Fracture Estimate Worksheet

sunglowcitrineUrban and Civil

Nov 15, 2013 (3 years and 11 months ago)

89 views

Fracture Estimate Worksheet


In order to give you and your client an accurate estimate to repair a fractured
bone, there are several requirements. Cutting corners can lead to unseen
fissure lines, additional fractures, unseen comminution, and joint
involve
ment that can alter the pre
-
surgical planning and adversely affect the
cost to the client.


1.

Orthogonal Views: I will not be able to quote or plan any fracture
without two views of the fracture.

Sedate if the patient is painful.

2.

Good Technique: Under or ove
rexposed radiographs are difficult to
read and interpret. The background should be black enough to barely
see your finger behind the radiograph; if not, increase the MaS. If the
background is black but the bone is too light, increase the KvP. Please
take T
ABLE TOP radiographs of all limbs that are 10cm or less.
Table top is far superior to Bucky. I can help you create a table top
technique chart if you do not have one. Measure both views separately
on the limb. Do not assume the technique will be the same f
or a lateral
and AP of any limb. Adjust the technique accordingly.

3.

Good Positioning: Please sedate your patient and get good positioning
of the fractured limb. Center the limb on the plate. Waiting until they
are under anesthesia for surgery to take good f
ilms eliminates the
possibility for doing good pre
-
surgical planning on my part. Sitting
the patient up on their haunches to get a good AP of the femur is
sometimes necessary to get good radiographs of a fractures femur.
Take DV, LAT, and Obliques of all p
elvic and acetabular fractures.

4.

Good Collimation: Please collimate to the affected limb only. Taking
a hip radiograph and including the stifles is not considered a stifle
radiograph. There should be visible collimation around the limb as
this will reduce
scatter and make the radiograph more detailed.

5.

Label the radiograph with date, left or right, and write down the
technique used so we can adjust for post
-
operative or retake films if
necessary.

6.

1+1 is not equal to 2
. If a patient has more than one injury,
look for
more. 37% of all pelvic fractures have neurological or urinary trauma.
A urinating patient does not mean the bladder is not ruptured! Unless
money is a serious issue, all trauma patients should have a chest and
abdominal radiograph, an ECG, and pe
lvic fractures should have a
cystogram with Renograffin diluted 50% with saline. Document all
recommendations and owner’s response. This is not necessary in those
cases where an owner can confirm the fracture occurred from playing,
jumping, or other non
-
bl
unt force trauma.

7.

Read my handout on digital pictures of radiographs and email me a
picture of the radiographs as well as a tracing in cases of bone plating.
The tracing allows me to confirm that I have the correct size plate in
stock and do not need to or
der one for FedEx shipment.

8.

Have the answer to a few questions including how this happened (low
force or high force), when this happened, age and condition of pet,
home environment (apartment, house, farm, single pet, multiple pet,
kids, pool, lake, river,
….), owner compliance, palpation of fracture
(stiff or loose), additional wounds on leg, additional injuries on pet,
open fracture or closed, how stoic is pet, and is the fracture
configuration going to share load.


Any questions, please feel free to call
me. We become a team once I
accept a surgical case and these recommendations are a good way for us
to make sure nothing is missed that could lead to angry or upset clients.
Surgeons are taught to think “worst case scenario” and be pro
-
active in
averting as

many
complications
as possible.