小动物骨折并发症.ppt

可行的骨骼不连接 生物活性中间人软骨和纤维组织增生骨反应？ Viable Non-union Hypertrophic “Elephant foot” Moderately Hypertrophic “Horse hoof callus” Oligotrophic Insufficient fixation Premature weight-bearing Plate fixation Some movement Not enough apposition Displacement 布列塔尼猎犬 1 year old female/spayed Brittany Spaniel Femoral fracture Owner – no money“cheapest repair” 12 weeks postsurgically / 非可行的骨不连接/ Uncommon Challenging 4 Subtypes 营养不良 坏死的 缺陷 萎缩性 Non-unions 营养不良的不连接 不佳血管?骨折断端有限的血液供应 X光片: 可见骨折的差距圆形骨边缘硬化最常见的玩具品种桡骨远端尺骨压裂 坏死性 Non-union 未捕获的片段？ 搬家？ 感染“死骨” Radiographs 死了尖锐的锯齿状片段 成为僵化 主要片段：四舍五入 缺失Non-union 缺少大片段枪伤？（软组织损伤）差距骨直径的1.5倍有限的成骨潜能胫骨/半径/尺骨 萎缩的Non-union 灾难端点“非可行”X光片：吸收和圆骨边缘骨质疏松在所有无骨 不连接 Tio 1 y oldDistalRadiusUlna fracture Tio Model of Non-Union Do NOT splint distal radius/ulna fractures in Miniature breeds!! Malunion Fracture healed in abnormal position Treatment options: Often limited Return to function possible? KeyPrevention Excellent Followup Ilial and acetabular fractures treated with cage rest One year later dog presents for obstipation Fracture Disease Complications associated with fracture treatment and limb immobilization Osteoporosis Muscle atrophy Joint stiffness Articular cartilage degeneration Adhesion of muscle to bone End result: Healed fracture and non-functional limb Pathophysiology of Fracture Disease Disuse osteoporosis Often due to immobilization in a cast or splint Disuse muscle atrophy Flexural contracture related to joint immobilization or pain Mechanical and biochemical changes in joints Quadriceps Contracture or “Tie-down” Most common and severe form of fracture disease in small animals Most common:Distal femoral fractures in young dogs and cats Prolonged coaptation in extension, esp S-T splints Clinical Signs of Quadriceps Contracture Rigid hyperextension of limb Fixed extension or hyperextension of stifle (genu recurvatum) Quadriceps muscles firm and atrophied Hip subluxation or patellar luxation secondarily Severe DJD of