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Small Ani. Sx- Orthopedics- Fracture Tx- INTRODUCTION

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wilsbach's version from 2015-11-23 15:51

Introduction: initial treatment, fracture classification

Question Answer
Trauma pt--> Fractures will be treated only when...the patient is stable
if you have an orthopedic trauma patient, what are some other possible concurrent problems that you must keep in mind?Shock, Thoracic trauma, Abdominal trauma, Neurological trauma, Orthopedic trauma
some symptoms of orthopaedic trauma you can use to dx it?Pain, inflammation, Instability, crepitus, Axis deviation
Complete orthopedic examination includes looking at what 3 things?Symptoms (Pain, inflammation, Instability, crepitus, Axis deviation), Radiographic examination, Neurological examination
Radiographic exam--> how much of the bone do you radiograph, and how many views do you take?Complete length of affected bone, 2 views (or more)
what is the Initial treatment for closed fractures? If Fracture below stifle / elbow? If Above stifle / elbow?(1) Realign (2) Pain management -----> IF BELOW STIFLE/ELBOW: Splinted bandage until patient stable. IF ABOVE STIFLE/ELBOW: Box confinement (cage rest)
If there is an open fracture, what 3 things must you evaluate?(1) Vascularization (2) Contamination (3) Bacterial culture & antibiogram
what are some things you should do cleanliness-wise when dealing with an open fracture?Always wear gloves, Cover the wound, Aseptic handling, Wound debridement, Flushing, Splinted bandage (Wet to dry)
Prognostic factors you must consider for a fracture (4)(1) Patient (age, health status) (2) Fracture classification (Open vs. close, severity) (3) Time after injury (4) Expected functional status
what is the AO Classification􀀁 of Long bone fractures like? 3 things to use to classify!!(1) Which bone- 1-4. (2) Location on bone 1-3. (3) Morphology A-C
AO classification--> how are the bones themselves classified? (1-4 are?)1- humerus 2- radius/ulna 3-femur 4-tibia/fibula
AO classification--> how are the locations of the fracture on the bone classified? (1-3 are?)1- proximal 2- shaft 3- distal
AO classification--> how is morphology of the fracture classified? (A-C are?)A- single fracture B-wedge or butterfly fracture C- complex fracture
Fracture classification--> cause. 4 ways to classify based on cause?(1) Direct trauma to the bone (HBC) (2) Indirect trauma (3) Repeated stress (4) Bone diseases (tumors, Nutritional disturbances, Osteomyelitis)
Fracture classification--> Communicating external wound. 2 ways to classify base on this?(1) open (2) closed
Fracture classification--> what are the 4 ways to classify open wounds?(1) Type I- Wound less than 1 cm (bone penetrating the skin) (Low velocity trauma) (2) Type II- Wound > 1 cm (from outside to inside) (3) Type III- Extensive soft tissue trauma (a-c) (4) Type IV- amputation or near-amputation
what is an open fracture type I?wound less than a centimeter, due to the bone penetrating the skin. Usually due to low-velocity trauma.
what is an open fracture type II?Wound > 1 cm (from outside to inside)
what is an open fracture type III?Extensive soft tissue trauma (a-c)
what is an open fracture type IV?amputation or near-amputation
fracture classification--> Location--> 5 ways you can classify a fx by location?(1) the Bone (femur, tibia...) (2) Epiphysis (Articular surfaces) (3) Physis (growing animals- salter-harris) (4) Metaphysis (5) diaphysis
Fracture classification--> Morphology--> If in the epiphysis, what are the two ways to classify it?(1) Partial articular (2) Complete articular
if you have a epiphyseal fx involving part or all of the articular surface, what must you do?Surgical treatment mandatory to avoid OA
Fracture classification--> Morphology--> If in the physism what are the 6 ways to classify it?(his diagram) (some cute thing from the internet)
Fracture classification--> Morphology--> Metaphysis / Diaphysis-- > COMPLETE--> what are the 3 ways to classify a complete metaphyseal/diaphyseal fx?(1) simple (2) wedge (3) Complex/ comminuted
Fracture classification--> Morphology--> Metaphysis / Diaphysis-- > INCOMPLETE--> what are the 2 ways to classify an incomplete metaphyseal/diaphyseal fx?(1) Fissure (2) Greenstick (one side of the bone broken and the other side bent)
Fracture classification--> DIRECTION--> 6 ways to classify fx based on direction of fx?(1) transverse (2) Oblique if greater than 30* (3) spiral (4) segmental (5) avulsion (6) compression
If there is a non-reducible fracture, what should you still try to do?Keep length and alignment
Fracture classification--> reducibility--> 2 ways to classify based on this?(1) reducible (2) non-reducible
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clinical cases

Question Answer
Cause? Open or closed? Location? morphology? direction? reducibility?o/c: closed Location: Femur, diaphysis. Morphology: complete, complex. Reducibility: Non-reducible
Cause? Open or closed? Location? morphology? direction? reducibility?Location: Distal humerus, epiphysis, articular. Morphology: Y-fracture. Reducibility: need to reduce+compress
Cause? Open or closed? Location? morphology? direction? reducibility?Location: Radius and Ulna, Diaphysis. Morphology: Complete, simple. Direction: oblique. Reducibility: Reducible (can't splint a oblique, it will just slide)
Cause? Open or closed? Location? morphology? direction? reducibility?Location: Radius and Ulna, diaphysis. Morphology: complete, complex. Reducibility: non-reducible
Cause? Open or closed? Location? morphology? direction? reducibility?Location: Femur, diaphysis. Morphology: complete, complex. (direction- segmental?) Reducibility: non-reducible
Cause? Open or closed? Location? morphology? direction? reducibility?Location: distal tibia, metaphysis/diaphysis. Morphology: Complete, complex. Reducibility: Non-reducible
Cause? Open or closed? Location? morphology? direction? reducibility?Open/close: Closed. Location: Femur, diaphysis. Morphology: Complete, complex. Reducibility: non-reducible
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Introduction: biomechanics, bone healing

Question Answer
Velocity--> what kind of fracture will a high-velocity insult cause? Low velocity?Low velocity: simple fracture. High velocity (energy): comminuted fracture
what are the 4 kinds of forces that can be acting in a fracture?(1) Axial compression (shear) (2) axial tension (3) bending (4) torsion
what is the force of axial compression like? (pic). And what kinda fx does it generally result in?compression from the "top and bottom" or basically the ends of the bone, results in oblique fractures (common in vert. body fx)
what kinda fx is this? what FORCE CAUSED THIS?oblique fracture due to AXIAL COMPRESSION force.
what are shear forces like (pic)? What are shear forces usually secondary to? Example of typical fx of this nature?SECONDARY TO AXIAL COMPRESSION! Typical fx is condylar distal fx of humerus
what is the force of axial tension like? (pic). What are 2 lesions which come from this type of force? What must you use to fix this type of fxleads to (1) Avulsion fractures (2) Fragment dislocation... need a Tension band to fix
Torsion forces are like what (pic)? what kinda fractures result from this?result in a Spiral fracture
Bending forces--> how does a bending force work? (pic). what kinda fx does it cause?Bones eccentrically loaded--> Transverse/ wedge fracture
BENDING FORCES--> the butterfly (wedge) size depends on what? What makes it bigger or smaller?Butterfly size related to energy. Bigger energy--> bigger butterfly
what are two things needed for good bone healing?(1) blood supply (viability) (2) stability (mechanical)
what are the two main blood supplies to the bone?(1) endosteal (main blood supply- coming from nutrient arteries on the inside) (2) Periosteal (main blood supply in young pts. VERY well vascularized)
what should you know about selecting implants based on type of fx?simple fx (like a transverse fx) can share some of the load so you will not need as big of a implant as compared to a communited fracture (they can't take any load)
how much movement is there in Absolute Stability?LESS THAN 2% movement. so basically none.
what type of bone healing occurs when there is Absolute Stability?Primary bone healing where there is no callus (Osteonal reconstruction). Anatomical reduction
what is Relative stability? what kinda bone healing takes place?greater than 2% stability, this is usually how normal bone heals, which is Secondary bone healing where there is callus formation
difference between primary and secondary bone healing?secondary bone healing includes callus formation
explain the stages of callus formationInflammation hematoma (still 100% movement in the fx) --> Soft callus / fibrous tissue, cartilage ( down to 10% movement) --> Hard callus (2% movement) --> remodeling
Primary vs. Secondary bone healing ----> which healing for articular fx? diaphyseal fx?ARTICULAR: Primary bone healing, with no callus formation (can't have gaps or steps in the articular surface!!). DIAPHYSEAL: you will need to make sure the bone is aligned and the proper length, and then you can have primary OR secondary bone healing (depends on implants and type of fracture)
what type of tools can you use to help with primary bone healing of a fx?plate with oval holes, if you apply screw eccentrically it'll compress the fx
You NEED to create a situation allowing primary bone healing with what kinda fractures?articular
you def know you have secondary bone healing when...you can't differentiate the medullary and cortical cavity
which heals faster- metaphyseal or diaphyseal? why?Metaphyseal heals faster, because it is Trabecular bone, so it has a better blood supply and heals faster, unline a diaphyseal fx which is composed of cortical bone
SUMMARY: 2 things you must do for INITIAL treatment?(1) Patient stabilization: Ensure survival of patient (2) Temporary external stabilization
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