DISEASES OF THE MUSCULOSKELETAL SYSTEM Chapter 7

FUNCTIONS OF THE MUSCULOSKELETAL SYSTEM Support structural support/framework for the entire body Storage Minerals (calcium) and lipids. Blood cell production. site of formation for all types of blood cells. Protection vital organs of the body Leverage Many of the joints of the body act as levers therefore assisting with movement. Provides a place for muscles, tendons, ligaments to attached Muscles and skeleton: Support: Skeleton-frame work Storage: Bones and tissue Blood cell production: Bone marrow produces RBC’s Protection: Skin Leverage: Essentially the attachment

MUSCULOSKELETAL SYSTEM Flexible articulations form joints The skeleton is the rigid frame Skeleton: frame Joint: movement Ligaments, muscle, tendons: attachment Muscles, tendons, and ligaments form a system of pulleys

CAUSES OF DISRUPTION TO THE MUSCULOSKELETAL SYSTEM DEGENERATIVE DISEASE TRAUMA Trauma: HBC Degenerative disease: Osteoarthrosis-can be seen in disc of necks or backs Inflammation: torn ligament Neoplasia: malignant tumors INFLAMMATION NEOPLASIA

TRAUMA: LONG BONE FRACTURES Humerus Radius Ulna Femur Tibia Fibula Bone disease, trauma or hbc (main reason you see it). I saw hbc a lot in ICU. Fun fact: It is actually better to set patient up on good pain control and wait to do the surgery the next day. When it first happens, it will be so swollen and surgery is much more traumatic. Deformity of bone, swelling

TRAUMA: CLASSIFICATION OF FRACTURES Open or Compound: broken bone exposed through skin Closed: broken bone beneath intact skin Simple: 1 fracture line (oblique, transverse, greenstick) Comminuted: multiple pieces Stable: ends opposed and fixed (ie. greenstick) Unstable: ends are not aligned, overlapped Compression: a crushing type injury usually of the vertebrae or growth plate If open, you will need to surgery right away. An open wound is at higher risk for infection. Oblique: angle break ,Transverse: straight across, Green stick: not a full break. Stable: because not a full break. Unstable: bone rubbing together.

TRAUMA: DIAGNOSIS OF LONG BONE FRACTURES This oblique fracture would also be an unstable fracture because the ends are overlapping Transverse fracture Oblique fracture

TRAUMA: DIAGNOSIS OF LONG BONE FRACTURES Comminuted: Think of crushed (that’s what it looks like)- remember multiple pieces. Green stick is seen in young animals. Greenstick fracture Comminuted fracture

TRAUMA: DIAGNOSIS OF LONG BONE FRACTURES Hair line fracture: Only the outer layer of the bone is broken. These can be treated with splints or cast. Fissure fractures

TRAUMA: DIAGNOSIS OF LONG BONE FRACTURES It occurs due to a rotational, or twisting, force. It looks like the bone was twisted and broken. Spiral Fractures Name is derived from rotational force placed on the bone which causes it to fracture the way it does

TRAUMA: DIAGNOSIS OF FRACTURES Occurs when one or more bones in the spine weaken and crumple These are also an emergency due to it being the spine and the holder for the spinal cord COMPRESSION FRACTURE

TRAUMA: OPEN or COMPOUND This is an emergency due to higher risk of infection In open fractures bone is exposed through the skin

METHODS OF FIXATION External Coaptation Internal Fixation Splints-a mold of material that surrounds affected area (half cast) Casts-moldable material(fiberglass): molded to the affected limb Internal Fixation IM pins Bone plates, screws Cerclage wire External Coaptation: The use of casts and bandages to help stabilize fractures Cast: They apply bandage material to the limb (not too tight), then they put the fiber glass into warm water. It is lifted out with tongs and placed over the bandage material. It takes about 10 mins to set. The warmer the water the quicker it sets. These patients are under anesthesia or sedation. Usually stays on for 4 weeks. Internal Fixation: A surgical procedure that stabilizes and joins the ends of fractured (broken) bones by mechanical devices such as metal plates, pins, rods, wires or screws Pins can go in through bone to hold them together. Plates usually on the side and screws are used to hold the plate in. Wire can be put through two sides of the bone and then twisted together to hold the bone in place.

METHODS OF FIXATION OF LONG BONE FRACTURES: SPLINTS Can be used for pre operative cases/ You start distally with bandage material and move proximal on limb Use stir-ups to keep bandage and splint from slipping. Need to see toes to check for swelling Fractured tibia splint (DOVE) temporally splint placement In a non-displaced fracture, the bone cracks either part or all of the way through, but does move and maintains its proper alignment QUICKSPLINT METASPLINT or SPOON SPLINT It is critical that the splint support both the joint above and below the injury !

METHODS OF FIXATION OF LONG BONE FRACTURES: CASTS Casts can be made plaster of paris or other moldable material (fiber glass) They apply bandage material to the limb (not too tight), then they put the fiber glass into warm water. It is lifted out with tongs and placed over the bandage material. It takes about 10 mins to set. The warmer the water the quicker it sets. These patients are under anesthesia or sedation. Usually stays on for 4 weeks.

METHODS OF FIXATION OF LONG BONE FRACTURES The Robert Jones bandage is a common external splint applied to a limb for the temporary support of a fracture before surgical intervention can occur. It is used to treat many canine and feline limb injuries (tibial fractures, severe limb lacerations) ROBERT JONES BANDAGE

METHODS OF FIXATION: SPLINTS AND CASTS NOTE: Casts and splints may not prevent rotation or overriding of fracture pieces, and may result in delayed healing or nonunion in some fractures. Splints should be changed weekly Casts can be left in place for several weeks. Nonunion: not getting better.

METHODS OF FIXATION OF FRACTURES Here they used a pin and used wire to go around it and help keep the limb from rotating. IM: Intramedullary pin IM (Steinmann) pins with cerclage wires

METHODS OF FIXATION OF FRACTURES Advantages of IM pins Prevent bending forces Disadvantages Do not prevent rotation or compressive (axial) forces Should be combined with other methods such as cerclage wire to prevent other forces Won’t bend the limb as much, break gets better faster. We leave these in place unless there is an issue.

METHODS OF FIXATION OF LONG BONE FRACTURES: BONE PLATES & SCREWS This is a very common method. Takes a lot of tools to make this happen in the OR. These are fun to scrub into because you will more than likely have to hold the bone for the surgeon.

METHODS OF FIXATION: EXTERNAL FIXATORS These are then covered with bandages around the insertion site and the bandages are changed sterilely. A patient had a shattered tibia and fibula. He had to have an exfix on for a good 6 months. WE would retake rads and then go in and remove bars as the leg improved. Also you tighten the screws as needed too. The point is to not have the bone move. External fixators are pins that penetrate the skin and bones that are attached to fixed bars using special clamps: Kirschner-Ehmer apparatus

CLIENT INFO Restrict activity Watch for drainage, swelling, heat from surgical sites or from splints/casts Metal (plates & pins) stronger than bone – but refracture may occur Follow up x-rays necessary Metal may cause cold sensitivity Management of open fracture wounds (DOVE) 9 mins