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
Before fracture planning after a traumatic event, you must first...
identify LIFE-THREATENING problems (CNS trauma, shock, respiratory collapse)
What are complications that can arise from thoracic trauma? (5)
- pulmonary contusions
- rib fractures/ flail chest
- diaphragmatic rupture
- pleural effusion
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
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
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
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]
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
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
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
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
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
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
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
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
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