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Management of Compound Fracture

An open fracture is an injury that occurs when a broken bone is exposed through the skin. This may mean that the bone is actually sticking out of the skin, or it may mean that the skin and soft-tissue is disrupted and exposes a path to the site of the fracture. Often called a compound fracture, an open fracture necessitates different treatment from the usual closed fracture.

Surgically Cleaning the Bone

Surgically cleaning the bone is one of the first steps for treating an open fracture. Most patients who sustain an open fracture undergo a surgery called “irrigation and debridement.” Irrigation means washing the bone and the site of the injury. Debridement is described in the next step.

Determining the extent of injury can be difficult just by looking at an open fracture. This is especially true in high-energy injuries including automobile collisions and gunshot wounds. With these types of injuries, even small penetrations in the skin can cover very large areas of soft-tissue damage around an open fracture. Therefore, when surgically cleaning the bone, it is important to do this in the operating room (OR) under anesthesia — trying to sufficiently assess and clean the bone in the emergency room, without adequate anesthesia, may be insufficient.

Contracted Leg in Calves

Definition

A shortening or contraction of the deep and superficial digital flexor tendons and associated muscles, sometimes also the carpal flexors, leading to abnormal flexion of the fetlock, possibly also of the pastern and carpal joint.

Hip joint is a ball and socket joint which involves cotyloid cavity of os-coxae and head of femur. Hip dislocation can be corrected by external immobilization of the area with POP cast and keeping the animal in a mobile sling for several weeks.

The dislocation involves cotyloid cavity and head of femur and the affected limb deviate outward. (Fig.1)

The fracture site is immobilized extending joint below and joint above level initially with plaster of Paris.(Fig.2)

Cloth bandage is applied over it for support involving joint above and joint below which should not be too tight or too loose.(Fig.3)

Second layer of cloth padding is provided over the first layer to provide more strength and further immobilization.(Fig.4)

Final immobilization is done by application of rubber belt or suspensory bandage. (Fig.5)

At the end the entire animal is kept in mobile sling for proper immobilization for some weeks and housed in limited space(Fig.6)

To know the method of immobilization of the limb after repair of the transected gastrocnemius tendon (tendo achiles).

Procedure

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

1^ST Stage

Immobilization of limb for avoiding movement at tendon suture site.

It is done by placing the sutured area within a pre- fabricated metal frame so as to keep the limb undisturbed at the suture site.

The frame is given in Figure 1.

The purpose of addition of the metal frame is to immobilize the limb keeping the fetlock and foot away from in a flexed manner to avoid weight bearing during healing period.

The limb is immobilized with netted bamboo splint (Fig. 2).

The immobilized limb is placed within the metal frame keeping the fetlock and foot in a flexed manner

Aim

To depict the detail method of tendon suturing of transected gastrocnemious tendon for union.

Procedure

After cleaning, debriding and flushing the transected site thoroughly local antiseptic and antibiotic is applied.

1. To expose the tendon ends clear visual as well as proper exposer the site was enlarged by two vertical incision placed at dorsal and ventral part of the transected site.(Fig.1).
2. The three different tendons and their locations is identified. The both end of tendon of a particular group are brought close together and joins end to end and retained with strong polyester suture putting to interrupted knots at 90 degree to each other.(Fig. 2).
3. Their peritendon cover are pulled over the suturing site from their either ends and are also retained in position with additional interrupted suture running at 90 degree to each other.(Flg. 3). In this way 4 interrupted suture are required for approaching one tendon.
4. In this way all the 3 tendons are joined with their respective other ends with suture. Total no of 12 interrupted suture are required for joining all the 3 structure of the gastrocnemious tendon. At the end the suture tendons are strengthened by placing to interrupted stainless steel suture. (Fig. 4).

Finally a flushing catheter was placed at higher level and the suture site is covered with a thick dry antiseptic absorbent cotton padding.

Definition

Digital tender include superficial digital flexor, DDF & suspensory ligament which is situated in volar & plantar upset of metacarpus and metatarsus. These tendons are generally transected during ploughing or intensional approach (Fig.1).

Sign

After cutting of these tendon the foot became flat and animal bears weight on fetlock is can’t able to walk freely.

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.

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.

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.

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

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.

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.

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

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.

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: 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