eChapters

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.

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

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.

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 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 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)

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)

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)

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).

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.

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.

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

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.

Procedure for Netted Padded Bamboo Splint

Marking of the bamboo splints is done maintaining equal distance (Fig.1).

At both the edges of the marking, grooving of the bamboo splints is done for perfect tieing of the plastic rope (Fig.2).

The bamboo splints are tied with the help of plastic rope maintaining 1 finger space between each bamboo splint (Fig.3).

Soft 8 layer padding of cotton is provided at both the ends of the netted bamboo splint in order to avoid injury (Fig.5).

The width of the netted padded bamboo splint should be upto one and half times of the limb’s circumference (Fig.6).

Indication

Fracture in case of large animals, act as soft padding

Procedure

A single piece of long cotton cloth is taken which is separated into two equal halves on the middle line (Fig. 1).

One of the 2 parts is taken and folded to form a bilayer padded cloth (Fig 2)

The bilayer padded cloth to further folded to form 4 layer padded cloth and subsequently to S and 16 layer padded cloth (Fig. 3).

The 16 layer padded cloth is thus used around the fractured limb from the joint above to joint below.

The other half of the doth from Fig 1 is then separated into further 2 parts horizontally (Fig. 4)

The pieces thus formed are folded to form 2 layer, 4 layers and 8 layers Cloth paddings in order to cover the ends of netted bamboo splints longitudinally and retention Is done with ropes.

Aim: To prepare a list of materials used for ammobilisation for fractured limb with gum bandage. Materials required

Definition

Compound fracture is a type of fracture in which a broken piece of bone protrudes to outside rupturing the skin with a risk of further infection.

Procedure of management

Clean and flush thoroughly the exposed bone using sterile NS followed by sterile medicated NS (NS with antibiotic or antiseptic). Figure (1)

Mop dry the wound thoroughly.

Apply topical antiseptic or antibiotic.

Put the bone inside the part.

With a sterile artery forcep fix a flushing catheter within the wound at its higher level. Figure (2)

Cover the wound over fracture site with sterile soft padded absorbent cotton padding. Figure (2)

The joint below and above of the fracture site covered with thick layered padded cloth before application of POP cast. Figure (3)

POP cast is wrapped as per the conventional procedure over the fracture site covering the joint below and above. Figure (4)

Objective

The poor quality of Plaster Of Paris makes the cast weak. For its strengthening, 4pieces of padded green bamboo splints are placed within POP cast along its four sides.

Requirements

4 green bamboo splints which are padded soft at both the ends

Aim

To know the portion of limb to be covered by P.O.P cast bandage for immobilization of fore limb (Fig 1a) & hind limb ( Fig 2a) bone fracture.

As per general rule, joint below and joint above should be covered.

Indication -To know the method of POP bandaging technique.

Method of preparation of POP bandage rolls-

A gauze bandage of 6" or 4" width is spread on a clean floor. Plaster of paris powder is spread uniformly over the entire length of bandage & is folded into roll bandage. In this way 4-6 bandage rolls are prepared.fig-1(a)&(b)

Method of preparation of pop bandage splints

The length of the prepared pop splint is determined by measuring the entire length of fractured bone along with the joint below and above the fractured site) are measured. This much of length of gauze is spread for splint preparation.

POP powder is impregnated upon gauze. The gauze is again spread over this much of length in this manner sprinkling of POP powder & overlapping gauze bandage upto 4-6 layer are continued [fig-1 (b)]

Fig. 1: Cotton Bandage

Aim

To know the various level of fracture & their appropriate method of immobilisation for large animal fracture.

Definition

Fracture is a disolution of bony continuity with or without displacement of the fragments.

Definition: A fracture is a dissolution of bony continuity with or without displacement of the fragments.

Different stages of fracture: Inflammatory phase, reparative phase, and remodelling phase.

Fundamental steps

Complete fracture- It is a fracture in which there is complete loss of bone continuity and the bone is divided into two or more fragments (Fig.1).

Green stick fracture- It is the fracture in which, the cortex opposite to the bending force fractures completely, while the cortex under the force remains in tact, commonly seen in immature animals, (Fig-2)

Overriding fracture-A fracture in which the fragments lie side by side, causing shortening of limb (Fig-3)

Transverse fracture-The fracture line here runs transverse to the long axis of bone. Such type of fracture is caused by bending forces (Fig-4).

Oblique fracture- In this the fracture line runs oblique to the long axis of the bone. Such type of fracture is caused by bending with axial compression (Fig-5).

Spiral fracture-Here the fracture line spirals along the long axis of bone. Such type of fracture is caused by torsion, twisting or rotational forces e.g. in humorous (Fig-6)

Comminuted fracture- In this fracture, at least three fracture lines inter connect each other at one point (Fig-7).

First Aid in Orthopaedic Patient

Immediately transfer the animal to a safety place.

The place should be well settled, well ventilated, neat and clean.

If the fracture site is limb and it is a simple fracture, immediately immobilize the animal with soft cotton padding and plastic scale placed at four sites.

If the fracture site is limb and it is a compound fracture, cover the fractured site v/ith th’ck padded clean cotton cloth and few bamboo splint placed on four sides to keep limb straight.

Control the bleeding, if bleeding occurs at time of covering of fractured site with thick padded clean cotton cloth.

If the fracture site is vertebral column, it is better not to lift the patient vigorously.

A patient with vertebral column fracture shouldn’t be allowed for standing.

M.mMedial malleolus

M.I., Lateral malleolus

T, Tibia

T. t., Tibial tarsal bone

T.f., Fibulartarsal bone

T.c. + 4, Fused central and fourth tarsal bones.

T.1, First tarsal bone

T.2+3, Fused second and third tarsal bones

Mt.2,Small, or second metatarsal bone

Mt.3+4, Large metatarsal or fused third or fourth metatarsal bon

FEMUR

The femur has a relatively small shaft, which is cylindrical in its middle. The trochanter minor has the form of a rough tuberosity.

The trochanteric ridge connects it with the trochanter major. The third trochanter is absent. The supracondyloid fossa is shallow. The proximal extremity is very wide.

The fovea capitis is a small depression on the middle of the heacKfor the attachment of the round ligament.

The trochanter major is very massive and is undivided; its lateral surface is very rough. The trochanteric fossa is deep. The ridges of the trochlea are less oblique.

ILIUM

The ilium are almost parallel to each other and form a much smaller angle with the horizontal plane than in the horse. They are relatively small. The gluteal line is prominent and is nearly parallel to the lateral border; it join the ischiatic spine. A rounded ridge separates the two parts of the pelvic surface. The surface for articulation with the sacrum is triangular. The tuber sacrale is truncated, does not extend so high as the vertebral spines, and is separated from the opposite angle by a wider interval than in the horse. The tuber coxae is relatively large and prominent; it is not so oblique as in the horse, and is wide in the middle, smaller at either end. The shaft is short and compressed from side to side.

The ilia are almost parallel to each other and form a much smaller angle with the horizontal plane than in the horses.they are relatively small. The glutei line is prominent and nearly parallel to the lateral border,it joins the ischiatic spine.A rounded ridge separates the two parts of pelvic surface.The surface for articulation with sacrum is triangular. The tuber coxae is relatively prominent and not so oblique as in horses, wide in middle,smaller at either end.Shaft is short and compressed from side to side.

Ischium is large.Its long axis is directed obliquely upward and downward forming an angle of 5o to 60 degree with horizontal plane.The transverse axis is obliquely downward and inward at similar angle so concave from side to side.Ventral surface has rough ridge for muscular attatchment. The ischiatic spine is high and thin and bears a series of vertical rough line. lschiuatic arch is narrow and deep.The tuber ischii is large and three sided bearing dorsal ,ventral, lateral tuberosities.The symphysis bears a ventral ridge which fades out at ischial arch.The acetabular branch of pubis is narrow and is directed laterally,and a little forward.The anterior border is marked by a transverse groove which ends below rough iliopectineal eminence. The symphyseal branch is wide and thin. The acetabulum is smaller than in horses. Rim is rounded and usually marked by two notches. One is directed to deep acetabular fossa and and converted to foramen. The other is anteromedial and small also replaced by foramen or absent.

DIGITS

Four digits are presents in the ox of these two the third and forth -are fully developed and have three phalanges and three sesamoid each.The second and fifth are vestiges.

FRIST PHALANX- (Fig.No.1)

The interdigital surface is flattened and its volor parts bears a prominence for the attachment of the interdigital ligaments.

The proximal extremity is relatively large and somewhat compressed from side to side.

The articular surface is concave from before backword and is divided by sagittal groove in two areas, of which the aboxial one is the larger and higher.

Behind tese are two facets for articulation with the sesamoid bones.

The distal extremity smaller than the proximal.

Fia.1. Left carous and adjacent bones of Ox: Front view:-

Ulna

Radius

Fused second and tliird carpals

Ulnar carpal

Radial carpal

Fourth carpal

Fused second and third carpals

Metacarpal tuberosity

Vascular groove

???????Intermediate carpal bone

The scapula is more regularly triangular than in horse, relatively, wider at the vertebral end and narrower at the distal end. The scapular index is about T.0.6. The spine is more prominent and is placed further forward, so that the supras- pinous fossa is narrow and does not extend to the lower part of the bone. The spine is sinuous, bent backward in its middle, forward below. Its free border is somewhat thickened in its middle, but bears no distinct tuber. Instead of little more prominent, and is prolonged by a pointed production, the acromion, from which part of the deltoid muscle arises. The sub scapular fossa is shallow. The areas for the attachment of the stratus muscle are not very distinct. The nutri- ent foramen is usually in the lower third of the posterior border. The glenoid cavity is almost circular and without any distinct notch. The tuberosity is small and close to the glenoid cavity. The coracoid process is short and rounded. The cartilage resembles that of the horse. The tuberosity unites with the rest.

LUMBAR VERTEBRAE (Fig. 1)

Lumbar vertebrae, six in number, are much longer than in the horse.

The body is much constricted in the middle, expanded at either end, and bears a rudimentary ventral crest.

The articular processes are large, and their facets are more strongly cun/ ed than in the horse.

The transeverse processes ail’curve foPA/ard, borders a.^e thin and irregular and often bear projections of variable size and form..

The spinous processes are relatively low wide, the last being the smallest; their summits are moderately thickened.

The cervical vertebrae are 7 in number.

The first and second cervical vertebrae are highly modified in conformity with the special function of support and movements of the head.

The third, fourth and fifth have the following characters:

The body is long. Ventral surface present a median ventral spine.

The dorsal surface has a flat central area which is narrow in the middle of the vertebrae, and wide at either end. On either side of this area there is a groove which lodges the longitudinal spinal vein.

The anterior extremity or head has an oval articular surface which faces forward and downward; it is strongly convex and wider above than below.

The posterior extremity is larger and has a nearly circular cotyloid cavity.

The arch is large and strong. It is perforated on either side by foramen which communicates with the foramen transverse hum. The vertebral notches are large.

The articular process are large. Their articular surface are extensive, oval in outline, and slightly concave.

This vertebra is decidedly atypical in form and structure. The body and spineous process are absent. It has the form of a strong ring, from which two curved plates, the wings, project laterally. The ring incloses a very large vertebral foramen and consistis of two lateral masses connected by dorsal and ventral arches.

The lateral masses (Massae laterales) present two deep oval anterior articular cavities (Foveae articulares craniales) which receive the occipital condyles; they are separated by a wide notch above and a narrow one below. The lateral margin is also notched, and a triangular non-articular depression cuts into the medial part of each cavity. The posterior articular surfaces (Facies articulares caudales) are somewhat saddle-shaped; they are confluent on the ventral arch, but are widely separated dorsally, and do not conform in shape to the corresponding surfaces of the axis.

The dorsal arch (Arcus dorsali,) presents a median dorsal tubercle (Tuberculum dorsale) and is concave ventrally. It is perforated on either side near its anterior margin by the inter vertebral foramen (Foramen invertebrale). The anterior border is deeply notched, and the posterior border is thin and concave.

The ventral arch (Arcus ventralis) is thicker, narrower, and less curved than the dorsal. In its lower surface is the ventral tubercle (Tuberculum ventrale), into which the terminal tendon of the longus colli muscle is inserted. The upper face has posteriorly a transversely- concave articular surface, the fovea dentis, on which the dens or odontoid process of the axis rests.

In front of this is a transverse rough excavation and a ridge for the attachment of the ligamentirm dentis.

Foramen magnum

Occipital condyle

Paramastoid process

Condyloid foramen

Foramen lacerum

Basilar part of occipital condyle

Basilar tubercles

Bulla tympanica

Foramen ovale(concealed by muscular process)

Meatus acusticus externus

The condition in the young subject is as follows:

The two parietals are united with each other and also with the interparietal and supraoccipital. The resulting mass is somewhat horse shoe shaped. Its occipital part (planum occipitale) forms the greater part of the posterior wall of the cranium and bears about its centre the tubersity for the attachment of the ligamentum nuche. From either side of this a line curves outward and divide the surface into an upper smooth area and a lower area which is rough for muscular technique. The upper borderjoins the frontal bone and concurs In the formation of the frontal eminence. The temperal part (Plana temporalla) are much smaller and are concave externally; they join the frontal above and the squamous temporal below. A median occipital crest extends ventrally from the external occipital protuberance.

1: extensor carpi radialis

2: m. extensor digiti III propr.

2: its tendon

3: m. extensor digiti communis

3: its tendon

4: m. extensor digiti IV. propr.

4’: its tendon :

5: m. ulnaris lateralis