Principles of Fracture Repair

General Principles of Fracture Repair or treatment includes-

1. Reduction of the fracture fragments
2. Retention of the fracture fragments
3. Immobilisation

In the Principles of Fracture Repair, The first consideration is preserving the patient’s life; repair of tissues and restoration of function are secondary. Treatment for shock, hemorrhage, and wounds of the soft tissues, if present, should be instituted immediately, and the patient should be made as comfortable as possible.

Examination of an animal with a fracture or suspected fracture should include the following–

1. Assessment of the animal’s general health.
2. Determination of whether tissues or organs adjacent to the fracture or other parts of the body have been damaged and, if so, to what extent.
3. Examination to ascertain whether fractures, ligamentous instability, or dislocations are present in other parts of the body.
4. Precise evaluation of the fracture or fractures.

Clinical signs

Even though they are not always readily detectable, visible signs at the fracture area include one or more of the following-

• Pain or localized tenderness
• Deformity or change in angulation
• Abnormal mobility
• Local swelling (This may appear almost immediately or not until several hours or a day after the accident. It usually persists for 7 to 10 days because of the disturbed flow of blood and lymph.)
• Loss of function
• Crepitus

Radiographic Examination

Radiographs of at least two views at right angles to each other are essential for accurate diagnosis and selection of the best procedures for reduction and immobilisation.

Reduction of the fracture fragments

If the displacement is slight, reduction can be effected by holding rigidly the upper segment of the fractured bone and then moving the lower segment into the correct position. When the displacement is well marked as in the case of over-riding fracture, it may be necessary to administer sedatives or general anaesthesia or local anaesthesia or muscle relaxant. The over-riding can be usually corrected by providing traction and counter traction combined with application of local manipulation. Open reduction is another technique in which the fractured fragments are reduced under direct vision and the fractured fragments usually immobilized using internal fixation technique.

Retention and immobilisation of the fracture fragments

Immobilisation involves fixing the bone fragments so that they are motionless with respect to each other during the healing process. The objectives are to stabilise the fragments and to prevent displacement, angulation, and rotation. Ideally, the fixation method used should-

1. Accomplish uninterrupted stabilization at the time of the original surgery,
2. Permit early ambulation, and
3. Permit the use of as many joints as possible during the healing period.

The peculiarities of each fracture will dictate or suggest the method of immobilisation to be employed. Some fractures lend themselves to a variety of methods, whereas in other fractures the methods may be very limited for a successful outcome.

Methods of fixation

The methods of fixation may be classified as follows–

1. Limb splintage (coaptation splints, casts, modified Thomas splint)
2. Bone splintage (intramedullary pin, external skeletal fixator, bone plate)
3. Compression (lag screw, cerclage/interfragmentary wire, tension band wire, tension band/compression plate)

Coaptation splints and casts are very commonly used for fracture immobilization. The commonly used coaptation splints and casts are listed below-

1. Gum bandage
2. Starch bandage
3. Splints and bandages
4. Plaster of Paris and gutters
5. Poroplastic felt
6. Thomas splints
7. Mason meta splints
8. Suturing bone fragments
9. Applying bone plates
10. Applying bone pins (External pinning and Intra-medullary pinning)