1. 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

2. 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

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

4. 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

5. 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

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

7. 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

8. 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

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

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

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

12. 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

13. 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)

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

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

16. 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

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

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

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