Practical Aspects of Fracture Management 2023 PDF
Document Details
Uploaded by LargeCapacityIsland
University of Liverpool
Rob Pettitt
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Summary
This document covers practical aspects of fracture management. It includes an overview of fracture forces, the different styles of implants, indications and contra-indications, their advantages and disadvantages. The presentation also touches on the relevance of this content to initial fracture assessment.
Full Transcript
Practical aspects of fracture management Rob Pettitt BVSc PGCert LTHE DSAS (Orth) SFHEA FRCVS Professor of Small Animal Orthopaedics Objectives Fracture forces Revise the different style of implants Indications and contra-indications Advantages and disadvantages What is the relevance to Day on...
Practical aspects of fracture management Rob Pettitt BVSc PGCert LTHE DSAS (Orth) SFHEA FRCVS Professor of Small Animal Orthopaedics Objectives Fracture forces Revise the different style of implants Indications and contra-indications Advantages and disadvantages What is the relevance to Day one?? Fracture forces Avulsion fractures Three main categories • Plates and screws • External skeletal fixators • Pins and wires Plates • Dynamic compression plates (DCP) • Locking plates • (Specialised plates) Dynamic compression plates • Neutral • Buttress • Compression • Non locking plates –stability through bone plate friction • Accurate contouring needed Locking Plates Locking plates Fixed angle implants Stability generated through interface between screw and plate Advantages of Locking Systems Excellent for use in poor quality bone Juvenile Osteopenic bone Improved vascularity Humans versus veterinary Less contouring Monocortical screws more stable Disadvantages of Locking Systems Lag screws cant be placed through the plate More expensive? Fixed angle systems cannot angle screws away from implants/fracture edges Screws Positional versus lag screws Function of the way it is placed Positional screws Lag screw Lag screw produces static interfragmental compression Lag screw is the most efficient method of creating compression External Skeletal fixators Pins Smooth pins? Pins Connecting bars Clamps Frame types Type 1 Type 2 Intramedullary devices Steinmann pin Rush pin (Kirschner wire Kuntschner nail Interlocking nail) IM pin Advantages •Good at resisting bending •Strength in bending proportional to (radius)4 •In neutral axis of bone •Often relatively inexpensive •May be used with other fixation devices •ESF •Plate Disadvantages •Poor at resisting rotation •Poor at resisting shear •Interferes with medullary blood supply •Difficult in chondrodystrophic dogs Use of IM pin •Medium-long oblique simple fractures •Cats – longer straighter diaphyses •NB chondrodystrophic dogs •With another fixation device •ESF •Cerclage wire •Interlocking mid diaphyseal transverse fractures •In combination with other technique for comminuted fractures •ESF •Plate Example IM pin •Technique •Direct pinning -normograde •Indirect pinning -retrograde •Choose correct pin size •Width •As large as possible •30% diameter if combining with plate or ESF •Length •Radiograph intact contralateral bone Cerclage wire •Introduction •Used in combination with IM pins for long oblique fractures •Must be tight to provide compression •1o bone union •Can slip along diaphysis •Cat v dog •Femur/humerus v tibia •Can groove diaphysis or use hemicerclage Cerclage wire Tying knot Pin and Tension band wire 4 A’s of fracture repair assessment • Apparatus • Alignment • Apposition • Activity In Summary Fracture forces Revise the different style of implants Indications and contra-indications Advantages and disadvantages What is the relevance to Day one??
