eChapters

Purpose-To now the technique of application of thick layer sterile absorbent protective cotton padding over fractured site and its retention with thread ligature in order to protect the bone from further damage

Site-Generally area joint above and joint below of fractured site of bone needs to be covered with a thick layer for perfect immobilization of fractured bone.

Aim: To know the technique of application of first layer padded cloth and its thread

Purpose

To strengthen gum bandage in order to keep the fracture perfectly immobilized.

Materials required

Soft cotton padding, Adhesive gum, netted bamboo with soft padding, retention ligature.

CORPUS

Fixation of rubber slipper over the foot, after application of fracture, immobilising devices the foot is protected with rubber slipper to avoiding soiling and affection of foot (Fig. No-1).

The foot protection the protective rubber slipper is applied given to both their foot (Fig No.2).

Gum bandage, immobilised limb (Fig No.3).

As well as POP cost application (Fig No. 4).

The rubber could be given anterior to posterior derection to avoid entering of soiling towards the foot.

The slipper retain in position with due to splint.

Classification of fracture and its repair in large animal practice by external completion method.

Aim

To know the different level of fracture limbs. In order to access their method of repair (Fig.1).

DEFINITION

Lower level fracture in animals include any fracture of the region from knee joint to foot in forelimb and from hock joint to foot in hind iimbs.

CFERA’nVE PROCEOURE-H ere the principle of treatmient is application of cast and conjoint metal ‘U’ plate over the fractured site. Permanent immobilization of the limb should be done only after 7 days to subside.

Length to be covered-Forelimb-above knee joint and below foot. Hind limb-above hock joint and below foot, (as shown in fig.1)

Padding-6-12 layer thick padded cloth should be vmapped applying gum.s throughout the doth area, over the fracture, it should not be too tight but it should be strong. Sloughing off the hoof may result due to hypostatic congestion; hence the hooves should not be left open. (Cotton pad as shown in fig.2)

Aim

To know the immobilization technique for fractured metatarsus.

The fractured metatarsus comes under lower level fracture whose immobilisation is cast as well as conjoined U-Plate application. (Fig. 1).

Requirements

Thick padded cloth (Fig. 2(a)

Padded netted bamboo splint (Fig. 2(b)

Conjoined U plate (Fig. 2(c)

Fracture of meta-carpals and meta-tarsals comes under lower level fracture. Padded cloth and netted bamboo splint along with conjoint U plate has been considered as standard method of repair.

The fractufe is a lower level fracture involving the meta-carpal and meta- tarsal bones. (Fig.1 & Fig.2)

The fracture site is immobilized extending joint below and joint above level initially with cloth or cotton padding.(Fig.3)

Netted bamboo splint Is applied over it for support involving joint above and joint below which should not be too tight or too loose.(Flg.4)

Splints are retained in position by thread with knots. The ends of bamboo splint kept padded to avoid skin damage.(Fig.4)

More strength is given to immobilisation by application of conjoint U- plate.Conjoint U-plate is a U shaped metallic plate used for lower level fracture immobilisation. (Fig.5 & Fig.6)

At the end the entire bandage is covered with cloth or a bandage roll.The hoof should also be bandaged to avoid damage due to improper blood circulation.(Flg.6)

Definition

Fracture of radius-ulna & tibia-fibula comes under middle level fracture.

Methods of Fracture Repair

External coagtation bandage along with thomas splint application.

Technique for Fracture Repair

Animal controlled with lateral recumbency with fractured limb upward.

Fracture of radius-ulna & tibia-fibula comes under middle level fracture. Pop caste application or bandage along with Thomas splint has been considered as standard method of repair.

The fracture site is immobilized extending between joint below and joint above level with either gum bandage or pop caste bandage (Fig.1).

Pop caste bandage is generally applied after 7 days. Hence gum bandage is preferred than pop caste bandage because of immediate application after occurrence of fracture (Fig.2).

For gum bandage application, a 8-16 layer thick cloth is wrapped over the fracture region covering the joint above & joint below of the site after liberal application of fevicol gum. The cotton cloth Is placed in position with few cotton thread knots (Fig.3).

4 bamboo splints are kept on the 4 sites of the limb over cotton padding. The end of bamboo splints kept padded to avoid skin damage. Splints are retained in position by thread with knots (Fig.4).

A 2^nd layer fevicol gum is applied over entire bandage & finally the entire bandage cloth is covered with bandage roll (Fig.5).

At the end the immobilized limb is over strengthened with Thomas splint (Fig. 6).

Definition

Fracture of humerus bone and femur bone are generally categorised under higher level fracture.

Methods Used For Fracture Repair

These level fractures are repaired appropriately by intramedullary pinning and Thomas splint application.

Only pinning or only Thomas splint are not the method for its repair as the distal fragments of bone get tourqed by pinning only and the fracture fragments get distracted by simple Thomas splint application.

Hence after pinning a humerus or femur bone, the limbs are kept immobilised perfectly by Thomas splint application.

When pinning as well as Thomas splint application are not possible the fractured bones are kept immobilised with fevicol gum bandage only. So for this purpose modification of velpeau sling is generally adopted and animal is restrained within limited space for 21 days.

Definition

Fracture of humerus and femeur bone has been grouped under higher level fracture. Pinning as well as Thomas splint application are considered to be the approved method of immobilization for repair of these bone fracture.

Both method of repair are highly essential. Any one method of repair has been considered dangerous for the animal. Only pinning of the bone makes the limb to be turked where as only Thomas splint application disturbes the bone alignment at fracture site. Hence leaving one method of repair other method is not possible.

When above method of repair is not possible a modification of velpue sling can be attempted.

Definition

Any fracture or discontinuity in bony structure like scapula and pelvic girdle present above the shoulder joint and hip joint respectively are called as highest level fracture.

Aim

To know the method of repair of highest level fracture.

Procedure

As there is no satisfactory method of external immobilisation till date, generally animal is kept under restricted movement. Sometimes application of charge (glue bandage) externally may give some satisfactory result.

Fracture of scapula, shoulder dislocation, fracture of pelvic girdle, hip dislocation have been grouped under highest level fracture.

For large animal, immobilization of bone & joint have not been developed satisfactorily/ till date. Hence after correction of dislocation or rearrangement of fractured the site Is kept immobilized with application of gum bandage.

Aim

To know the use of Conjoined ‘U’ Plate with Padded ring for fracture side immobilization.

Site to be immobilized

Upper 3^rd metacarpus, Carpo - meta carpo joint dislocation, Radio - Carpal Joint dislocation. Lower Radius & Ulna fracture are can also be immobilised with this device

Definition

Handing pin cast is used for management of longbone fracture. Pin which is used for immobilisation of fracture of proximal radial and tibial bones is called hanging pin cast.

Special equipment

Intramedullary pin, hand driven drill, plaster of paris bandage Procedures :,

Definition

Humerus is long selender and has slight spiral twist.

Oblique type of fracture is most common in diaphyseal region.

It come under higher level of fracture.(Fig. No-1)

Appropriate method of fixation is by intramedullary pinning and modified thomas splint.

Definition

Fracture of femur comes under higher level fracture (Fig. 1) where the appropriate treatment is intramedullary pinning and modified Thomas Splint.

Requirement

Parentral sedative

Local anaesthesia

6mm 1fit long intramedullary pin (Fig.No-3)

Electric bone drill

Bone hammer

Pin cutter

Clsssification

Fracture of upper third humerus, shoulder dislocation and scapula has been grouped under highest level fracture. (Fig.1)

Purpose

To know the method of casting the highest level fracture by modified valeau sling application.

Requirement

Thick 8 layer cotton padding, adhesive gum, 6"-8" long bandage rolls.

Indication: Highest level fracture (femur fracture) (Fig. 1)

Treatment: Modified Velpeau Sling application

Requisite

Adhesive gum

Damage Cloth

Strong bamboo

4 feet long of 4 inch diameter

Gl.Wire

6 mm diameter of 34 kg G.l. wire

Aim:- To know the measurement for preparation of an appropriate size of ring of Thomas splint for a large animal.

Objective: Measurement of an appropriate size Thomas splint essential to avoid complications like tight fitting which may affect bone healing.

Materials required: 6mm G.l. wire, jute thread

Aim

To know the methods of preparation of side bars for large animal Thomas splint fabrication

Procedure

Two strong dry matured bamboo splints are of more than actual length of Thomas splint are prepared, (figure 1)

Three nicks at a distance of 2 inch are grooved on the side of the side of the splint at one end of the splints for keeping the tying end of the ropes in position (figure -2)

The bamboo splints at the lateral ends are thinned to some extent. For knob kniiting of splint to the metal ring by making an arc (figures).

All the steps are depicted in figure 1 -4.

Before fixing the metal ring with the bamboo extention splint the thinned ends are emersed inside water for easy arching of the bamboo splint.

Purpose

Method of tying with bamboo splint with ring is very important because of the following points.

A string fitting with the bamboo splint is required as with loose fitting with it may come up at any stage before actual bone healing.

Aim

To knw the method of softening the ring of the perpendicular Thomas splint to avoid direct trauma of the metal wire with the skin.

Materials required

Jute /thin gunny bag,bandage roll,cotton threads

Aim: Bending of the lower half of the ring of Thomas splint to an angle 45- 60degree to comfort the limb and to provide free circulation.

Importance

After tieing the ring with bamboo splint and padding the ring with jute and cotton .bending the lower half of the ring upto more than 45 degree angle is highly essential because of placement of the fractured limb within the ring of Thomas splint comfortably, so as to the flow of blood circulation in fractured limb uninterruptedly.

Aim: To know the actual length of a Thomas splint & measurement for an animal.

Procedure

Animal is kept in lateral recumbancy with affected limb upward.

After padding & medical bending of Thomas splint, it is fitted upon the fractured limb.

At the time of measurement, the limb should be kept vertical to body for accurate measurement, otherwise the length of Thomas splint may be shorteror longer if the limb is kept forward or backward respectively.

The ring of the Thomas splint is kept close to the axilla (forelimb), groin (hind limb).

Limb is put downward & Thomas splint is pushed upward keeping both the extension bamboo of Thomas splint in crossed manner, measurement of length of Thomas splint is taken up to the bulb of the heel & mark is recorded.

The excess length is trimmed short (figure-1). Two nicks are made on the distal end for retaining the thread in position.

Both the distal ends are tied together with thread, soft padding is placed at the site where hoof is to be kept & retained in position with bandage (figure-3).

Indicaion

To know the importance and method of net fabrication in large animals thomas splint. Objective;

To make the application of thomas splint lightest.

To avoid use of plaser of pahs bandage.

To prevent possible all direction of the immobilised limb in thomas splint.

Aim: To know the method of securing thomas splint, in the forelimb.

Description

After immobilising the fracture site covering the distal as well as proximal end properly the thomas splint is fitted over the forelimb.

The foot is immobilised to the distal end of Thomas splint.

The immobilised forelimb kept closed and straight with the posterior extension of bamboo of the thomas splint. The limb is fixed with posterior bamboo splint with bandage roll at several place to avoid anterior, posterior movement of the limb.

At the time of fixing the limb with posterior extension bamboo of the Thomas splint, bandage are rapped along with the netting of thomas splint, to avoid medullary lateral movement of the immobilised limb.

Finally the immobilised forelimb is rapped along with the bandage roll including both the anterior and posterior extension of bamboo splint.

To avoid outside movement of the immobilised limb, the method of immobilisation of fracture of forelimb has been shown in fig-1.

Purpose:- To know the method of fitting the immobilised fractured hind limb in Thomas splint.

Description

The fractured site is immobilised properly covering the area joint below and joint above from the fractured site.

The immobilised limb is kept within the prepared Thomas splint.

The immobilised limb is kept straight and come close with the front extension bamboo of the Thomas splint.

The foot is fixed to the distal end of the Thomas splint with bandage roll.

In the first attempt the immobilised limb is secured with the front bamboo splint with bandage roll at several places to avoid posterior movement of the immobilised limb.

At the time of fixing the immobilised limb with anterior extension bamboo of Thomas splint, the limb is fixed with the netting of Thomas splint to avoid medial movement of immobilised limb.

Finally the immobilised limb is covered with bandage roll wrapping around both the anterior and posterior extension bamboo of the Thomas splint to avoid outer movement of the immobilised limb.

The method of immobilisation of the hind limb with Thomas splint has been shown in the figure.

Definition : These are the splints made out of light metal rods or bamboo for correction and immobilization of middle and higher level fracture in animals.

Aim: To secure the foot on the distal end of Thomas splint.

Procedure

1. Foot is placed upon the distal end of Thomas splint.
2. The foot of the animal is wrapped V’- two round with bandage cloth.(Fig.1)
3. 2^nd round of bandage cloth is wrapped around the distal end of Thomas splint.(Fig.2)
4. In 3^rd attempt, the bandage roll is taken from the ground level of the foot & including the distal end of foot.(Fig.3)
5. The bandage roll is taken through the gap between anterior end of Thomas splint.(Fig.3)
6. In 4th attempt, the bandage roll is taken from the volar or plantar aspect of the limb and passed upon the ground level of foot as well as the distal end of Thomas splint.(Fig.4)
7. Final 2 rounds of bandage cloth is wrapped through entire surface of foot.

Reference: Tyagi R.P.S. and Singh J, (2013), Ruminant Surgery, CBS Publishers, New Delhi, pp-353,354

Large animal orthopedic patients are often managed with modified Thomas splints and to achieve an acceptable outcome with this device the following points should be kept in mind.

Animals initially find discomfort with the splint and try to reject it by kicking and often show violent movements. Hence initial acclimatization with the device by close observation and supervision of the patient is essential.

Recumbent animals should be supported in standing position by a sling and they should be managed with the principle “12 hrs on sling and 12 hours on floor”.

Movement of the animal should be restricted.

Aim

Purpose: As there is no institution for preparation ofthomassplintfor large animal till date for which physician are preparing thomas splint hear the patient at the time of need.

These thomas splint are generally prepared with useof bamboo, Gl wire, jute of cottonbandages. These thomas splint are generally weak. These thomas splint work for (2-3) month.

For this reason there is necessity of fabrication of large animal thomas splint with us e of other strong and lightest material for long time stonage and use.

Defination

Dislocation of carpometarcarpus and tarso metatauses along with upper fracture of MC and MT bone (Fig. 1 and Fig.2). It is considered as difficult fracture and may not be healed appropriately by the usual procedure of lower level fracture repair method. Due to constant movement of fracture ends its treatment should be similar to middle level fracture repair method.

Materials Required

Thick padded cloth

Adhesive gum (fevicol)

Netted bamboo splint

Thomas splint

Defination

Dislocation of carpometarcarpus and tarso metatauses along with upper fracture of MC and MT bone (Fig. 1 and Fig.2). It is considered as difficult fracture and may not be healed appropriately by the usual procedure of lower level fracture repair method. Due to constant movement of fracture ends its treatment should be similar to middle level fracture repair method.

Materials Required

Thick padded cloth

Adhesive gum (fevicol)

Netted bamboo splint

Thomas splint

Purpose

As the immobilisation of upper third part of radius ulna is very difficult ,the purpose of the immobilisation tech. Is to fix the upper third of radius-ulna with the posterior half of ring of Thomas splint with bandages are very important for achieving no movement of fracture fragment during healing.

Indication

Correction of upper third fracture of radius-ulna by Thomas splint application indicated in higher level fracture.

Definition

Fracture of Upper 3rd of tibio-fibula Presence as a difficult Problem for the Surgeon to immobilise it Perfectly. As the fracture site generally moves within the imobiliser. Its healing becomes difficult. The aimof immobilisation technique of upper 3rd tibio-fibula fracture is to fix the upper 3rd of tibio-fibula with the anterior half of ring of thomas splint with bandages. This is an important step for achieving no movement of fracture fragment during healing.

Indication

Correction of upper 3rd fracture of tibio-fibula (Fig.1) by thomas splint application.

Use of conjoined Thomas splint for bilateral tibia fibula fracture for large animal.

Aim

To know the immobilization technique for both tibia-fibula fracture in large animal practice.

Instruments

Conjoined Thomas splint (Fig 1).

Definition: Mandible forms the skeleton of lower jaw and comprises of a body and two rami. The two halves of this bone fuse incompletely at the mandibular symphysis, situated at the midline within the body.

Indication: Immobilization of fractured mandible, minimally or non displaced fractures with an intact opposite hemimandible, vertical ramus fracture.

Anasthesia: Local anaesthesia for large animals. A20 gauze 2.5 cm needle is used to deposit 5-1 Omi of lidocaine at the exit site and into the canal.

Objectives

Immobilization of fracture of mandible.

Requirements

‘U’ Plate 4 Pins Electric drill Orthopaedic hammer Pin cutter

Procedure

Under local infiltration of an anesthetic & parenteral sedatives the 4 pins are drilled 2 on either side of the fracture site from one side mandible to other side mandible. During drilling the pin, the holes, importance should be given for the passage of the pin through prefix of the drill hole in metal frame

The fracture end should come accurate apposition during pinning procedure & the symmetry of the fractured mandible should be as norma! as possible.

Sterilised antiseptic gauge bandages are covered, the pin between frame and the body. The pins are retained in position either with nut-bolt or by passing a plastic tube after which the hole of the plastic tube is filled with resin.

Aim: To know the method of immobilization of the limb after repair of the flexor tendon.

Procedure

The immobilization procedure of limb after flexor tendon repair is done in 2 stages.