1. MANAGEMENT OF FRACTURES
AJADI R ADETOLA
DEPARTMENT OF VETERINARY MEDICINE & SURGERY

2. Aim of Fracture Management
Restore bone back to normal anatomical alignment
Restore function
Alleviate or control pain
Treat soft tissue damage
Prevent infection

3. Emergency Treatment of Fractures: General Measures
Ensure adequate ventilation
Control haemorrhage
Treat shock
Prevent infection
Repair wound

4. Splinting Aimed at preventing injury to soft tissue
Reduce soft tissue injury
Alleviate pain occasioned by bone movement
Use Robert Jones dressing, Thomas splint, Plastic splint or Mason metal splint

5. Fracture: Causes of pain
Movement of bones against each other
Post-operative oedema or swelling
Role of interleukins secondary

6. Fracture Management: Pain Relief
Application of splint
Use of tranquilizer
Use of opioid analgesics
Non-steroidal analgesics

7. Fracture and Shock Usually associated with severe trauma
Psychogenic shock is common in toy breeds

8. Fracture: Management of shock
Maintain patent air- passage way and ventilate the animal
Maintain circulating blood volume
Control pain
Administer corticosteroid
Administer tranquilizer

9. Bone Reduction: Definition
The entire process of restoring close apposition and alignment of the fracture fragments

10. Close Reduction
Non invasive method of restoring close apposition and alignment of fracture fragments

11. Close Reduction: Advantages
Minimal risk of haemorrhage
Minimal risk of infection
Minimal requirement for anaesthesia
Relatively cheap
Required little instrumentation or expertise

12. Close Reduction: Disadvantages
Increased risk of soft tissue damage
Poor or inadequate bone reduction
Interposition of soft tissue between fragment ends
Does not allow the use of internal immobilization device
Higher incidence of non-union or mal-union

13. Close Reduction: Techniques
Manipulation: toggling or angulation
Traction
Counter-traction

14. Open Reduction: Definition
Restoration of closed apposition of bone fragments through skin incision and muscle separation at the fracture site.

15. Open Reduction: Indications
Recent fractures in which muscle spasm makes close reduction difficult
Intracapscular fracture
Delay or non-union fracture
Application of internal fixation device
Treatment of malalignment
Removal of sequestra
Removal of internal fixation

16. Open Reduction: Advantages
Allows accurate reduction
Allows use of internal fixation device to provide rigid immobilization
Prevent injury to nerves and blood supply
Prevents interposition of soft tissue between fracture ends
Minise complications of fracture healing

17. Open Reduction: Disadvantages
Increase risk of infection
Interference at first stage of bone healing
Increased risk of anaesthesia
Increased instrumentation and expertise
Stripping of muscle from periosteum may cause delayed union
It is expensive

18. Signs of Adequate Bone Reduction
Restoration of length not of paramount important in quadruped
Re-alignment of bone and adjacent joints
Correction of rotational displacement
Apposition of fragments ends sufficient to ensure healing
Radiographic verification of bone alignment

19. Fracture Immobilization: Definition
Fixation of the fracture segment in the reduction position during the period of healing

20. Features of Ideal Fixation Method
Should maintain apposition of the fracture fragments throughout the period of bone healing.
Should allow movement of as many joints as compatible with the apposition
Should not compromise blood or nerve supply to the bone or soft tissue
Should be removable or completely inert in tissues for the life of the animal
Be well tolerated by the animal and require minimum after care
Be economically feasible for average client

21. External Immobilization Devices
Plaster of Paris cast
Plaster splint
Mason metal splint
Aire cast
Thomas splint
Modified Robert Jones
Kirschner- Ehmer splint

22. Limitations to The Use of External Immobilization Device
Stability of the fracture
Location of the fracture
Presence of infection
Temperament of the animal
Availability of material

23. Plaster of Paris Cast: Advantages
Easy to apply
Ready availability of materials
Cast can be molded to maintain very definite position of the bones
Allows for easy ambulation

24. Plaster of Paris Cast: Disadvantages
Can easily be made too tick or heavy
Provides inadequate immobilization of the femur or humerus
May further impede circulation in cases of severe post- operative swelling
Impairs treatment of open wound
Does not allow for vaporization of wound exudates
Requires general anaesthesia or tranquilization inorder for cast to set properly set

25. External immobilization device: Signs to monitor
Change in temperament of the animal
Unexplained soiling of the device
Swelling proximal or distal to the device
Inability of the animal to tolerate the device
Displacement of the device from the site of application

26. Internal Fixation Devices: Advantages
Early return to full function of limbs
Accurate anatomic reduction
Avoidance of fracture diseases
Accessibility for treatment of soft tissue injuries
Minimal care during convalescence

27. Internal Fixation Devices
Intramedullary pins
Bone plates
Intrafragmentary compression devices

28. Intramedullary Pins Steinman pins Rush pins Kuentscher nail Jonas pins
Kirschner wire

29. Bone Plates Finger or small fragment plates Compression plates
Spinal plates

30. Intrafragmentary compression devices
Cortical screw
Lag screw
Tension band wire
Cerclage wire
Hemi- cerclage wire
Smille nail

31. Treatment of Fracture: First 6-8 hrs
Debride the edges of the wound
Protect wound with sterile gauze
Apply traction to prevent bone movement and clip the hair
Scrub the area and apply drape
Trim the edges of the wound and enlarge if necessary
Irrigate wound with copious amount of ringers solution
Trim away all devitalized tissue and remove bone without soft tissue attachment
Re-drape and prepare for aseptic surgery
Reduce the fractured bone
Apply a suitable fixation device

32. Treatment of open fracture: Wound closure
Early wound closure turns open fracture into closed fracture thus preventing secondary infection and osteomyelitis
Undermine skin edges to provide some relief of tension
Close fascia loosely to prevent trapping of fluid
Eliminate all dead space
Apply local antibiotics

33. Contra-indications to primary wound closure
Wound over hours
Severe swelling
Extensive skin necrosis
When adequate debridement is not possible

34. Treatment of Fracture: After 8- 10 hrs
Do not close the wound immediately as infection is likely to occur
After debridement, pack the wound with sterile Vaseline gauze
Immobilize area with Robert Jones dressing or plaster cast
Administer systemic antibiotics and observe closely for sign of local or systemic infection
Close wound 6-7 days after and institute definitive fracture treatment
Bone plate is preferred in the presence of threatened infection as it leaves the medullary blood supply intact

35. THANK YOU