eChapters

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).

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

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.

Fig. 1: Cotton Bandage

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)]

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.

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

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)

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

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.

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).

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.