2. DISEASES OF THE MUSCULOSKELETAL SYSTEM
Chapter 7

3. 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

4. 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

5. 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

6. 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

7. 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.

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

9. 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

10. 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

11. 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

12. 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

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

14. 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.

15. 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 !

16. 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.

17. 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

18. 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.

19. 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

20. 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.

21. 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.

22. 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

23. 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