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94 Cards in this Set
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- Back
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What are the four major categories of surgical treatment for joint disease?
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Arthroscopy
Soft Tissue Reconstruction Fracture Repair Joint Replacement |
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Which of the following is an incorrect statement regarding joint surgery?
a) Full thickness lesions are debrided allowing a gradual slope up to healthy cartilage. b) Fibrillated cartilage is always removed. c) Partial thickness lesions are NOT converted to full thickness. d) Subchondral bone is debrided to subchondral bone plate. e) Necrotic bone is debrided. |
a) Full thickness lesions are debrided allowing a gradual slope up to healthy cartilage.
This is FALSE! A sharp vertical edge is left when debriding full-thickness lesions. |
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Choose arthrotomy or arthroscopy...
...best joint visualization. |
arthroscopy
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Choose arthrotomy or arthroscopy...
...allows for a quicker return to use. |
arthroscopy
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What are two ways of providing joint distension in an arthroscopic procedure?
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Sterile isotonic fluid
Inert gas |
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T or F:
Unlike articular cartilage, synovium can regenerate over time. |
True!
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Fusion of a joint is called a(n)....
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arthrodesis
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What are some common arthroscopic procedures that are performed?
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Removal of fragments
Exploration and diagnosis Fracture reconstruction Synovectomy Joint resurfacing Lavage of septic joints |
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What are the options for treatment of a cranial cruciate ligament?
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Intraarticular reconstruction
Extraarticular reconstruction TPLO |
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Which of the following commonly comprise implants?
a) Metal b) Ceramic c) Polymer d) Cadaver tissues e) Wood |
a) Metal
b) Ceramic c) Polymer Note: cadaver tissues (allografts) would be considered a biomaterial |
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What type of alloy is the most common implant material?
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Stainless steel
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What type of metal implant material has some degree of tissue integration?
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Ti and Ti alloys
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This type of alloy is used primarily for joint replacements...
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...Co alloy
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What are the 4 types of corrosion that metal implants are subjected to?
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Pitting
Galvanic Fretting Stress |
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What are the two categories of ceramic implants? Give examples of each...
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Calcium Sulfates (plaster of Paris)
Calcium Phosphates (hydroxyapatite, beta tricalcium phosphate) |
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What are the types (forms) of metal implants?
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Plates
Rods Pins Screws Wire Joint replacements Sutures |
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T or F:
A LCP screw through one cortex is as strong as a DCP through 2 cortices. |
True!
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Self tapping screws are associated with ___________ bone.
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cancellous
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Which type of wire is used for fracture repair across a physis?
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Kirschner wire
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Which pin type is associated with external fixation?
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Steinmann pins
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Characterize the following macroscopic bone types by their microscopic sub-structure:
Cortical bone Cancellous bone Bone callous Trabecular bone Compact bone |
Cortical bone (lamellar)
Cancellous bone (lamellar) Bone callous (woven) Trabecular bone (lamellar) Compact bone (lamellar) |
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What type of bone is found...
...in the center and ends of long bones. |
Trabecular or cancellous bone
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What is the makeup of bone in terms of organic matrix, inorganic matrix, and water?
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Organic 21%
Inorganic 71% Water 8% |
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What are the 3 types of growth cartilage (give examples)?
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Discoid growth plate (ends of long bones)
Spherical growth plate (centrifugal growth; cuboidal bones) Apophysis (Olecranon process) |
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In which growth zone do most growth plate fractures occur?
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Hypertrophic zone
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The law stating that bone increases in mass where it is stressed and decreases in mass where stress is reduced is..
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...Wolff's Law
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What are the stresses that are applied to bones?
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Compression
Torsion Shearing Bending Tension |
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What are the three major fracture configurations?
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Transvers
Oblique Butterfly |
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Put the following in the correct order of bone healing:
Lamellar bone Granulation tissue Mineralized Woven bone fibrous tissue fibrocartilage hematoma |
Hematoma > Granulation Tissue > Fibrous Tissue > Fibrocartilage > Mineralized > Woven Bone > Lamellar bone
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What are the two modes of bone healing?
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Primary and secondary
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What are the 3 phases of bone healing? Approximately how long is each?
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Inflammatory (2-3wks)
Reparative (2-12mos) Remodeling |
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What are the 3 plating techniques? What type of fracture is commonly associated with each?
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Compression (simple)
Buttress (highly comminuted) Neutralization (1 fragment) |
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Why is micromotion sometimes a desired feature of fracture stabilization?
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Encourages callus growth
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What type of bone is commonly used in grafts? Where does this bone come from?
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autogenous fresh cancellous bone from flat bones
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What are the main functions of bone grafts?
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Osteogenesis
Osteoinduction (growth factors) Osteoconduction (matrix scaffold) |
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Which growth factor stimulates callus formation?
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BMP-2 (Bone Morphogenic Protein)
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What are the categories for classifying fractures?
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Simple vs. comminuted
Open vs. closed Displaced vs. non-displaced Configuration Location |
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Choose the Salter-Harris classification...
...involves complete physeal separation. |
Type I
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Choose the Salter-Harris classification...
...fracture extends through epiphysis, physis, and metaphysis. |
Type IV
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Choose the Salter-Harris classification...
...Intra-articular fracture through epiphysis and physis |
Type III
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Which of the following is a surgical emergency?
a) All physeal fractures iin young animals. b) Grade 2 and greater open fractures c) Salter-Harris type V and VI fractures in young animals d) All open fractures |
a) All physeal fractures iin young animals.
d) All open fractures |
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How is fracture displacement classified?
a) by the distal fragment b) by the proximal fragment c) by the position of the largest fragment d) by the position of the smallest fragment |
a) by the distal fragment
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Choose the type of open fracture...
...cause of wound is bone penetrating the skin |
type 1
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Choose the type of open fracture...
...cause of wound is external trauma |
Types 2, 3, and 4
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Choose the type of open fracture...
...HBC |
Types 3 and 4
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Choose the type of open fracture...
...nearly amputated limb |
Type 4
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After you've ruled-out other injury and have confirmed an orthopedic injury with clinical signs, what is your next step?
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ORTHOGONAL views, y'all!
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What are the 4 A's of fracture repair?
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Alignment
Apposition Apparatus Activity |
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What is "the mechanic" and "the gardner"?
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Mechanic (open fixation)
Gardner (closed fixation w/external devices) |
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T or F:
Open fixation is imperative for articular and physeal fractures. |
True!
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Choose open or closed (external) fixation...
...preserves the fracture clot. |
closed (external)
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Choose the type of open fracture...
...allows anatomic reconstruction of fracture pieces. |
open
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Choose the type of open fracture...
...useful in highly comminuted fractures. |
closed (external)
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Choose the type of open fracture...
...easier to achieve good cortical apposition and limb alignment. |
open
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What hardware is typically used to repair a long oblique or spiral fracture using an open approach?
a) interlocking nails b) IM pins + cerclage wire c) Steinman pins + Kirschner wire d) bone plates |
b) IM pins + cerclage wire is probably the best choice
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Which piece of orthopedic hardware resists forces in ALL directions?
a) IM pin b) interlocking nails c) plates d) none of the above |
c) plates!
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Which orthopedic hardware has the best resistance to bending?
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Intelocking nails
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Which ortho hardware is used to repair physeal fractures?
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Kirschner wires & Steinmann pins
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What type of external fixation is depicted here?
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Type II
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What are the three parameters to consider when determining which type of fixation to use?
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Biological (healing potential)
Mechanical (fracture config and # limbs affected) Clinical (compliance, pain tolerance) |
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Describe the PERFECT FRACTURE in terms of mechanical fracture assessment. What is the shittiest fracture?
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Perfect = 10 = single limb, simple transverse non-displaced diaphyseal fracture in a small dog
Shitty = 1 = multiple limbs, highly comminuted, large dog |
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Describe the LEAST RISK in terms of biological fracture assessment.
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Juveinile in good health, closed fracture, cancellous bone, low velocity injury
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What are common fixation methods for moderate scoring in fracture assessment?
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Type I-B or II fixator
Interlocking nails IM + external fixation |
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What are common fixation methods for low scoring in fracture assessment?
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Plates
Interlocking nails Plate + rods Type III (ring) fixators |
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What are common fixation methods for high scoring in fracture assessment?
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cast
Type I external fixator IM pin + cerclage |
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What is a malunion?
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A fracture or osteotomy that has healed in a non anatomic position.
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What are some causes of malunion?
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Inadequate stabilization
Inadequate blood supply Inadequate reduction Infection Bone loss |
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Choose malunion, non-union or delayed union...
....fuzzy fracture line. |
delayed union
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Choose malunion, non-union or delayed union...
...associated with pseudoarthroses. |
non-union
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Choose malunion, non-union or delayed union...
...can heal without surgery. |
non-union
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Choose malunion, non-union or delayed union...
...associated with angular limb deformities. |
malunion and non-union
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Choose malunion, non-union or delayed union...
...radiolucent fracture site. |
non-union
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Choose malunion, non-union or delayed union...
...sealed-off medullary cavity. |
non-union
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What are the 3 types of viable non-unions?
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Hypertrophic (elephant's foot)
Moderately hypertrophic (horse's hoof) Oligotrophic viable |
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T or F:
With viable non-unions, there is no hope for healing. |
False
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What are hypertrophic viable nonunions caused by?
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Fracture instability
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What are the 4 types of non-viable non-unions?
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Necrotic Nonviable Nonunion
Defect Nonviable Nonunion Atrophic Nonviable Nonunion Dystrophic Nonviable Nonunion |
What type of nonunion is depicted here? Which bones does this commonly affect?
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Dystrophic nonviable nonunion;
Distal radius/ulna of toy breeds |
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What is a possible sequel to a fracture gap that is greater than 1.5x the diameter of the injured bone?
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Defect nonviable nonunion
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End-stage pseudoarthrosis is otherwise known as
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Atrophic nonviable nonunion
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What are general treatments for nonunions?
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Remove fibrous tissues
Open medullary canal (if closed) Culture and sensitivity Bone graft RIGID FIXATION |
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How do high speed and low speed fractures differ?
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Low speed usually chronic
High speed usually comminuted |
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About how much in the hole will a horse owner be in for a long bone fracture repair? A pastern repair?
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Long bone (10-20K)
Pastern (5-10K) |
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An open fracture in a horse approximately equals ___________ the cost and ____________ the prognosis.
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Double the cost
Half the prognosis |
Describe how a fracture in region 2 would be splinted.
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Caudal and lateral splint from ground to elbow or stifle
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Describe the splinting technique for a fracture in region 3.
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Lateral splint from ground to shoulder/tuber coxae
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Failure to splint a horse fracture =
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DEATH & MALPRACTICE
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How would you load a horse with a forelimb injury in a trailer and why?
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Ass forward; if you have to brake suddenly, horse can put weight on pelvic limbs
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In large animals, a fracture with an associated laceration but no bone exposure is which type of fracture?
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Type 1 open fracture
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Which fractures can be treated with stall rest in large animals?
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Pelvic fractures
Incomplete nondisplaced radial fractures Some humeral fractures in cattle |
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What is a common mode of external fixation in large animals? What are drawbacks to this method?
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Transfixation pin casts;
battle between pin loosening and fracture healing hard to keep reduction when placing cast |
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What combination of orthopedic hardware provides a 10x increase in fatigue life of plate?
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IM pins + Buttress plates (bridging plate fixation)
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What are the three main types of plates in use for fracture repair?
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DCP (dynamic compression plate)
LC-DCP (low-contact DCP) LCP (locking compression plate) |
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T or F:
One difference between the LCP and the DCP is that the DCP does not have to be placed in compression mode while the LCP does. |
False! They both can be placed neutrally
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