小動物骨折并發(fā)癥課件

Fracture

Complications骨折并發(fā)癥

執(zhí)業(yè)獸醫(yī)師賈新生下載地址：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(yù)期的時間內(nèi)沒有達到理想的愈合,但是骨折還在慢慢愈合超過4個月的延遲愈合疤痕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4個月后

延遲愈合延遲愈合的治療骨折修復(fù)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(fù)查X光片增加/修改固定術(shù)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

沒有了成骨細胞活性骨折部位活動手術(shù)干預(yù)骨折愈合骨不連可行的（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(yīng)受損

軟組織損傷的程度

最初的創(chuàng)傷的嚴重性粉碎骨質(zhì)流失斷流的骨折碎片感染骨頭愈合，只要他們有血液供應(yīng)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)扎線單一IMpin臨床癥狀-骨不連接非使用肢體變痛肌肉萎縮關(guān)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(guān)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(yīng)？ViableNon-unionHypertrophic“Elephantfoot”ModeratelyHypertrophic“Horsehoofcallus”O(jiān)ligotrophicInsufficientfixationPrematureweight-bearingPlatefixationSomemovementNotenoughappositionDisplacement非可行的骨不連接

UncommonChallenging4Subtypes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

有限的血液供應(yīng)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：四舍五入萎縮的Non-union災(zāi)難

端點“非可行”

X光片：

吸收和圓骨邊緣

骨質(zhì)疏松

在所有無骨不連接Tio1yold

Distal

Radius

Ulna

fractureMalunionFracturehealed

inabnormalpositionTreatmentoptions:OftenlimitedReturntofunctionpossible?

Key

Prevention

ExcellentFollowupIlialandacetabularfracturestreatedwithcagerestOneyearlaterdogpresentsforobstipationFractureDiseaseComplicationsassociatedwithfracturetreatmentandlimbimmobilizationOsteoporosisMuscleatrophyJointstiffnessArticularcartilagedegenerationAdhesionofmuscletoboneEndresult:

Healedfractureandnon-functionallimbPathophysiologyofFractureDiseaseDisuseosteoporosisOftenduetoimmobilizationinacastorsplintDisusemuscleatrophyFlexuralcontracturerelatedtojointimmobilizationorpainMechanicalandbiochemicalchangesinjointsQuadricepsContractureor“Tie-down”MostcommonandsevereformoffracturediseaseinsmallanimalsMostcommon:

DistalfemoralfracturesinyoungdogsandcatsProlongedcoaptationinextension,espS-TsplintsClinicalSignsofQuadricepsContractureRigidhyperextensionoflimbFixedextensionorhyperextensionofstifle(genurecurvatum)QuadricepsmusclesfirmandatrophiedHipsubluxationorpatellarluxationsecondarilySevereDJDofstiflesecondarily10dayoldfractureSiamese,1yold,SalterHarris2FractureofdistalfemurEndresult:severequadricepstiedownTreatmentofQuadricepsContractureNoconsistentlyeffectivesurgicaltreatmentReleaseofadhesionsReleaseofperiarticulartissueMyoplasties,arthrodesisConsideramputationPREVENTIONthekey:Earlypostoperativelimbuseiscrucial!StableimplantsGoodanatomicreductionPost-opphysicaltherapyhelpfulUsea90-90flexionbandageaftersurgeryImplantComplicationsBreakingPulloutScrewlooseningSummaryofFractureComplicationsDoctorerror:Improperuseofexternalcoaptationorimplants!!!

Clienterror:InadequateconfinementFailuretogiveantibioticsFailuretomakescheduledrechecksFlawinmanufacturingofimplant(Rare!)Plainoldbadluck:undetectedneoplasia;Cushing’sdisease,etc.FractureComplicationsandYourClientClientsoftenveryupsetwhena$2000surgeryfailsGuiltfromfeelingresponsibleforinitialinjuryFailuretofollowyourinstructionsPoorpre-orpostopcommunication:GETITINWRITINGAskthemtoexplaininstructionst