft tissue present for closure, b- no soft tissue for closure, c- arterial compromise
  10. How do you score the mechanical factors that may affect a fracture patient?
    • Low Score (1-worst)- non load sharing, large/ obese, multiple limbs fractures
    • Intermediate Score (~5)- neutralization is possible, medium-sized patient
    • High Score (10-best)- good load sharing, small patient
  11. How do you score the local biological factors that may affect a fracture patient?
    • Low Score (1-worst)- high energy injury¬†(high velocity fracture, such as bullet wound), long open reduction, grade III open fracture
    • Intermediate Score- two piece fracture, short open reduction, grade II open fracture
    • High Score (10-best)- low energy fracture, closed reduction, grade I open fracture
  12. How do you score the systemic biological factors that may affect a fracture patient?
    • Low score (1-worst)- geriatric patient, debilitated animal (comorbidities, endocrine dz--> slower healing)
    • Intermediate Score- mature patient, otherwise healthy
    • High Score (10-best)- immature animal (juvenile bones heal better but watch out for disturbances of growth), otherwise healthy
  13. What are pre-op fracture planning considerations? (5)
    • pre-measure and pre-contour implant
    • ensure surgical field is adequate for exposure
    • make sure there is a surgical field prepared in case of need for bone graft
    • plan for reduction
    • consider elective limb shortening
  14. What types of fractures require immediate repair? What types can delay treatment 1-2 days? What types can delay treatment 4-5 days?
    • Immediate: spinal fracture, open fracture
    • delay 1-2 days safely: luxation, articular fracture, physeal fracture
    • delay 4-5 days safely: closed long bone fracture, pelvic fracture
  15. What are the principal of orthopedic surgery for internal fixation? (4)
    • anatomic reduction and alignment
    • stable fixation
    • preservation of blood supply
    • early, active, pain-free mobilization
  16. Describe the interfragmentary strain theory.
    • 100% strain on site leads to formation of granulation tissue
    • 15% strain on site leads to cartilage formation
    • 2% strain leads to bone formation
    • IE. BONE FORMS UNDER PRESSURE- COMPRESS FRACTURE SITES

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Author:
Mawad
ID:
324960
Filename:
SAOP1- Fracture Planning
Updated:
2016-10-26 17:48:59
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vetmed SAOP1
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vetmed SAOP1
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