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Quiz: External Coaptation vs Surgical Fixation for Bone Fractures

Sang Chul Woo, DVM, Carolina Veterinary Specialists, Huntersville, North Carolina

Christian Latimer, DVM, CCRP, DACVS-SA, Carolina Veterinary Specialists, Huntersville, North Carolina

Orthopedics

|May 2020|Peer Reviewed|Web-Exclusive

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When treating fractures, clinicians must decide whether to recommend surgical fixation or external coaptation via a cast or splint. Indications for splinting or casting include stable, closed fractures distal to the knee and elbow joints.

Although external coaptation is often inexpensive and noninvasive, it can be misused as the main treatment for fractures.1 Potential complications include soft tissue injury; malunion, delayed union, or nonunion; and comorbid diseases or conditions associated with joint stiffness, muscle atrophy, and/or osteopenia from disuse. Incorrect treatment selection can also lead to complications. Open or unstable fractures, especially those involving the humerus or femur, should not be casted or splinted as a sole means of management.

Surgical intervention can be beneficial, as it allows for strong fixation and appropriate reduction. However, surgery has a higher initial cost and an associated risk for anesthetic complication, infection, implant failure, and poor bone healing following surgical trauma, leading to malunion, delayed union, or nonunion.2 In addition, postoperative external coaptation may introduce additional complications.

This quiz addresses common fracture cases and appropriate treatment options.

5  Questions
Multiple Choice Questions
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Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 1

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1/5  Questions
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When making clinical decisions for fracture management, which of the following should be considered? 

Select one of the above choices and click submit.
Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 1
2/5  Questions
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Which of the following is not an indication for external coaptation as a primary treatment?

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Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 1
3/5  Questions
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Remmi, a 12-week-old intact male Pomeranian, was presented with left-side thoracic limb lameness after jumping off his owner’s bed.

Clinician's Brief

Based on this radiograph, which of the following is not an appropriate treatment for the fractures?

Select one of the above choices and click submit.
Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 1
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Chloe, an 8-month-old spayed Chihuahua, was presented with left-side pelvic limb lameness after being attacked by a larger dog.

Clinician's Brief
Clinician's Brief

Based on these radiographs, which treatment is most appropriate?

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Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 1
5/5  Questions
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Cooper, an 8-year-old neutered male miniature schnauzer, was presented with left-side thoracic limb lameness after falling ≈6 feet from a tree.

Clinician's Brief
Clinician's Brief

Based on these radiographs, which treatment is most appropriate?

Select one of the above choices and click submit.
Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 1
5/5  Questions
Multiple Choice Questions
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Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 1

Final score
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4  Questions
Multiple Choice Questions
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Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 2

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1/4  Questions
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Ella, a 1-year-old spayed boxer, was presented with lameness of the left thoracic limb, possibly resulting from trauma. On physical examination, moderate swelling affecting her left distal antebrachium was observed. The owner expressed significant financial concerns regarding potential surgical repair.

Clinician's Brief
Clinician's Brief

Based on these radiographs, splinting is an appropriate treatment.

Select one of the above choices and click submit.
Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 2
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Champion, a 2-year-old neutered male American Staffordshire terrier, was presented after being hit by a car. He was non-weight–bearing on the left pelvic limb, and radiographs revealed a highly comminuted, closed mid-diaphyseal femoral fracture.

Clinician's Brief
Clinician's Brief

Because of good blood supply and ease of splinting, conservative management can be used to treat this patient’s femoral fractures.

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Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 2
3/4  Questions
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Sammy, a 7-year-old neutered male Labrador retriever crossbreed, was presented after falling off a balcony. His owner reported abnormal mentation; initial physical examination confirmed dull mentation. A mild amount of hemorrhage was coming from a small wound between his eyes. Mild left-sided epistaxis was also present. Mannitol and hypertonic saline were administered, and Sammy was hospitalized. His mentation normalized over 24 hours. Because there was concern for a skull fracture, skull radiography was performed. 

Clinician's Brief

Based on this radiograph, which is the most appropriate next step?

Select one of the above choices and click submit.
Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 2
4/4  Questions
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Roxy, a 12-week-old intact female English bulldog, developed left thoracic limb lameness after playing outside with other dogs. Radiography was performed because of a concern for humeral condylar fracture.

Clinician's Brief

Based on this radiograph, which is the most appropriate treatment for this patient’s fracture?

Select one of the above choices and click submit.
Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 2
4/4  Questions
Multiple Choice Questions
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Quiz: External Coaptation vs Surgical Fixation for Bone Fractures Part 2

Final score
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Video Ella ambulating with a splint 6 weeks after her initial injury. Surgery was not pursued due to finances; however, her fractures healed well with a caudal antebrachial splint placed for 8 weeks.

References

For global readers, a calculator to convert laboratory values, dosages, and other measurements to SI units can be found here.

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