小動物骨折并發(fā)癥

1、FractureComplications骨折并發(fā)癥,赤峰樂園動物醫(yī)院 執(zhí)業(yè)獸醫(yī)師 賈新生下載地址：http://www.frankjia.com/,并發(fā)癥主要來自,延遲愈合不愈合畸形愈合骨折病,延遲愈合,在預期的時間內沒有達到理想的愈合,但是骨折還在慢慢愈合http://www.frankjia.com/,超過4個月的延遲愈合疤痕,最常見的延遲愈合和不愈合,不穩(wěn)定血液供應受損骨折線間距過大組織不足或者

2、減少感染 -> 延遲愈合骨或骨碎片受損http://www.frankjia.com/,Radiographs: 延遲愈合,,骨折線仍然沒有明顯的（羊毛或羽毛狀的外觀）無骨硬化最小的愈傷組織形成的？（一般不銜接,案件為例,4歲的貴賓犬混合嚴重粉碎性近端三分之一股骨骨折http://www.frankjia.com/,4個月后,延遲愈合,9 months post-op,不愈合植入物損壞,延遲愈合的治療,,骨折修復

3、,穩(wěn)定,不穩(wěn)定,拖延時間,檢查雇主遵守休息/嚴格控制行使在4-6周復查X光片,增加/修改固定術,感染,清創(chuàng)死骨,,,,,,,,,,,移植嗎？,,增加/修訂延遲愈合,增加穩(wěn)定性重新排列對合撤除中間影響愈合組織,不聯(lián)合http://www.frankjia.com/,,沒有了成骨細胞活性骨折部位活動手術干預骨折愈合http://www.frankjia.com/,假關節(jié),充滿血液循環(huán)無硬化骨組織的纖維素囊,,骨不連,可行的

4、（生物活性，血管）斷裂的不穩(wěn)定性肥厚貧營養(yǎng)自生能力（生物活性，股骨頭缺血性）供血不足（營養(yǎng)不良性骨折不愈合）感染/封存（壞死骨不連）過度骨折間隙（缺損骨不連）廢用性（萎縮性骨折不愈合）,骨折不愈合的原因,血液供應受損軟組織損傷的程度最初的創(chuàng)傷的嚴重性粉碎骨質流失斷流的骨折碎片感染骨頭愈合，只要他們有血液供應和穩(wěn)定，在面對感染,骨折不愈合的原因,不穩(wěn)定孔隙減少骨枷減少不適當?shù)闹踩氩划斒褂玫闹踩氕h(huán)扎線

5、單一IM pin,骨折不愈合的原因,骨質疏松瘤骨折發(fā)生部位比率 60% in radius/ulna25% tibia15% femur,臨床癥狀-骨不連接,非使用肢體變痛肌肉萎縮關節(jié)僵硬排列不齊的肢體捫不穩(wěn)定上觸診疼痛可能形成假關節(jié),可行的骨骼不連接,生物活性中間人軟骨和纖維組織增生骨反應？,Viable Non-union,Hypertrophic“Elephant foot”,Mo

6、derately Hypertrophic“Horse hoof callus”,Oligotrophic,Insufficient fixationPremature weight-bearing,Plate fixationSome movement,Not enough appositionDisplacement,布列塔尼獵犬,1 year old female/spayed Brittany SpanielFemor

7、al fractureOwner – no money“cheapest repair”12 weeks postsurgicallyhttp://www.frankjia.com/,非可行的骨不連接http://www.frankjia.com/,Uncommon Challenging4 Subtypes營養(yǎng)不良壞死的缺陷萎縮性,,Non-unions,營養(yǎng)不良的不連接,不佳血管 骨折斷端有限的

8、血液供應X光片:可見骨折的差距圓形骨邊緣硬化最常見的玩具品種橈骨遠端尺骨壓裂,壞死性 Non-union,未捕獲的片段？搬家？感染“死骨”Radiographs死了尖銳的鋸齒狀片段成為僵化主要片段：四舍五入,缺失Non-union,缺少大片段槍傷？（軟組織損傷）差距>骨直徑的1.5倍有限的成骨潛能脛骨/半徑/尺骨,萎縮的Non-union,災難端點“非可行”X光片：吸收和圓骨邊緣骨質疏松

9、在所有無骨,,不連接,Tio1 y oldDistalRadiusUlna fracture,Tio,Model of Non-Union,Do NOT splint distal radius/ulna fractures in Miniature breeds!!,Malunion,Fracture healed in abnormal positionTreatment options:Often limit

10、edReturn 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 fract

11、ure treatment and limb immobilizationOsteoporosisMuscle atrophyJoint stiffnessArticular cartilage degenerationAdhesion of muscle to bone End result: Healed fracture and non-functional limb,Pathophysiology of Frac

12、ture Disease,Disuse osteoporosisOften due to immobilization in a cast or splintDisuse muscle atrophyFlexural contracture related to joint immobilization or painMechanical and biochemical changes in joints,Quadriceps

13、Contracture or “Tie-down”,,Most common and severe form of fracture disease in small animalsMost common:Distal femoral fractures in young dogs and catsProlonged coaptation in extension, esp S-T splints,Clinical Signs o

14、f Quadriceps Contracture,Rigid hyperextension of limbFixed extension or hyperextension of stifle (genu recurvatum)Quadriceps muscles firm and atrophiedHip subluxation or patellar luxation secondarilySevere DJD of sti

15、fle secondarily,10 day old fracture,Siamese, 1y old, Salter Harris 2 Fracture of distal femur,,End result: severe quadriceps tiedown,Treatment of Quadriceps Contracture,No consistently effective surgical treatmentRelea

16、se of adhesionsRelease of periarticular tissueMyoplasties, arthrodesisConsider amputationPREVENTION the key:Early post operative limb use is crucial!Stable implantsGood anatomic reductionPost-op physical therapy

17、helpfulUse a 90-90 flexion bandage after surgery,Implant Complications,BreakingPulloutScrew loosening,,,,,,,Summary of Fracture Complications,Doctor error:Improper use of external coaptation or implants!!! Client

18、error:Inadequate confinementFailure to give antibioticsFailure to make scheduled rechecksFlaw in manufacturing of implant (Rare!)Plain old bad luck: undetected neoplasia; Cushing’s disease, etc.,Fracture Complicati

19、ons and Your Client,Clients often very upset when a $2000 surgery failsGuilt from feeling responsible for initial injuryFailure to follow your instructionsPoor pre- or post op communication: GET IT IN WRITING Ask th