SmA Sx Ortho Tx Options

nrawrgoo's version from 2016-05-06 03:27


Question Answer
What is the goal of fx tx?Early ambulation + complete return of fx
What are 2 options for conservative fx mgmt?1) Box confinement 2) Splint/Cast
What are 3 types of fx that could be tx'ed w/ box confinement? 1) some PELVIC fx (Acetabulum & Pelvic Floor) 2) SCAPULAR 3) Pathologic fx
What age of animal could you consider tx'ing w/ box confinement?VERY YOUNG ( < 3mo)
What are 2 things that you must include in your discharge along w/ box confinement?Pain meds & leash walking
What type of fx should you NEVER cast?NEVER cast an OPEN fx!
What are 3 indications to use a splint/cast?1) CLOSED fx BELOW elbow/knee (must stabilize prox & distal jts, impossible above elbow/stifle) 2) CLOSED reduction possible 3) YOUNG, faster healing pts ....Ex = greenstick fx, simple transverse fx (minimal displacement)
What is neutralized by casting proximal & distal jts?Rotation
What is the ONLY FORCE neutralized by splint/cast?BENDING forces ONLY
Are splints more or less stable than casts?LESS stable
What is the time frame for splints? And their function?TEMPORAL fx stabilization, few days....NOT PERMANENT like a cast. Use for ancillary support, MC, MT or digits
What is imp to remember when working w/ the cast material to apply it?Work cast w/ PALMS OF HANDS, fingertips --> Pressure points --> Pressure sores...also remember to stabilize the jts prox & distal to the fx
What is indicated for post-cast tx?RGs, 24 hr hospitalization, DAILY control by O, WEEKLY control by DVM, Cast changes every 1-2 wks, RGs every 1-2 wks
What does axial compression result in? And what are 2 indications to not perform axial compression?Axial compression --> bone to bone contact....DO NOT do for oblique or non-reducible fx
What are 3 types of nails/pins that may be used for sx fx repair?Kirschner wire (K-wire) < 2mm, Steinman pins 2-5mm, Intra-Medullary (I.M) pins
What type of sx should you use an I.M pin for?Long bone DIAPHYSEAL fx'es
What force(s) do I.M pins neutralize?Neutralize BENDING forces ONLY, NO rotational or axial stability
When can you NOT use an I.M pin?NOT in comminuted fx'es
Can I.M pins be used alone?NO!!!! NEVER ALONE! Always in COMBINATION w/ Cerclage wires, Ex-fix or Plates
What percentage of the medullary cavity should I.M pins occupy?60-70% of medullary cavity
What are 2 instruments used to insert I.M pins?Jacobs Chuck & Cutting pliers
What are the 2 ways to insert an I.M pin?Normograde or Retrograde
Descirbe Normograde placement of I.M pins & in what bones is this done?Pins inserted from END OF BONE; i.e -TIBIA, FEMUR, HUMERUS ***(TQ)
Describe Retrograde placement of I.M pins & in what bones is this done?PIns inserted from FX SITE; i.e - FEMUR & HUMERUS ***(TQ)
What bone should you NEVER PUT AN I.M PIN IN?!RADIUS!!! (Will absolutely hit articular surface)
What are 2 things to keep in mind when placing an I.M pin?1) Should extend ENTIRE LENGTH of bone 2) Protect nn & jt by measuring length
What is the purpose of interlocking nails?Interlocking nails = screws & bolts used to lock I.M pins
Where is the ONLY PLACE interlocking nails can be used?STRAIGHT bones ONLY
What 2 forces are neutralized by interlocking nails?Rotational & Compression forces counteracted
What are 2 indications for using K-wires?S-H fx'es (aka growth plate fx'es) & SMALL bone FRAGS (fast-healing areas, stable fx'es)
What are 2 areas of bones that are fast healing?Metaphyseal & physeal areas
When using K-wires as TENSION BANDS, how are they placed & how many do you need?Tension bands are placed CROSSED or PARALLEL; req 2 or more to neutralize rotation (TQ)
What 2 instruments are req'd to place K-wires?Jacobs chuck or Power drills ( more precise, more P therefore don't bend during application) & Cutting pliers (used to insert wires)
What is the advantage of orthopedic wire over pins?Wire is more malleable
What 3 instruments are req'd to place orthopedic wire?Pliers, Cutting pliers & special tension instruments
What is the indication to use cerclage wire?OBLIQUE/SPIRAL fx'es (TQ)
What are 2 things you must ABSOLUTELY keep in mind in order to use cerclage wire? :OrNLY use when you can do ANATOMICAL REDUCTION of fx & ONLY when you have TWO pieces to put together!
Question Answer
How many cerclage wire(s) should I use?MUST have 2+ wires
Can I use cerclage wire alone?NO!!!! MUST COMBINE w/ other implants & must be TIGHT! Cerclage wires NOT STRONG ENOUGH ALONE!
What is a potential con of using cerclage wire?Damage blood supply if not tight enough! (TQ)
What are 2 indications to use interfragmentary wires?1) Maxilla/Mandibular fx 2) Scapula/flat bones (may place around TOOTH ROOTS TOO!)
What fx should be treated w/ a tnesion band device?AVULSION fx'es (Apophyses)
What is the definition of an avulsion fx?Fx in the INSERTION of a tnedon/lig (Olecranon, Greater Trochanter,Tibial tuberosity, malleoli)
How does a tension band device work? (What forces are altered?)Changes DISTRACTION force to COMPRESSION force + neutralizes TENSION
What are 3 indications for using an ex-fix?1) LONG bones, better BELOW stifle/elbow (above this area = lots of mm --> discomfort + inflamm) 2) Maxilla/Mandible 3) Used in open or closed fashion
What is imp to know about ex-fix & blood supply?Ex-fix PRESERVES blood supply during fx tx
What are 2 additional things ex-fixes can be used for?1) Temporary stabilization of jts (tendon repair, wound tx) 2) Tx of OSTEOMYELITIS, corrective osteotomies
What 3 things are needed to place an ex-fix?Pins, Clamps & Connecting Bars
Tell me about the pins used to place an ex-fix....: Smooth or threaded; +ve thread = thread diameter < shaft diameter vs -ve thread = thread diameter > shaft diameter, end or centrally threaded
Question Answer
How does one apply the pins in an ex-fix?Pilot hole --> place pins w/ power drill @ LOW speed to prevent heating bone
What are 5 principles you need to follow when applying an ex-fix?1) 2 or MORE pins per frag, MORE pins = MORE stability 2) Pin DIAMETER must be 25% of the bone diameter 3) Place pins 2 pin diameters AWAY from fx line 4) Apply in distant to fx -> close to fx -> close to fx -> distant to fx technique 5) Place connecting bar CLOSE to skin but NOT touching
What are the 5 types of ex-fixes?Type 1 = Unilateral, MOST COMMON, used for TRANSVERSE fx, biomechanically weakest Type 2 = Bilateral & uniplanar, stronger than Type 1 Type 3 = Bilateral & Biplanar, super strong! 3 connecting bars...also Tie-in configuration & Ring fixator (= Llizarov)
What is the advantage & diasadvantage of an ex-fix?Adv = NO implant in fx area , Disadv = ST trauma + post-op care req'd
What are 2 complications seen w/ ex-fixes?1) Pin tract INFXNS 2) LOOSENING of implants
How are articular fx always tx'ed?Tx surgically with screws/ K-wires
Can screws be used with or without plates, yes or no?YES
What are the 2 types of screws?A) Cancellous screw B) Cortical screw
Describe cancellous screws: Used in metaphyseal bone for prox & distal ends, thin core w/ deep threads,
Describe cortical screws: Used in diaphyseal bone, hard vertical bones, thick core w/ small threads (stronger)
Question Answer
How do you position a lag screw?PLace lag screws PERPENDICULAR TO FX (glide hole on 1 side of fx is larger & thread hole on other side for compression is smaller)
What is the function of a lag screw?COMPRESS fragments together (TQ)
What is the indication to use a lag screw?JT FX'ES (TQ) & oblique fx'es