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Principles of fracture fixation

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Abstract

It is now more than 100 years since Dr William Halsted devised a list of surgical principles to guide surgeons on improving their surgical technique, but they still remain valid today. The chapter looks at aims of fracture surgery; importance of the soft tissue envelope; application of AO principles; decision making in fracture stabilization; asepsis; antibiotics; analgesia; open fractures; articular fractures; fractures in juvenile animals; postoperative management of fracture patients.

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Figures

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8.3 Ventrodorsal hip-extended radiograph of a dog with bilateral femoral fractures, stabilized 8 weeks earlier. The right femur had a simple oblique fracture which was reconstructed and stabilized using lag screws and a neutralization plate. This fracture healed directly with the resultant lack of callus. A more comminuted fracture was present on the left. This was reduced indirectly and stabilized using a pin and plate applied as bridging fixation. Secondary (callus) healing has occurred.
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8.4 (a) Non-sterile orthopaedic drill inside a sterile drill shroud (a drape designed specifically for the instrument). (b) Sterile chuck and key prior to attachment to the drill inside the sterile drape. (Courtesy of R Hewitt and H McCrorie)
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8.5 Four-quarter draping of the limb to allow all around access. (a) The paw is protected with a cohesive dressing and the limb is suspended. (b) After complete or partial four-quarter draping, (c) the paw can be grasped by the surgeon in an aseptic fashion using an impermeable drape. (d) A final layer of sterile cohesive bandage material is applied and the final quarter drape applied if this has not already been done.
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8.6 After four-quarter draping of the limb and draping of the paw, a further large impermeable drape can be placed to cover the entire surgical field. The limb is pulled through a hole cut in the drape.
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8.8 A folding fracture of the femur in a cat with nutritional secondary hyperparathyroidism. Note the poor definition between the bone and soft tissues.
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8.9 Location of the common sites of avulsion fractures at traction epiphyses.
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8.10 Craniocaudal radiograph of the distal ulna in a dog showing the unique conical shape of the physis (arrowed). Lateral forces applied to the ulna result in compression of the physis which can lead to damage to the germinal chondrocytes (a Salter–Harris type V injury).

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