Page 762 - Cote clinical veterinary advisor dogs and cats 4th

359.e2 Fracture Complications/Disease

Fracture Complications/Disease Client Education
Sheet
VetBooks.ir BASIC INFORMATION DIAGNOSIS • Limb amputation if problem is intractable

weeks for simple wounds, up to 6 weeks if
Definition Diagnostic Overview • Continue appropriate antibiotics total 2
Fracture complications include infections Physical exam and radiographs are usually osteomyelitis/septic arthritis
(wound/joint/bone), implant failure, inadequate sufficient to establish a diagnosis; bacterial Recommended Monitoring
bone union, stress-protection osteopenia, culture and sensitivity is sometimes indicated.
malalignment, implant-related cold conduction, • Serial radiography to evaluate bone healing
ischemic/rub wounds, muscle contracture, Differential Diagnosis • Serial exams/goniometry to evaluate limb
neurologic deficits, and osteoarthritis. These • Bone neoplasia function/range of motion
result in temporary or permanent abnormal • Osteomyelitis
limb function. Osteomyelitis is discussed in • Joint subluxation PROGNOSIS & OUTCOME
another chapter (p. 725). • Septic arthritis
• Other nonfracture causes of lameness • 94% of septic arthritis resolves with irrigation
Epidemiology and appropriate antibiotic treatment for a
SPECIES, AGE, SEX Initial Database minimum of 28 days
Muscle contracture is most common in young • Orthopedic exam (p. 1143) • Nerve damage: good if deep pain sensation
dogs with femoral fractures. • Neurologic exam (p. 1136) preserved, poor if lost
• Evaluate range of motion (goniometry) • Good for most vascular inadequate unions
RISK FACTORS • Orthogonal-view radiography when treated properly, guarded if atrophic
• Limb trauma • CBC considered when infection suspected nonunion
• Open or infected fractures • Culture and susceptibility testing of wound • Poor if joint ankylosis or muscle contracture
• Surgical technique errors if infection suspected • Residual osteopenia expected after plate
• Poor postoperative care/rehabilitation removal
• Inadequate stabilization Advanced or Confirmatory Testing
• Arthrocentesis with synovial fluid analysis PEARLS & CONSIDERATIONS
Clinical Presentation if septic arthritis suspected (pp. 1059 and
DISEASE FORMS/SUBTYPES 1384) Comments
Delayed union/nonunion/malunion, implant • If indicated, muscle biopsy • Prevention of contractures is easier than
failure, neurologic deficits, joint ankyloses, • If indicated, electromyography treatment.
stress-protection osteopenia, malalignment, • For distal limb fractures, the use of smaller
implant-related cold conduction, ischemic/ TREATMENT implants with added external coaptation
rub wounds, muscle contracture, osteoarthritis, may reduce risks of stress protection or cold
surgical site infection, osteomyelitis, septic Treatment Overview conduction.
arthritis The goals are to restore limb function and
resolve any infection.
HISTORY, CHIEF COMPLAINT
• Abnormal wound or limb alignment/function Acute General Treatment
after fracture stabilization • Replacement of failed implants and restabi-
• Lameness, specifically when outside in the lization of fracture(s)
cold (implant-related cold conduction) • Extracorporeal shock wave therapy (ECSW),
pulsed electromagnetic fields (PEFs), or
PHYSICAL EXAM FINDINGS autogenous bone graft/graft substitutes,
Any of these findings: joint or limb swelling, depending on type of inadequate bone
draining tracts, lameness, limb malalignment, union
knuckling or collapse of limb, muscle atrophy/ • Plate removal if stress-protection osteopenia
fibrosis, ischemic necrosis, rub wounds, or cold conduction
decreased range of motion • Intensive physical rehabilitation to fight/
prevent muscle contractures
Etiology and Pathophysiology • Consider resection of scar tissue to
• Inappropriate selection of implants during regain joint range of motion if muscle
repair contracture
• Excessive patient activity after surgery • For infected wound, irrigation and cepha-
• Inadequate postoperative rehabilitation to lexin 22-30 mg/kg PO q 12h until culture/
enhance range of motion/limb function sensitivity results are available
• Impingement of implants on joints, nerves, • For septic arthritis, joint irrigation with ingress/
or soft-tissue structures egress 18-gauge needles or via arthroscopy/
• Nerve injury arthrotomy
• Severe soft-tissue damage from injury/surgery,
and subsequent ischemia/fibrosis Chronic Treatment FRACTURE COMPLICATIONS/DISEASE Left
• Bacterial contamination of the fracture/ • Continue the ECSW or PEF protocol (if quadriceps contracture after femoral fracture repair
implants chosen) to treat a delayed union. and no physical rehabilitation in a young dog.

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