Management of Fractures

• Influenced by soft tissue damage

• Handle without damaging vascularity

• Stability – reduction- manipulation, mechanical traction, open approach

Immobilization Holding the fractured ends so that they are

motionless with respect to each other. Internal/ external(coaptation splint and thomas splint)

External: Ehmer sling: to reduce anterior dorsal

coxofemoral luxation in dogs and cats Doesnot immobilize the hip joint – places femoral

head into a position within the acetabulum Use: abduction and internal rotation of femur and

flexion of knee Application: figure of 8 dressing

Splints First aid measure – long

bones Wood , PVC , metal bars Padded prior to its

application Placed over well padded

and bandaged limb to prevent sores

Disadv: Periodically checked

Reset;/change Sores / abrasions Difficult to retain above

knee/ hock

Casts: Used with /without

splints Plaster cast, fiber

glass cast Ideal : easy to

apply Light in weight economical Hardens quickly Resistant- moisture

Disad: cannot be used for proximal fractures

Pop: inexpensive , mouldable, Does not harden quickly, not resistant to moisture (Fiber glass)

Thomas splint: Alone or in

combination with internal device

Al or light iron pipe

Ring fit into axillary or groin areas

Leg bars straight for forelimbs

Contoured to the angle of stifle and hock

ADVANTAGES Rarely fails if applied

properly Can be used for

femur and humerus along wit internal devices

Disadvan: abrasions and sores

Cannot be used alone in proximal

Internal immobilization Failures are due

to faulty technique

improperly designed device

Break in asepsis Inadequate poc

IMP Adv: Sound and

economical method

Suits for long bones frac

Axial allignent and stability

More than 2 pins (stack pinning) in larger medulla

Steinmann pins, K nail, rush pins ets

Normograde and retrograde – chucks

Disav:loosening migration Corrosion Infection No rotational

stability

K- nail Stabilizes – by filling the marrow

cavity and contacting as much of the cortical surface as possible due to a V or clover leaf shape

Adv: use of v. heavy intramedullary pin in large animals can be avoided

Disadvan: should not be used where there are longitudinal or cortical cracks

Rush pins A pair of pin is

used to immobilize bone

Elastic bending nature – produces – spring like action to provide a rigid fixation

Generally inserted from distal end of bone

Fractures of distal femur, tibia, humerus etc, ie, supracondylar and also diaphyseal fractures of tibia

Length- 2/3rd to 3/4th of the length of diaphysis of bone

Disadvantage; Contraindicated in young animals because of soft cortex and epiphyseal region damage

Wires

Circlage- oblique fractures/ longitudinal splits of bone – with IMP

Full circlage/ hemicirclage

Transfixation assembly Frac. Of radial and

tibial shafts 2 or more IMP –

inserted transversely- proximal and distal fractured fragment

Protruding ends – maintained in position- connecting external bars/ plaster cast.

Adv: Good rotational stability Easily goes with soft tissue

injury Suits young animals –

where bone is thin and soft for plate and screw

Contact with surface of bone is min. so no hinderance in bl.supply

Disadv: Soft tissue infection Bone necrosis- due

to gen. of heat while passing pins through power drills- loosening.

Fatigue/ pathological fractures at point of insertion

Hanging pin cast Principle that

proximal and distal joints- should be included in the cast– not uniformly applicable – anatomical disposition of some bones

Fracture of Prximal radius and tibia

Instead of using pins in both fragment , only one pin inserted transversely in proximal and distal part is immobilized with a cast anchoring the proximal transverse pin

Disadv: Cannot prevent overriding

Plate Maximum rigidity at fractured site is provided

Early ambulation

Adv: axial compression Counteract rotational force Donot occlude intramedullary

cavity to compromise intraosseous circulation

Rigid stability so even in presence of inf. – bone heals with min. callus

Deminerilization of bone- left insitu

Expensive and requires lot of experience

Requires complete exposure of site- disrupts soft tissue attachment and blood supply

External circular fixators 2 or more circular

rings – 2 proximal and 2 distal (or one)

2 pins are first perpendicularly passed at 2 sites proximally and 2 sites distally to fractured site- fixed from outside to external circular rings assembly

ADV; v. stable fixation – radius and tibia in LA

Helpful in compound fractures also

No bandaging required so no pressure atrophy– facilitates daily dressing

Disadv: Cannot be used in proximal

bone due to heavy assembly Pin tract sepsis, implant

failure, osteomyelitis

Tension band wiring Indicated for

avulsion frac.- olecranon, treater trochanter, os-calcis etc

2 K wires- fix avulsed fragment back to the shaft-wiring is done in figure of 8 fashion