Surgical Skills - Study Tips 4

What is a simple fracture?

A fracture that did not break the skin and in 2 or less pieces

What is a comminuted fracture?

A fracture in 3 or more pieces

How many classifications/grades of open fractures are there?

3

What is a grade I fracture?

◦Small puncture

◦No longer visible

◦Minimal soft tissue damage

What is a grade II fracture?

◦Larger puncture/tear

◦More soft tissue damage

What is a grade III fracture?

◦Large tears; +/- loss of skin

◦Extensive soft tissue damage

◦Shearing injuries

◦Bone exposed

How are fractures classified?

According to the mechanism of puncture and the severity of soft tissue damage

What components are included with bone plates and screws for internal fixation?

◦Titanium or stainless-steel implants

◦Soft tissue and muscle dissection; open or closed techniques

◦Expose fracture

◦Plate placement

◦Screw placement

What components are included with interlocking nails for internal fixation?

◦Medullary cavity

◦Screws at proximal and distal aspects

◦No extensive soft tissue dissection

What components are included with intramedullary pins for internal fixation?

◦Medullary cavity

◦Open or closed technique

◦Alone, stacked, combination

◦Can migrate; +/- removal

What components are included with orthopedic wires for internal fixation?

◦Cerclage

◦Fragment reduction and fissure protection

◦Full cerclage

◦Hemicerclage

What post-op care is needed for internal fixation patients?

◦Strict confinement for 6-8 weeks

◦E-collar

◦Sling support

◦Suture removal

◦Follow-up rads; 4 & 8 weeks post-op

◦Implants usually not removed

◦Pain management!

◦PT/Rehab protocol

What are examples of external fixation?

 Casts, rigid splints, SK fixation

What are the components for linear and circular fixators in external fixation?

◦Threaded cross pins attached to bars or rings

◦Removed when fracture healed

What are the components of a ring/circular fixator in external fixation?

◦Different sized rings

◦Various pin types

◦Pin placed under tension 

What does post-op care look like for external fixation patients?

◦Periodic visits (cleaning, clamp tightening)

◦ Bars/rings padded

◦Assess for infections

◦Rads every 4 weeks

◦Activity restricted

What are some of the complications for fixations?

Non-union, malunion, delayed union, aseptic loosening, implant failure, infection

What are “elective” orthopedic surgeries?

CrCL tears, MPL’s, Arthritis

How are different orthopedic injuries diagnosed?

◦Physical exam

◦High-quality radiographs

◦Bloodwork

How can different orthopedic injuries be repaired?

◦Surgery

◦Splint/casts

◦Rehab/PT

◦Amputation

What are the guidelines when applying splints/casts/bandages?

Not to apply too tightly, blood flow is not compromised, ensure the splint/cast/bandage will not slip

Who can do client education?

The tech

How can client education be done?

• Talk to the owner

  • Don’t talk at them, or down to them

  • Don’t read the paper to them

  • Don’t mess up the animal’s name or their gender

How often should incisions be checked?

At least twice daily

How often should feeding tubes be checked?

1-2 times daily while cleaning

How often should bandages be checked?

At least twice daily

What should a client look out for with gastrointestinal surgery?

• Watch for peritonitis

  • Depression, lethargy, nausea, vomiting

  • Swollen painful abdomen, increased bruising, fever

What should a client look out for with perianal surgery?

Straining, vocalizing when defecating, posturing a lot without pooping, or defecates without control

What should a client look out for with cystotomy?

Straining to urinate, trouble getting a good stream, or cannot urinate

What should a client look out for with onychectomy?

Swelling, discharge, bleeding, and worsening or appearance of lameness

What should a client look out for with orthopedic surgery?

Implant failure, infection, lameness, not healing, etc.

What should a client look out for with TECA/aural hematoma?

Foul odor, abnormal discharge, skin irritation

What should a client look out for with c-sections?

Foul odor; painful, red, swollen nipples; constipation, abnormal incision

What should a client look out for with dental extractions?

Foul odor, not eating, long-term bleeding, pawing/rubbing face

What surgery needs to be done to keep the animal away from clay, clumping litter, and using shredded paper instead?

Onychectomy

Who may need special diets?

Cystotomy, perianal surgery, gastrointestinal surgery, dental extractions, c-section

When should you use a cold pack?

For 2-3 days post-op to minimize swelling & bruising

When should you use a warm pack?

For 3-7 days post-op to help with comfort and healing, done 3-5 times daily or more if seroma forms

How should swelling move?

Ventral/distal and resolve

What kind of discharge is normal?

Clear

How do you keep a bandage dry?

▫  Medi paw

▫  IV bag

How often should bandages be changed?

Weekly

What needs to be monitored for with bandages?

Slippage and swollen toes

How often should an external fixator be checked?

Twice daily

What is checked on external fixation?

Pins (secure w/ no change in drainage) & bolts/rings/ bars (no cracks, not loose)

What can you use to clean an external fixation?

Diluted chlorhexidine BID or allow it to scan over to seal

What is plegia?

Paralyzed, can’t move legs

What is paresis?

Weak moving legs/walking

What is mono?

One leg

What is para?

Both back legs

What is tetra?

All four legs

What is hemi?

One side, left/right legs

What is ataxia?

Wobbly when walking, uncoordinated

What is the order of nerve function when it’s being lost?

Conscious proprioception → Motor function/urination → Superficial pain → Deep pain

What is included with bladder care post-op?

▫  Often patients can’t urinate unassisted

▫  Bladder expression is warranted

When is bladder expression needed?

▫  Usually nonambulatory patients

▫  No urination in 6-8 hour period

▫  Don’t let patient overflow!

What is overflow?

🞄 Overflow incontinence can be confused with normal urination

🞄 Small amount of urine noted frequently, bladder is full

🞄 Causes patient discomfort, soiling, bladder atony

Who is prone to UTIs?

Dogs that can’t walk

How are UTI’s prevented?

Frequent complete emptying of bladder

What drugs are used to treat urine retention?

•Diazepam

•Phenoxybenzamine/ Prazosin

•Bethanecol