what must you always do before fixing ortho injury?
TRIAGE!!
and a complete physical, orthopaedic, and neuro assessment prior to definitive care
what is the sequence of triage checkpoints to ensure a patient is stable?
A - airway is patent
B - animal is breathing spontaneously and effectively
C - evidence of circulation
D - assess other disabilities
what are examples of visible signs of a fracture?
- Pain or localized tenderness
- Deformity, change in angulation of bone, or altered alignment of joints
- Perceived abnormal motion
- Local swelling (this may appear almost immediately or not until several days afterward and usually persists for 7-10 days because of disturbed flow of blood and lymph)
- Loss of function
- Crepitus
during ortho exam (following traumatic injury or not), you are assessing long bones and joint for … (5 points)
Pain
Range of Motion
Instability
Crepitus
Effusion or Swelling
= PRICE
what do you need for proper radiographic diagnosis (and subsequent selection of best procedures for reduction/immobilization)?
need at least 2 views at right angles to each other, aka orthogonal views
can computed tomography (CT) help diagnose a bony injury?
yes - especially useful in trauma cases with multiple injuries
single or multiple scans can be performed with minimal manipulation of the patient
if the patient’s physiological status is poor, what can we do for diagnostics?
obtain a single view of the area of interest (without sedation) to confirm presence & severity of fracture
should i use sedation to get a radiograph?
YES!!! radiographs require uncomfortable positioning which can be stressful for the animal. to get an appropriately positioned radiograph you MUST SEDATE!
what is a pathologic fracture? how to fix this?
bone disease causing destruction or weakening of the bone in which trivial trauma produces a fracture
predisposing cause must be resolved before repairing fracture
what type of fracture is more common when there are pathologic causes of bone weakness?
compressive fractures are more common than an oblique fracture
loss of mineral in bone matrix = decrease in compressive strength
trauma is the most common cause of fractures in vet med. what are the 3 subdivisions of fractures?
- direct violence applied to bone
- indirect violence - force transmitted thru bone/muscle to point of fracture
- repeated stress - repetitive loading causing damage at faster rate than can be repaired
there are two types of soft tissue wounds: closed and open. what are the subcategories for open wounds?
- Type I: <1cm, clean laceration; bone creates a puncture wound
- Type II: >1cm, mild soft tissue trauma (external source), no flaps/avulsions
- Type III: extensive soft tissue injury, variable skin loss, result of high-energy trauma
- Type IIIa: soft tissue available for wound coverage
- Type IIIb: soft tissue loss, bone exposure with periosteum stripped from bone
- Type IIIc: arterial supply to distal limb damaged, must repair arteries to salvage limb
what seven things must you remember for the successful management of an open fracture?
- patient assessment
- fracture classification
- antibiotic therapy (broad spectrum)
- debride & irrigate
- wound management
- restore soft tissue
- fracture stabilization
True or False: physeal fractures occur in animals of all ages
FALSE!
physeal fractures only occur in young animals who still have growth potential of their bones!
what are the 6 types of Physeal Fractures classified by the Salter-Harris classification system?
SH-I: thru physis
SH-II: thru physis & portion of metaphysis
SH-III: thru physis, portion of epiphysis, intra-articular
SH-IV: articular fractures, thru epiphysis, across physis, thru metaphysis
SH-V: crushing of physis (not visible on radiograph) - physeal growth ceases
SH-VI: partial physeal closure resulting from damage to portion of physis
what happens with fractures that crush or cross the growth plate?
these could:
- irreversibly injure chondrocytes of the reserve (resting) cell layer of the growth plate, or
- damage the branch of the epiphyseal artery that nourishes these cells
how are fractures classified according to AO foundation?
first by number of long bone
* 1= humerus
* 2 = radius/ulna
* 3 = femur
* 4 = tibia/fibula
second by “bone zone”
* 1 = proximal
* 2 = shaft
* 3 = distal
third by severity of fracture
* A = single fracture
* B = wedge
* C = complex, more than 1 fragment
each of the above can be further grouped into degree of complexity based on extent of bone fragmentation
what are three terms that describe the orientation of the fracture line relative to bone’s long axis?
Transverse - crosses bone not more than 30deg
Oblique - crosses bone at greater than 30deg
Spiral - fracture line curves around diaphysis
extent of damage: what is an infarction?
fractures of trabecular bone without external deformation of the cortex
often associated with necrosis or inflammation of bone as predisposing factors
extent of damage: what is an incomplete fracture?
fractures that disrupt only 1 cortex
a greenstick fracture in young animals (bending of non-fractured cortex)
extent of damage: what is a complete fracture?
single circumferential disruption of bone
any fragmentation that results in defect at site must be smaller than 1/3 bone diameter
extent of damage: what is a multi-fragmented fracture?
aka comminuted fractures
these have one or more completely separated fragments of intermediate size, such as:
- wedge fracture
- reducible wedges
- nonreducible wedges
- multiple or segmental fracture
what specific nomenclature is used to describe fractures seen at proximal and distal metaphyseal bone zones?
- extra-articular fracture = articular surface separated from diaphysis but isn’t fractured; aka metaphyseal fractures
- partial articular fracture = part of joint surface involved, remaining part still attached to diaphysis
- complete articular fracture = joint surface fractured, completely detached from diaphysis
what is an impacted fracture?
bone fragments driven firmly together as a result of compressive forces
