Where have the 'simple' fractures gone?

Re: Where have the 'simple' fractures gone?

Anthony Todd — Fri, 14 Feb 2014 21:10:45 GMT

[quote user="Hannah Wynne Richards"]

Malcolm That's a brilliant idea! Why doesn't every practice open it's own school?

Wynne

[/quote]

Great I can teach them all how to do it properly.

[hides behind sofa]

Re: Where have the 'simple' fractures gone?

Martin Atkinson — Fri, 14 Feb 2014 13:17:01 GMT

[quote user="Hannah Wynne Richards"]

Malcolm That's a brilliant idea! Why doesn't every practice open it's own school?

Wynne

[/quote] Sometimes I feel that I have given the number of work experience requests I receive!

Re: Where have the 'simple' fractures gone?

Hannah Wynne Richards — Fri, 14 Feb 2014 12:22:12 GMT

Malcolm That's a brilliant idea! Why doesn't every practice open it's own school?

Wynne

Re: Where have the 'simple' fractures gone?

Malcolm Ness — Fri, 14 Feb 2014 12:14:48 GMT

[quote user="Martin Atkinson"]However there are only so many golden eggs the goose can lay and it is finally catching up with us.[/quote]

Not a bit of it - open a vet school. At least £9000.00 a year for each student and no nights on call!!

Re: Where have the 'simple' fractures gone?

Wren — Fri, 14 Feb 2014 11:50:14 GMT

[quote user="Hannah Wynne Richards"]

And yet another veterinary school openeing

Wynne

[/quote]

747 applications for 45 places apparently

Re: Where have the 'simple' fractures gone?

Hannah Wynne Richards — Fri, 14 Feb 2014 10:43:55 GMT

And yet another veterinary school openeing

Wynne

Re: Where have the 'simple' fractures gone?

Martin Atkinson — Fri, 14 Feb 2014 10:20:43 GMT

Definitely see hardly any RTA cases especially long bone fractures and it is undoubtedly partly due to better brakes and bigger/softer bumpers but like Malcolm I also wonder if it is also part of the general decrease in pet ownership. We have buried our heads in the sand over this and got adept at making more money out of fewer cases - not necessarily cynically milking those who do come in because we also have more time but just by there being more we can do these days and more clients are insured so can afford it. However there are only so many golden eggs the goose can lay and it is finally catching up with us.

Re: Where have the 'simple' fractures gone?

Malcolm Ness — Fri, 14 Feb 2014 09:49:27 GMT

There is certainly less fracture work about than in days gone by. Even in ortho referral practice we are seeing fewer fractures and many of the fractures we do see have some degree of predisposing pathology - for example the distal humeral condylar and Y fractures and the distal ulna radius fractures in miniature breeds. Speaking to the manufacturers and suppliers of trauma implants (plates, screws, Ex fix etc) their market is getting smaller. Several reasons I think. First and foremost is change of attitudes to pet-keeping - it is no longer acceptable, let alone common practice, to let dogs roam free. When I first qualified, it was the norm to see significant numbers of dogs running about through housing estates and unsurprisingly, some of them were hit by cars. Similarly with cats, 30 years ago the notion of keeping a cat permanently indoors would have been considered cruel by many, perhaps most, people but that too has changed. Finally, there are similar or fewer pets and vastly more vets so each vet has an ever-diminishing number of patients under their care. Again, 30 years ago, most SA vets would expect to do 8 or 10 bitch speys a week, today most vets will do considerably less than that. Fewer patients leads to fewer fractures.

Re: Where have the 'simple' fractures gone?

ChrisBVSc — Fri, 14 Feb 2014 08:23:07 GMT

Interesting - I thought I was just unlucky (me, not the animals!) to have only seen very occasional fractures in my 6.5 years of work so far. (only the last 3 in 100% small animal though). This has led to me having practically zero experience of orthopaedic surgery, simply because the caseload hasn't been there - we get the occasional 'nasty' fracture that goes off to the referral centre, quite a few cruciates (not entirely relevant to the topic of discussion but as 'orthopaedic' as it seems to get around here) - I can do a lateral suture if they want it, but a lot are referred for TPLO etc. But 'simple' fractures - can't remember the last time we had one of those!

Re: Where have the 'simple' fractures gone?

Mark Holmes — Fri, 14 Feb 2014 07:17:07 GMT

Simple - natural selection for cats who can cross the road

Re: Where have the 'simple' fractures gone?

Neil Wheadon — Fri, 14 Feb 2014 00:38:18 GMT

[quote user="Laurence Webb"] perhaps now nearly all cars have ABS brakes [/quote]

My esteemed nurse whom I am working with today suggests the opposite, faster cars so when they hit the cat they cause more damage which does tally with all the 'private' badly damaged cats.

Neil

Re: Where have the 'simple' fractures gone?

Neil Wheadon — Thu, 13 Feb 2014 23:47:44 GMT

Really interesting observation.

Doing OOH work in a PDSA clinic, I see a regular supply of fractures OOH in PDSA animals. There was a fractured tibia here yesterday in a cat, , but can't remember the last private case that I saw OOH with a confirmed fracture.

Neil

Re: Where have the 'simple' fractures gone?

Laurence Webb — Thu, 13 Feb 2014 23:20:01 GMT

[quote user="Michael Woodhouse"]It was suggested to me as a student that it's more due to a de-skilling of general practice the greater availability of referral specialists/Specialists. Things they would have done 15 years ago (and likely mended) now get sent off.[/quote] Presumably the referral practices are leaflet dropping the cats directly, because neither they or their owners ask us for the phone number.

Re: Where have the 'simple' fractures gone?

Robin Grimmer — Thu, 13 Feb 2014 23:09:51 GMT

More indoor cats?

Re: Where have the 'simple' fractures gone?

Michael Woodhouse — Thu, 13 Feb 2014 23:07:06 GMT

It was suggested to me as a student that it's more due to a de-skilling of general practice the greater availability of referral specialists/Specialists. Things they would have done 15 years ago (and likely mended) now get sent off.

We must get shiny leaflets from a couple of referral centres per week.

Re: Where have the 'simple' fractures gone?

Stephen Courtney — Thu, 13 Feb 2014 23:00:00 GMT

It is clearly down to better nutritional make up of commercial petfoods, surely?

joking aside, i would agree. Ain't no such injury as a simple fracture these days!

Re: Where have the 'simple' fractures gone?

Laurence Webb — Thu, 13 Feb 2014 22:56:27 GMT

I agree - I've been at my current practice for 14 years and used to see a steady stream of fractured cat legs and pelvises plus minor stuff like broken dogs toes. They seem to have pretty much dried up.

The last fractured cat I saw was my neighbour's who smashed his leg up so badly I had little option but to amputate it anyway.

Perhaps more people keep their pets in at night (though most still don't), perhaps now nearly all cars have ABS brakes they get hit less often but overall I can't see any real reason for the change. I assume dogs still run around so why aren't they breaking toes?

The lack of simple fractures alongside the tendency to refer anything other than simple stuff to an orthopod must make getting surgical experience for new grads increasingly difficult if this trend is typical.