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basic idea about fracture and methods of management
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Submitted by Submitted by
A.PRAKASHA.PRAKASH
BVN 03038BVN 03038
FINALBVSCFINALBVSC
Based on Based on
1.1. Presence of communicating external Presence of communicating external wound.(open & closed)wound.(open & closed)
2.2. Extent of damage( complete , Extent of damage( complete , greenstick,fissure fracture)greenstick,fissure fracture)
3.3. Direction and location of fracture Direction and location of fracture (transverse, oblique, spiral, (transverse, oblique, spiral, communited, multiple, impacted, communited, multiple, impacted, avulsion, unicondylar, bicondylar avulsion, unicondylar, bicondylar fracture.fracture.
4.4. Stable and unstable fracture.Stable and unstable fracture.
Tension
Bending
Rotation
Compression
Fracture Forces
Shear
SHEARTensile and compressive forces act perpendicular or normal to a structure's surface
Principles of Internal Principles of Internal FixationFixation
The Goals of fracture repair areThe Goals of fracture repair are
Promote/enhance/allow bone healingPromote/enhance/allow bone healing Atraumatic techniqueAtraumatic technique Good reduction/alignmentGood reduction/alignment Stable fixationStable fixation Early return to full function****** Early return to full function******
Principles of Internal Principles of Internal FixationFixation
Open reduction Open reduction Surgical exposure of the fracture site for fixationSurgical exposure of the fracture site for fixation Fixation is usually internalFixation is usually internal
Closed reductionClosed reduction Fracture site is not openedFracture site is not opened External fixation (casts, splints, etc.) External fixation (casts, splints, etc.) Becoming more popular with advanced imagingBecoming more popular with advanced imaging
Principles of Internal Principles of Internal FixationFixation
Advantages of internal fixationAdvantages of internal fixation Rigid fixation usuallyRigid fixation usually Allows weight bearing during healingAllows weight bearing during healing
Health of the limb and joints Health of the limb and joints Increases the circulationIncreases the circulation Promotes healingPromotes healing
Hidden implantsHidden implants No extensive careNo extensive care
Principles of Internal Principles of Internal FixationFixation
Disadvantages of internal fixationDisadvantages of internal fixation
InvasiveInvasive Potential to slow healing Potential to slow healing InfectionInfection Longer procedureLonger procedure Higher cost Higher cost
Principles of Internal Principles of Internal FixationFixation
Factors affecting fracture repairFactors affecting fracture repair Type of fracture (simple/comminuted)Type of fracture (simple/comminuted) Anatomical area Anatomical area
ArticularArticular Which limbWhich limb Where on the boneWhere on the bone
Extent of soft-tissue damageExtent of soft-tissue damage Duration of fractureDuration of fracture
Principles of Internal Principles of Internal FixationFixation
Factures affecting fracture repairFactures affecting fracture repair
Animal’s age, weight and temperamentAnimal’s age, weight and temperament Owner’s finances Owner’s finances Available aftercareAvailable aftercare Equipment available Equipment available Surgeon’s experienceSurgeon’s experience
Plates come in a wide variety of shapes and
sizes
ScrewsScrews Cortical ScrewsCortical Screws
More threads, low pitch, More threads, low pitch, less thread depthless thread depth
Only fully threadedOnly fully threaded Used for cortical boneUsed for cortical bone
Cancellous ScrewsCancellous Screws Less threads, steep Less threads, steep
pitch, wide threadpitch, wide thread Fully and partially Fully and partially
threadedthreaded Used in soft boneUsed in soft bone
ScrewsScrews
Used to secure bone plates to boneUsed to secure bone plates to bone Used as primary means of fracture Used as primary means of fracture
repair repair Used to hold fracture fragments in Used to hold fracture fragments in
place place Used to compress fracture fragmentsUsed to compress fracture fragments Used to form prosthetic ligamentsUsed to form prosthetic ligaments
ScrewsScrews
Lag principleLag principle
Used to compress fracture fragmentsUsed to compress fracture fragments Used to hold plates on bone Used to hold plates on bone Threads only engage far cortexThreads only engage far cortex
(Or they don’t engage the plate)(Or they don’t engage the plate) Can be accomplished with Can be accomplished with
Partially threaded screw Partially threaded screw Over drilling near cortexOver drilling near cortex Articular fracturesArticular fractures Sacroiliac luxationsSacroiliac luxations
Bone PlatesBone Plates
Bone plates and screws offer Bone plates and screws offer versatile method of fracture of versatile method of fracture of stabilization.stabilization.
Necessary for many fractures.Necessary for many fractures. Requires specialized equipment and Requires specialized equipment and
training.training. Not readily available in many Not readily available in many
practices.practices. More expensive than pinning.More expensive than pinning.
PlatesPlates Plate placementPlate placement
Reconstruct the boneReconstruct the bone Contour plate Contour plate Drill, measure, and tap screw holes (one Drill, measure, and tap screw holes (one
by one)by one) Apply screws from the fracture site out, Apply screws from the fracture site out,
alternating bone fragmentsalternating bone fragments Engage at least six cortices per a major Engage at least six cortices per a major
bone fragmentbone fragment More for comminuted fractures if possibleMore for comminuted fractures if possible
Bone PlatesBone Plates
CounteractCounteract
TensionTension CompressionCompression ShearShear Bending Bending Rotational forcesRotational forces
Bone plates should be placed on the Bone plates should be placed on the
tension side of the bonetension side of the bone
Tension side of the boneTension side of the bone
FemurFemur CraniolateralCraniolateral
Tibia*Tibia* CraniolateralCraniolateral
HumerusHumerus CraniolateralCraniolateral
RadiusRadius CranialCranial
Ulna*Ulna* CaudalCaudal
Mandible*Mandible* dorsaldorsal
Some are not plated on the tension side due to impracticality and added difficulty
CompressionCompression
Mechanical compression Mechanical compression added to the fracture added to the fracture site.site.
The weight-bearing load The weight-bearing load is shared by both the is shared by both the plate and the bone.plate and the bone.
Primary bone healing Primary bone healing usually results.usually results.
Plate is applied Plate is applied eccentrically.eccentrically.
NeutralizationNeutralization Plate protects primary Plate protects primary
repair from weight-bearing repair from weight-bearing forcesforces
The weight-bearing load is The weight-bearing load is shared by both the plate shared by both the plate and the boneand the bone
Stabilize with series of lag Stabilize with series of lag screws and cerclege wires.screws and cerclege wires.
Numer of cortices is allowed Numer of cortices is allowed is six.is six.
ButtressButtress
Spans a gap to prevent Spans a gap to prevent collapse of a fracture collapse of a fracture
AllAll of the weight-bearing of the weight-bearing forces are transmitted forces are transmitted through the platethrough the plate
Minimum of cortices Minimum of cortices applied is 8.applied is 8.
For optimal strength use For optimal strength use broad plate and stacked broad plate and stacked vcp plates..vcp plates..
PlatesPlates
Dynamic compression platesDynamic compression plates
Allows compression of major bone Allows compression of major bone fragmentsfragments
External compressionExternal compression
Screws must be Screws must be LOADEDLOADED in order to get in order to get compressioncompression(eccentric placement in screw hole)(eccentric placement in screw hole)
Plate can function in compression, Plate can function in compression, neutralization, and as a buttress plate neutralization, and as a buttress plate depending on how the screws are applieddepending on how the screws are applied
1)1) Load Drill Guide:Load Drill Guide: Provides 1 mm Provides 1 mm compression, screws are placed eccentricallycompression, screws are placed eccentrically
2) 2) Neutral Drill GuideNeutral Drill Guide:: Places the drill hole Places the drill hole centrally, thus little displacement is provided.centrally, thus little displacement is provided.
Removing ImplantsRemoving Implants
In general, it is recommended that In general, it is recommended that all orthopedic implants be removed all orthopedic implants be removed
In practice, however, we rarely In practice, however, we rarely remove orthopedic implantsremove orthopedic implants
Removing ImplantsRemoving Implants
Why don’t we remove themWhy don’t we remove them
CostCost Post-op confinement requiredPost-op confinement required Traumatic surgeryTraumatic surgery Anesthesia riskAnesthesia risk Potential for refracturePotential for refracture
Removing ImplantsRemoving Implants
When to recommend removalWhen to recommend removal
Interferes with function Interferes with function Loosening or breakage Loosening or breakage InfectionInfection Thermal conductionThermal conduction Biological reaction to implantsBiological reaction to implants Young dogs?????Young dogs?????
AGEAGE Post operative time forPost operative time for
Plate removalPlate removal
1.1. Under 3 monthsUnder 3 months
2.2. 3-6 months3-6 months
3.3. 6-12 months6-12 months
4.4. Over 1 yearOver 1 year
4 weeks4 weeks
2-3 months2-3 months
3-5 months3-5 months
5-14 months5-14 months
Removing ImplantsRemoving Implants
Radiographs should document Radiographs should document healing prior to removalhealing prior to removal Unless implant failureUnless implant failure
Warn owners about potential for Warn owners about potential for bone breakagebone breakage Cage rest required after plate removalCage rest required after plate removal
Good idea to culture implantsGood idea to culture implants
Plating is superior over other methodPlating is superior over other method
IM pins are cheaper than plates and IM pins are cheaper than plates and interfere with blood supply lessinterfere with blood supply less
Little equipment is required for pin Little equipment is required for pin placementplacement
IM pins can migrate, especially if IM pins can migrate, especially if motion is presentmotion is present
IM pins are not ideal for comminuted IM pins are not ideal for comminuted or transverse fractures or transverse fractures
Advantages of one over anotherAdvantages of one over another Interlocking nails counteract all fracture forces Interlocking nails counteract all fracture forces
and may do it better than platesand may do it better than plates
Interlocking nails do require a lot of equipment Interlocking nails do require a lot of equipment and some expertise to place them, but are and some expertise to place them, but are cheaper than platescheaper than plates
Interlocking nails are limited by the type of Interlocking nails are limited by the type of fracture you can repair and the size of the fracture you can repair and the size of the animalanimal
Plating advantagePlating advantage
Plates counteract all fracture forcesPlates counteract all fracture forces Plates are versatile and can be applied to many Plates are versatile and can be applied to many
fracture types and animal sizesfracture types and animal sizes Plating requires some expertise and expensive Plating requires some expertise and expensive
equipmentequipment Plating requires an aggressive surgical Plating requires an aggressive surgical
approach in most instancesapproach in most instances Plates may interfere with blood supply more Plates may interfere with blood supply more
than any of the other implantsthan any of the other implants Clinically not a major problemClinically not a major problem
Advantages of one over anotherAdvantages of one over another
Open approaches can delay fracture Open approaches can delay fracture healing and predispose to infectionhealing and predispose to infection Plates/screwsPlates/screws Interlocking nails Interlocking nails
Closed approaches can be used withClosed approaches can be used with IM pinsIM pins
External fixatorExternal fixator Interlocking nails require a limited approachInterlocking nails require a limited approach