小动物骨折并发症.ppt
FractureComplications骨折并发症,赤峰乐园动物医院 执业兽医师 贾新生下载地址：,并发症主要来自,延迟愈合不愈合畸形愈合骨折病,延迟愈合,在预期的时间内没有达到理想的愈合,但是骨折还在慢慢愈合,超过4个月的延迟愈合疤痕,最常见的延迟愈合和不愈合,不稳定血液供应受损骨折线间距过大组织不足或者减少感染-延迟愈合骨或骨碎片受损,Radiographs:延迟愈合,骨折线仍然没有明显的（羊毛或羽毛状的外观）无骨硬化最小的愈伤组织形成的？（一般不衔接,案件为例,4岁的贵宾犬混合严重粉碎性近端三分之一股骨骨折,4个月后,延迟愈合,9 months post-op,不愈合植入物损坏,延迟愈合的治疗,骨折修复,稳定,不稳定,拖延时间,检查雇主遵守休息/严格控制行使在4-6周复查X光片,增加/修改固定术,感染,清创死骨,移植吗？,增加/修订延迟愈合,增加稳定性重新排列对合撤除中间影响愈合组织,不联合,没有了成骨细胞活性骨折部位活动手术干预骨折愈合,假关节,充满血液循环无硬化骨组织的纤维素囊,骨不连,可行的（生物活性，血管）断裂的不稳定性肥厚贫营养自生能力（生物活性，股骨头缺血性）供血不足（营养不良性骨折不愈合）感染/封存（坏死骨不连）过度骨折间隙（缺损骨不连）废用性（萎缩性骨折不愈合）,骨折不愈合的原因,血液供应受损软组织损伤的程度最初的创伤的严重性粉碎骨质流失断流的骨折碎片感染骨头愈合，只要他们有血液供应和稳定，在面对感染,骨折不愈合的原因,不稳定孔隙减少骨枷减少不适当的植入不当使用的植入环扎线单一IM pin,骨折不愈合的原因,骨质疏松瘤骨折发生部位比率 60%in radius/ulna25%tibia15%femur,临床症状-骨不连接,非使用肢体变痛肌肉萎缩关节僵硬排列不齐的肢体扪不稳定上触诊疼痛可能形成假关节,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 fixationPremature weight-bearing,Plate fixationSome movement,Not enough appositionDisplacement,布列塔尼猎犬,1 year old female/spayed Brittany SpanielFemoral fractureOwner no money“cheapest repair”12 weeks postsurgically,非可行的骨不连接,Uncommon Challenging4 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,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 limitedReturn 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 immobilizationOsteoporosisMuscle atrophyJoint stiffnessArticular cartilage degenerationAdhesion of muscle to bone End result:Healed fracture and non-functional limb,Pathophysiology of Fracture 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 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 of 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 stifle 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 treatmentRelease of adhesionsRelease of periarticular tissueMyoplasties,arthrodesisConsider amputationPREVENTION the key:Early post operative limb use is crucial!Stable implantsGood anatomic reductionPost-op physical therapy 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 error:Inadequate confinementFailure to give antibioticsFailure to make scheduled rechecksFlaw in manufacturing of implant(Rare!)Plain old bad luck:undetected neoplasia;Cushings disease,etc.,Fracture Complications 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 them to explain instructions to you,Fracture Complications and Your Client,Give all the options the first time you see the clientSurgery AmputationEuthanasiaNo treatment(if this is humane)Referral,Questions?,
