小动物骨折并发症ppt课件

1、FractureComplications骨折并发症骨折并发症 赤峰乐园动物医院 执业兽医师 贾新生下载地址：frankjia/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到达理想的愈合,但是骨折还在渐渐愈合frankjia/超越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缺乏或者减少感染 - 延迟愈合骨或骨碎片受损frankjia/Radiographs: 延迟愈合骨折线依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构成的？普通不衔接案件为例4岁的贵宾犬混合严重粉碎性近端三分之一股骨骨折frankjia/4个月后延迟愈合9

2、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憩/严厉控制行使在4-6周复查X光片添加/修正固定术感染清创死骨移植吗？添加/修订延迟愈合添加稳定性重新陈列对合撤除中间影响愈合组织不结合frankjia/没有了成骨细胞活性骨折部位活动手术干涉骨折愈合frankjia/假关节充溢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才干生物活性，股骨头缺血性供血缺乏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缘由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

3、流失断流的骨折碎片感染骨头愈合，只需他们有血液供应和稳定，在面对感染骨折不愈合的缘由不稳定孔隙减少骨枷减少不适当的植入不当运用的植入环扎线单一IM pin骨折不愈合的缘由骨质疏松瘤骨折发生部位比率 60% in radius/ulna25% tibia15% femur临床病症-骨不衔接非运用肢体变痛肌肉萎缩关节生硬陈列不齐的肢体扪不稳定上触诊疼痛能够构成假关节可行的骨骼不衔接生物活性中间人软骨和纤维组织增生骨反响？Viable Non-unionHypertrophic“Elephant footModerately Hypertrophic“Horse hoof callusOligotr

4、ophicInsufficient fixationPremature weight-bearingPlate fixationSome movementNot enough appositionDisplacement布列塔尼猎犬1 year old female/spayed Brittany SpanielFemoral fractureOwner no money“cheapest repair12 weeks postsurgicallyfrankjia/非可行的骨不衔接frankjia/Uncommon Challenging4 Subtypes营养不良坏死的缺陷萎缩性Non-un

5、ions营养不良的不衔接不佳血管 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种类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死了锋利的锯齿状片段成为僵化主要片段：四舍五入缺失Non-union短少大片段枪伤？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一切无骨不衔接Tio1 y oldDistalRadiusUlna fractureTioModel of Non-UnionDo NOT splint distal radius/

6、ulna fractures in Miniature breeds!MalunionFracture healed in abnormal positionTreatment options:Often limitedReturn to function possible?KeyPrevention Excellent FollowupIlial and acetabular fractures treated with cage restOne year later dog presents for obstipationFracture DiseaseComplications asso

7、ciated with fracture treatment and limb immobilizationOsteoporosisMuscle atrophyJoint stiffnessArticular cartilage degenerationAdhesion of muscle to bone End result: Healed fracture and non-functional limbPathophysiology of Fracture DiseaseDisuse osteoporosisOften due to immobilization in a cast or

8、splintDisuse muscle atrophyFlexural contracture related to joint immobilization or painMechanical and biochemical changes in jointsQuadriceps Contracture or “Tie-downMost common and severe form of fracture disease in small animalsMost common:Distal femoral fractures in young dogs and catsProlonged c

9、oaptation in extension, esp S-T splintsClinical Signs of Quadriceps ContractureRigid hyperextension of limbFixed extension or hyperextension of stifle (genu recurvatum)Quadriceps muscles firm and atrophiedHip subluxation or patellar luxation secondarilySevere DJD of stifle secondarily10 day old frac

10、tureSiamese, 1y old, Salter Harris 2 Fracture of distal femurEnd result: severe quadriceps tiedownTreatment of Quadriceps ContractureNo consistently effective surgical treatmentRelease of adhesionsRelease of periarticular tissueMyoplasties, arthrodesisConsider amputationPREVENTION the key:Early post

11、 operative limb use is crucial!Stable implantsGood anatomic reductionPost-op physical therapy helpfulUse a 90-90 flexion bandage after surgeryImplant ComplicationsBreakingPulloutScrew looseningSummary of Fracture ComplicationsDoctor error:Improper use of external coaptation or implants! Client error

12、: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 ClientClients 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 e