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ASHOK KUMAR BALWADA MVSc SURGERY 5133

General
Early

Local
Late

Crush syndrome Tetanus Gas gangrene Fat Embolism

Occur in
Large bulk of muscle crushed Tourniquet left for too long period

What happened?
1st theory =Compression releasedacid myohaematin enter the circulationkidneyblocks the tubulesSHOCK 2nd theory= Renal artey SPASManoxic tubule cells necroseSHOCK
Treatment=

amputation

Tetanus organism live only in dead tissueexotoxin blood & lymph to CNS anterior horn cell

Sign develop Tonic clonic contraction Jaw and face (trismus ) Neck and trunk Diaphragm and Intercostal muscle spasmASPHYXIA

By clostridial infection (esp C.welchii) Anaerobic with low oxygen tension Produce toxinsdestroy cell walltissue necrosis Spreading Treatment Deep penetrating wound should be EXPLORED ALL dead tissue completely EXCISED Doubt about tissue viabilityleft it OPEN

Local Visceral Injury Vascular Injury Nerve Injury Injury of tendon and joint Infection

Fracture around the trunk are often Cx by injury to the adjacent viscera : Etc: Pelvic fracture Etc : Rib fracture lungs

Bladder and urethral rupture


penetration to the

Pneumothorax

direct trauma or due to uncontrolled movements of the fracture fragment during struggling of the animal before fixation of the fracture. Cold extremities distal to the site of injury and excessive bleeding from the injured site.

Treatment Ligation of the involved vessel and proper reduction and rigid fixation of the fracture. prognosis good = surrounding soft tissue is intact. Poor= surrounding soft tissue is severely damaged and signs of ischemia in the involved extremity have become apparent(amputation).

Cause due to direct trauma uncontrolled movements of the fractured ends Radial, obturator, suprascapular and peroneal nerves are more prone to injury. Simple contusion with temporary loss of nerve function complete severing of the nerve and paralysis of involved part.

Treatment Early and effective fixation of fracture should be provided. Prognosis partial nerve damage is good and most cases recover spontaneously in few weeks following fracture treatment and good nursing, In case of complete damage of the nerve, the prognosis is guarded particularly if the animal is recumbent.

occur in fractures involving articular surface or when associated with joint dislocation. Abnormalities in articulations and roughening of the articular surfaces may lead to abnormal wear and arthritic changes. The affected part should be rigidly immobilized to prevent further damage.

Causes:
Open fracture (common) Use of operative method in the Tx of #

Wound becomes inflamed and starts draining seropurulent fluid. Infection may be superficial, moderate (osteomyelitis), severe (gas gangrene). Post-traumatic wound infx is most common cause of chronic osteomyelitis union will be slow and chance of refracturing.

Treatment: Antibiotic Excising all devitalised tissue If Sign of acute infx and pus formation : tissue around the fracture should be opened & drained

Failure of implant Delayed union Non-union Malunion Joint stiffness Avascular necrosis Shortening of bone

Occur more frequently in heavy adult cattle and buffaloes. The complications include excessive wear and tear of plaster cast, bending of splints and bending and loosening of plates, screws and intramedullary pins. The disparity in the size of large ruminants and the currently available internal fixation devices is the major cause of the implant failure.

Selection of devices of appropriate size and strength, their proper fixation and additional external support can reduce the incidence of implant failures to a great extent

Fracture takes more than the usual time to unite. Causes


Inadequate blood supply Severe soft tissue damage Improper fixation Excessive traction Infection Metabolic disturbances ( hyperparathyroidism)

Clinical features

Fracture tenderness

(Esp when subjected to stress)

X-Ray

Visible fracture line Very little callus formation or

periosteal reaction

Severe soft tissue damage

Infection

Excessive traction

Treatment

Conservative

- To eliminate any possible cause - Immobilization - Exercise

Operative

- Indication : Union is delayed > 6 mths No signs of callus formation - Internal fixation & bone grafting

Condition when the fracture will never unite without intervention Healing has stopped. Fracture gap is filled by fibrous tissue (pseudoarthrosis) Causes
Improper Treatment of delayed union Too large a gap Interposition of periosteum, muscle or cartilage between the fragments

Clinical features

Painless movement at the fracture site

X-Ray
Fracture is clearly visible Fracture ends are rounded, smooth and sclerotic Atrophic non-union : - Bone looks inactive

rounded)

(Bone ends are often tapered /

- Relatively avascular Hypertrophic non-union : - Excessive bone formation ` - on the side of the gap - Unable to bridge the gap

Hypertrophic non-union

Atrophic non-union

Treatment

Hypertrophic non-union (Esp long bone)

Rigid fixation (internal / external) sometimes need bone grafting

Atrophic non-union

Fixation & bone grafting

Condition when the fragments join in an unsatisfactory position (unaccepted angulation, rotation or shortening) Causes
Failure to reduce a fracture adequately Failure to hold reduction while healing proceeds Gradual collapse of comminuted or osteoporotic bone. injury to the epiphyseal area in young animals

Clinical features

Deformity & shortening of the limb Limitation of movements

Treatment

Angulation in a long bone (> 15 degrees)

Osteotomy & internal fixation

Marked rotational deformity

Osteotomy & internal fixation

Common complication of fracture Tx following immobilization Common site : knee, elbow, shoulder, small joints of the hand Causes
Oedema & fibrosis of the capsule, ligaments, muscle around the joint Adhesion of the soft tissue to each other or to the underlying bone (intra & peri-articular adhesions) Synovial adhesions d/t haemarthrosis

Treatment

Prevention :

- Exercise - If joint has to be splinted Make sure in correct position

Joint stiffness has occurred:

- Prolonged physiotherapy - Intra-articular adhesions Gentle manipulation under anaesthesia followed by continuous passive motion - Adherent or contracted tissues Released by operation

Circumscribed bone necrosis Causes


Interruption of the arterial blood flow It is a common complication when the fracture involves the articular end of a bone fractured fragment is devoid of soft tissue attachments and depends entirely on intramedullary circulation for nutrition. excessive periosteal stripping during surgical intervention

Clinical features Joint pain, stiffness, swelling X-Ray The adjoining normal bone, however, shows the signs of demineralization due to hyperaemia. The adjacent normal bone appears to be mottled while the avascular bone retains its original appearance. However, gradually the avascular bone loses its original appearance and ultimately collapses into an irregular mass end result will be non-union, and osteoarthritis

Treatment early and rigid fixation can prevent avascular necrosis. If extensive soft tissue damage, excision of avascular fragments is indicated. Excision arthroplasty can minimize the changes and disorganization of the adjacent joint surfaces and maintains the functional activity by formation of false joint in cases of fractures of the femoral head and neck

Cause Loss of bone following comminuted and multiple fracture Overriding of fracture fragment Injury to epiphyseal plate Treatment Prevented by using proper reduction and fixation techniques In bone loss use of bone graft