Fracture Management for the Small Animal Practitioner

List of Contributors xv Preface xvii Section 1 General Information 1 1 Fracture Identification 3 Anne M. Sylvestre 1.1 Number of Fragments 3 1.2 Fracture Configuration 3 1.3 Location on the Bone 7 1.4 Salter- Harris Fractures 7 2 Open Fractures 9 Anne M. Sylvestre 2.1 First Degree 9 2.2 Second Degree 9 2.3 Third Degree 9 Reference 10 3 Patient Management 11 Anne M. Sylvestre 3.1 The Patient 11 3.1.1 Upon Admission 11 3.1.2 Immediate Postoperative Care 11 3.1.3 Upon Discharge From Hospital 11 3.1.4 Outside and Walks 12 3.1.5 Follow-up Radiographs and Healing Times 13 3.1.6 Implant Removal 13 3.2 The Owner 14 3.2.1 Slippery Floors 14 3.2.2 Stairs 15 3.2.3 No Jumping 15 3.2.4 Common Stressors 15 3.2.5 Crates 15 3.2.6 Icing 15 3.2.7 Gentle Passive Range of Motion (PROM) 16 3.2.8 Urination and Bowel Movements 16 3.2.9 Food and Water 16 3.2.10 Cats 17 3.3 Managing Osteoarthritis (OA) 17 References 17 4 Bandages and Splints 19 Jennifer White and Anne M. Sylvestre 4.1 The Bandage 19 4.1.1 Layers of a Bandage 19 4.1.2 Creating the Bandage 19 4.2 Forelimb 27 4.2.1 Velpeau Sling 27 4.2.2 Spica Bandage 30 4.2.3 Antebrachial Bandages 31 4.2.4 Bandages for a Manus 37 4.2.5 Carpal Flexion Sling 37 4.3 Hind Limb 39 4.3.1 Ehmer Sling 39 4.3.2 Robert Jones Bandage 39 4.3.3 Crural and Tarsal Bandages 39 4.3.4 Bandages for a Pes 47 4.3.5 Robinson and 90-90 Slings 47 4.4 Bandage Care 47 4.4.1 Home Care Instructions 47 4.4.2 Bandage Changes 50 4.4.3 Bandage/Splint Complications 50 Reference 60 Section 2 The Forequarter 61 5 Mandible and Maxilla 63 Teresa Jacobson 5.1 Mandibular Fractures 63 5.1.1 Mandibular Symphyseal Separation 63 5.1.2 Rostral Mandibular Fractures 63 5.1.3 Fracture at the Level of the Mandibular First Molar 64 5.1.4 Temporomandibular Luxation 65 5.1.5 Other Mandibular Fractures 68 5.2 Maxillary Fractures 68 5.2.1 Fracture and/or Avulsion of the Incisive Bone 68 5.2.2 Fractures of the Maxillary Bone 68 5.3 Managing Expectations 68 5.4 Alternatives When the Treatment of Choice is Not an Option 68 5.5 Potential Complications of Maxillofacial Fracture Repair 69 References 74 6 Scapula 75 Anne M. Sylvestre 6.1 Fractures 75 6.1.1 Fractures Through the Body and Spine of the Scapula 75 6.1.2 Acromion Fractures 76 6.1.3 Fractures of the Neck of the Scapula 76 6.2 Managing Expectations with Recommended Treatments 78 6.3 Alternatives When Treatment of Choice is Not an Option 78 References 79 7 Shoulder Joint 81 Anne M. Sylvestre 7.1 Fractures and Luxations 82 7.1.1 Avulsion of the Supraglenoid Tuberosity 82 7.1.2 T or Y Fractures of the Scapular Neck and Glenoid Rim 82 7.1.3 Other Fractures Involving the Shoulder Joint 82 7.1.4 Medial Luxations 82 7.1.5 Lateral Luxations 84 7.2 Managing Expectations with Recommended Treatments 84 7.3 Alternatives When Treatment of Choice is Not an Option 86 7.3.1 Fractures 86 7.3.2 Luxations 86 References 86 8 Humerus 87 Catherine Popovitch, Thomas W.G. Gibson, and Anne M. Sylvestre 8.1 Fractures 88 8.1.1 Physeal Fractures of the Proximal Humerus 88 8.1.2 Two-Piece Humeral Shaft Fractures 88 8.1.3 Multifragmented Humeral Shaft and/or Supracondylar Fractures 89 8.2 Managing Expectations with Recommended Treatments 90 8.3 Alternatives When Treatment of Choice is Not an Option 90 References 91 9 Elbow Joint 93 Anne M. Sylvestre 9.1 Fractures and Luxations 94 9.1.1 Condylar Fractures 94 9.1.2 Bicondylar Fractures 94 9.1.3 Acute Luxations 94 9.1.4 Chronic Luxations 99 9.1.5 Proximal Ulnar Fractures 100 9.1.6 Monteggia Fractures 100 9.2 Managing Expectations with Recommended Treatments 101 9.3 Alternatives When Treatment of Choice is Not an Option 101 9.3.1 For Patients with a Fracture 101 9.3.2 For Patients with a Luxation 102 References 102 10 Radius and Ulna 105 Catherine Popovitch, Thomas W.G. Gibson, and Anne M. Sylvestre 10.1 Fractures 106 10.1.1 Fractures of the Proximal Ulna 106 10.1.2 Fractures of the Proximal Radius 106 10.1.3 Fractures of the Radius in Toy Breed Dogs 106 10.1.4 Fractures of the Radius and Ulna in Non-Toy Breed Dogs and Cats 107 10.1.5 Isolated Fractures of the Shaft of the Ulna 112 10.1.6 Physeal Fractures of the Distal Radius 112 10.2 Managing Expectations with Recommended Treatments 114 10.3 Alternatives When Treatment of Choice is Not an Option 114 References 117 11 Carpal Joint 119 Anne M. Sylvestre 11.1 Fractures and Ligamentous Injuries 120 11.1.1 Fractures of the Styloid Process of the Radius or Distal Ulna 120 11.1.2 Fractures of the Radial Carpal Bone 120 11.1.3 Fractures of the Accessory Carpal Bone 122 11.1.4 Fractures of the Ulnar Carpal Bone 123 11.1.5 Collateral Ligament Injuries 123 11.1.6 Shearing Injuries 124 11.1.7 Hyperextension Injuries 125 11.1.8 Luxation of the Antebrachiaocarpal Joint 125 11.1.9 Luxation of the Accessory Carpal Bone 125 11.1.10 Luxation of the Radiocarpal Bone 126 11.2 Managing Expectations with Recommended Treatments 127 11.3 Alternatives When Treatment of Choice is Not an Option 127 11.3.1 For Patients with a Fracture 127 11.3.2 For Patients with Ligamentous Injuries 128 11.4 About Pancarpal Arthrodesis 128 11.5 About Partial Carpal Arthrodesis 128 References 129 Section 3 The Hindquarter 131 12 Pelvis 133 Anne M. Sylvestre 12.1 Co-morbidities 134 12.2 Fractures 134 12.2.1 SI Luxations/Fractures 134 12.2.2 Fractures of the Ilial Shaft or Wing 134 12.2.3 Acetabular Fractures 137 12.2.4 Ischial Fractures 137 12.2.5 Fractures of the Pelvic Floor 137 12.2.6 Summary of Indications for Surgical Repair of Pelvic Fractures 138 12.3 Managing Expectations with Recommended Treatments 139 12.4 Alternatives When Treatment of Choice is Not an Option 139 References 140 13 Coxofemoral Joint 141 Thomas W.G. Gibson and Anne M. Sylvestre 13.1 Fractures and Luxations 141 13.1.1 Acetabular Fractures 141 13.1.2 Hip Luxations 142 13.1.3 Alternative Treatment of Choice: Open Reduction 146 13.1.4 Capital Physeal Fractures of the Proximal Femur 148 13.1.5 Fractures of the Femoral Neck 149 13.2 Managing Expectations with Recommended Treatments 150 13.3 Alternatives When Treatment of Choice is Not an Option 150 13.3.1 Acetabular Fractures 150 13.3.2 Luxations 150 13.3.3 Femoral Head and Neck Fractures 151 13.4 About the FHO 151 References 152 14 Femur 153 Thomas W.G. Gibson and Anne M. Sylvestre 14.1 Fractures 154 14.1.1 Avulsion Fractures of the Greater Trochanter 154 14.1.2 Fractures of the Femoral Shaft 154 14.1.3 Physeal Fractures of the Distal Femur 157 14.2 Managing Expectations with Recommended Treatments 159 14.3 Alternatives When Treatment of Choice is Not an Option 159 References 161 15 Stifle Joint 163 Anne M. Sylvestre 15.1 Fractures and Luxations 164 15.1.1 Articular Distal Femoral Fractures 164 15.1.2 Patellar Fractures 164 15.1.3 Traumatic Patellar Luxations 166 15.1.4 Collateral Ligament Damage 166 15.1.5 Luxation of the Stifle Joint 166 15.1.6 Articular Proximal Tibial Fractures 169 15.2 Managing Expectations with Recommended Treatments 170 15.3 Alternatives Treatment When Surgery is Not an Option 170 References 170 16 Tibia and Fibula 171 Thomas W.G. Gibson and Anne M. Sylvestre 16.1 Fractures 172 16.1.1 Tibial Tuberosity Avulsion Fractures 172 16.1.2 Tibial Plateau Physeal Fractures 172 16.1.3 Proximal Tibial Shaft Fractures 173 16.1.4 Fractures of the Mid- and Mid-to-Distal Portions of the Tibial Shaft 173 16.1.5 Fractures of the Distal Tibial Shaft 177 16.1.6 Physeal Fractures of the Distal Tibia/Fibula 177 16.1.7 Fractures of the Fibular Shaft Alone 177 16.2 Managing Expectations with Recommended Treatments 178 16.3 Alternatives When Treatment of Choice is Not an Option 178 References 181 17 Tarsal Joint 183 Anne M. Sylvestre 17.1 Fractures and Ligamentous Injuries 184 17.1.1 Articular Distal Tibial Fractures 184 17.1.2 Fractures of the Medial Malleolus or the Lateral Malleolus 184 17.1.3 Medial or Lateral Collateral Ligament Injuries 186 17.1.4 Luxations of the Tarsocrural Joint 186 17.1.5 Shearing Injuries 186 17.1.6 Fractures of the Calcaneus 188 17.1.7 Fractures/Luxations of the Talus 192 17.1.8 Fractures/Luxations of the Central Tarsal Bone 193 17.1.9 Fractures of the Numbered Tarsal Bones 193 17.1.10 Luxation of the Intertarsal and/or Tarsometatarsal Joints 194 17.2 Managing Expectations with Recommended Treatments 194 17.3 Alternatives When Treatment of Choice is Not an Option 195 17.4 About Pantarsal Arthrodesis 195 17.5 About Partial Tarsal Arthrodesis 195 References 197 18 Paw (Manus and Pes) 199 Anne M. Sylvestre 18.1 Fractures and Luxations 199 18.1.1 MC/MT Fractures 199 18.1.2 Phalangeal Fractures 202 18.1.3 Luxations of the Inter-Phalangeal or MC/MT-Phalangeal Joints 203 18.2 Managing Expectation with Recommended Treatments 204 18.3 Alternatives When Treatment of Choice is Not an Option 204 References 204 Section 4 Fracture Repair Techniques 205 19 Essential Information on Fracture Repair 207 Anne M. Sylvestre 19.1 Forces Applied to a Bone 208 19.2 Techniques for Reducing a Fracture 208 19.2.1 Distraction 209 19.2.2 Lever 209 19.2.3 Toggle 209 19.2.4 Oblique Fractures 210 19.2.5 Using the Plate 211 19.3 Instrumentation 211 19.3.1 Drills 211 19.3.2 Fracture Repair General Instruments 213 References 214 20 Pins and Wires 215 Catherine Popovitch 20.1 Case Selection 215 20.2 Instrumentation 215 20.3 Fundamentals of Application 215 20.3.1 Cerclage Wires 215 20.3.2 Pins 216 20.4 Pinning Techniques for Various Long Bones 218 20.4.1 Humerus 218 20.4.2 Radius 218 20.4.3 Femur 218 20.4.4 Tibia 220 References 221 21 Plating 223 Anne M. Sylvestre 21.1 Case Selection 223 21.2 Instrumentation 223 21.2.1 Bone Screws 223 21.2.2 Bone Plates 224 21.2.3 Plating-specific Instruments 225 21.3 Fundamentals of Application 226 21.3.1 Selecting a Plate 226 21.3.2 At Surgery 227 21.3.3 Pin-Plate Combination 228 21.3.4 Stack Plating 230 21.4 Postoperative Care 230 21.5 Plating Techniques for Various Long Bones 230 21.5.1 Humerus 230 21.5.2 Radius 230 21.5.3 Femur 230 21.5.4 Tibia 232 References 233 22 External Fixators 235 Kathryn Wander 22.1 Case Selection 235 22.2 Basic Rules of External Fixation 235 22.2.1 Pins 235 22.2.2 Connecting Bars 236 22.2.3 Clamps 236 22.3 Fundamentals of Application 237 22.4 Fixators: Biomechanics/Constructs 237 22.4.1 Acrylic Splints/Constructs 238 22.4.2 Circular External Fixators 239 22.5 Postoperative Care 239 22.6 Complications 241 22.7 Preferred Technique for Various Long Bones 242 22.7.1 Tibial Fractures 242 22.7.2 Humeral Fractures 242 22.7.3 Femoral Fractures 242 22.7.4 Radial Fractures 242 References 243 23 Repair of Physeal Fractures 245 Thomas W.G. Gibson 23.1 Physeal Fractures 245 23.1.1 Crossed Pin Technique 246 23.2 Avulsion Type Physeal Fractures 247 23.2.1 Tension Band Wiring Technique 247 23.3 Repair Techniques for Various Physeal Fractures 247 23.3.1 Proximal Humerus 247 23.3.2 Proximal Ulna 247 23.3.3 Proximal Radius 247 23.3.4 Distal Radius 247 23.3.5 Greater Trochanter 248 23.3.6 Distal Femur 248 23.3.7 Tibial Tuberosity 248 23.3.8 Proximal Tibial Physis 248 23.3.9 Distal Tibial Physis 248 References 248 24 Fractures of the Jaw 251 Teresa Jacobson 24.1 Anatomical Considerations 251 24.2 Jaw Fracture Management 251 24.2.1 The Principles of Jaw Fracture Management 252 24.2.2 Intubation Considerations for the Fracture Repair 253 24.2.3 Feeding Plan Post Jaw Fracture Repair 253 24.3 Pain Management 254 24.4 Maxillofacial Fracture Repair 255 24.5 Methods of Maxillofacial Fracture Stabilization 257 24.5.1 Tape or Nylon Muzzles 257 24.5.2 Osseous Wiring Techniques for Maxillofacial Fracture Repair 257 24.5.3 Intra-Dental Wiring Techniques with Acrylic Reinforcement 260 24.5.4 Bonding the Maxillary to the Mandibular Canines 265 24.6 Bone Grafts 266 24.7 Teeth in the Fracture Line 266 24.8 Antibiotic Therapy in Maxillofacial Fracture Repair 267 24.9 Irrigation of the Appliance 267 24.10 Recheck Examinations 267 References 267 25 Approaches to the Long Bones 269 Anne M. Sylvestre 25.1 Approach to the Diaphysis of the Humerus 269 25.1.1 Patient Position 269 25.1.2 The Surgical Approach 269 25.2 Approach to the Diaphysis of the Radius 271 25.2.1 Patient Position 271 25.2.2 Surgical Approach 271 25.3 Approach to the Femoral Diaphysis 271 25.3.1 Patient Position 271 25.3.2 The Surgical Approach 272 25.4 Approach to the Tibial Diaphysis 272 25.4.1 Patient Position 272 25.4.2 The Surgical Approach 272 Reference 274 26 Implants 275 Harold Wotton 26.1 Maneuvering Orthopedic Implants 275 26.2 Quality Implants: Essential Information on Quality Implants 276 26.3 Titanium vs Stainless Steel 276 Index 279