《小动物骨折并发症》PPT课件.ppt
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1.增加稳定性2.重新排列对合3.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IMpin骨折不愈合的原因骨质疏松瘤骨折发生部位比率60%inradius/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-unionHypertrophic“Elephant foot”Moderately Hypertrophic“Horse hoof callus”OligotrophicInsufficient fixationPremature weight-bearingPlate fixationSome movementNot enough appositionDisplacement布列塔尼猎犬1yearoldfemale/spayedBrittanySpanielFemoralfractureOwnernomoney“cheapestrepair”12weekspostsurgically非可行的骨不连接UncommonChallenging4Subtypes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Tio1yoldDistalRadiusUlnafractureTioModel of Non-UnionDoNOTsplintdistalradius/ulnafracturesinMiniaturebreeds!MalunionFracturehealedinabnormalpositionTreatmentoptions:OftenlimitedReturntofunctionpossible?KeyPreventionExcellentFollowupIlial and acetabular fractures treated with cage restOne year later dog presents for obstipationFracture DiseaseComplicationsassociatedwithfracturetreatmentandlimbimmobilizationOsteoporosisMuscleatrophyJointstiffnessArticularcartilagedegenerationAdhesionofmuscletoboneEndresult:Healedfractureandnon-functionallimbPathophysiology of Fracture DiseaseDisuseosteoporosisOftenduetoimmobilizationinacastorsplintDisusemuscleatrophyFlexuralcontracturerelatedtojointimmobilizationorpainMechanicalandbiochemicalchangesinjointsQuadriceps Contracture or“Tie-down”MostcommonandsevereformoffracturediseaseinsmallanimalsMostcommon:DistalfemoralfracturesinyoungdogsandcatsProlongedcoaptationinextension,espS-TsplintsClinical Signs of Quadriceps ContractureRigidhyperextensionoflimbFixedextensionorhyperextensionofstifle(genurecurvatum)QuadricepsmusclesfirmandatrophiedHipsubluxationorpatellarluxationsecondarilySevereDJDofstiflesecondarily10 day old fractureSiamese,1y old,Salter Harris 2 Fracture of distal femurEnd result:severe quadriceps tiedownTreatment of Quadriceps ContractureNoconsistentlyeffectivesurgicaltreatmentReleaseofadhesionsReleaseofperiarticulartissueMyoplasties,arthrodesisConsideramputationPREVENTIONthekey:Earlypostoperativelimbuseiscrucial!StableimplantsGoodanatomicreductionPost-opphysicaltherapyhelpfulUsea90-90flexionbandageaftersurgeryImplant ComplicationsBreakingPulloutScrewlooseningSummary of Fracture ComplicationsDoctorerror:Improperuseofexternalcoaptationorimplants!Clienterror:InadequateconfinementFailuretogiveantibioticsFailuretomakescheduledrechecksFlawinmanufacturingofimplant(Rare!)Plainoldbadluck:undetectedneoplasia;Cushingsdisease,etc.Fracture Complications and Your ClientClientsoftenveryupsetwhena$2000surgeryfailsGuiltfromfeelingresponsibleforinitialinjuryFailuretofollowyourinstructionsPoorpre-orpostopcommunication:GETITINWRITINGAskthemtoexplaininstructionstoyouFracture Complications and Your ClientGivealltheoptionsthefirsttimeyouseetheclientSurgeryAmputationEuthanasiaNotreatment(ifthisishumane)ReferralQuestions?
