VCS 502: VETERINARY ORTHOPEADICS & DIAGNOSTIC IMAGING LECTURE NOTES DR. TIMOTHY, A.O. OLUSA (DVM, MVSc) DEPARTMENT OF VETERINARY MEDICINE & SURGERY UNIVERSITY OF AGRICULTURE ABEOKUTA, NIGERIA AUGUST, 2010

TOPIC: COMPLICATIONS OF FRACTURE MANAGEMENT INTRODUCTION What is a fracture? ►A break in the continuity of the cortex of the bone What is the goal of fracture management? ►To re-establish continuity of broken segments and subsequent functionality

INTRODUCTION (CONT’D) What are the complications that can occur while managing fracture ? ► DELAYED UNION ► NON UNION ► MAL UNION ► OSTEOMYELITIS

WHAT IS DELAYED UNION? A fracture that do not heal within the expected period of time (usually 6-8 weeks). The period of healing depends on: ► Age ► Species ► Fracture site ► Type of fracture

WHAT ARE THE MAJOR CAUSES OF DELAYED UNION? Inadequate immobilization Inadequate blood supply Mal-alignment of fracture fragments Interposition of soft tissues in fracture site

ARE THERE OTHER CAUSES OF DELAYED UNION? Age Infection Starvation Type & site Pathological bones High dose of corticosteroids

HOW IS DELAYED UNION RECOGNIZED? When a fracture is taking longer time to heal than it should When radiographic signs shows: ► persistent radiolucent fracture line ► minimum periosteal reaction with no bridging callus at the fracture site

HOW IS DELAYED UNION MANAGED? Make sure fixation method is adequate Restrict activity Prolong immobilization Wait & re-radiography in 4 wks ► With adequate time and immobilization, most fractures will unite

NON UNION What is non union? ► Cessation of bone healing ► Union will not occur without surgical intervention

What can cause non union? Inadequate immobilization Improper reduction Rotation Angulations/collapse of fracture segments during healing

How can non union be detected? Painful motion at fracture site Muscle atrophy Progressive deformity Disuse of limb

How can non union be confirmed? Radiographic signs: ► sclerotic bone ends ► gap btw bone fragments ► sealed medullary cavities ► Smooth rounded fracture ends ► Pseudo- arthrosis ► No evidence of bridging callus

Can non union be treated? Yes! This relies on the surgeon’s ability to identify the etiology of the problem. E.g: If fracture is unstable? ► provide adequate stability If avascular? ► encourage vascularity (add autogenous cancellous graft)

Still managing non union! Remove dead/necrotic bone (sequestra) Provide rigid internal fixation Pack site with autogenous cancellous graft Control infection

MALUNION What is malunion? ► Angulatory or rotatory deformity ► Occurs when bone heal into malposition or nonfunctional anatomic position

What can cause malunion? Non treatment of fractures Premature removal of internal or external fixation Improper reduction Rotation, angulations or collapse of fracture fragments during healing process

How is malunion recognized? Radiographic signs: ► Good callus formation ► Malaligned, rotated or distracted healed bone

Can malunion be treated? Osteotome the fracture site Re-align Place rigid internal fixation

OSTEOMYELITIS What is osteomyelitis? How is it diagnosed and managed? ► Find out! ► It’s your take home test (25 marks)!