1.2 Equine Limb Bandaging, Coaptation, and Stabilization Flashcards
What are the main purposes of bandaging?
- covering and protection of wounds
- prevention of swelling / edema
- immobilization of the limb (limit wound breakdown)
What are the layers of bandage application?
(1) core layer
- apply wound dressing
- orthopedic padding (cotton wool between toes, or extra cast padding around Achilles tendon)
(2) padding layer
- apply padding: cotton wool (RJB) or cast padding (normal bandage/ modified RJB)
- conform to limb with conforming gauze
(3) shell layer
- apply cohesive bandaging tape
- seal top and bottom withadhesive bandaging and white tape
What are the main purposes of limb casts?
- treatment of fractures
- treatment of joint luxations
- protection of wounds and lacerations
- stress protection after internal fixation
What are the main steps to cast application?
- minimal orthopedic padding
- apply cotton stockinette
- apply cast felt to proximal margin
- apply casting tape
- apply heel wedge
- incorporation of gigli wire
“after the wound is treated appropriately (i.e. cleaned, debrided, repaired) a dressing is placed over the wound. Stockinette and cast padding and felt is placed, followed by cast material. It is essential that movement of the limb be minimized until the cast has hardened.”
What is transfixation casting?
Place 2-4 pins proximal to the fracture and incorporate these pin ends in the cast shell. This disperses the forces away from the area you hope to protect. Many complications possible, but sometimes no other options exist.
Often pins and cast removed, and then a new cast without pins is placed so that the horse does not fracture its limb due to the new holes in the bone.
Indications
- Repaired or conservatively treated distal limb fracture that is unstable under axial loading
- Fetlock breakdown injuries
- Often a salvage procedure
A “large animal external fixator” is a similar procedure. It uses a device with pins rather than pins going through a cast. No cast is used why this method: allows access to wound if present. Disadvantage: cannot alter the pin location, as they are connected to the device.
Why do you cast in the field if possible?
prevents a fracture from becoming open, which would increase the risk of tissue damage and infection.
- if safely feasible (foals, distal forelimbs etc.)
- most reliable and stable external coaptation
- can insert Gigli wire (quick and safe removal)
- limb can be casted in any position, still valuable
What is the approach to the fracture patient?
(1) take charge of the situation
- help personnel
- avoid the help of a distraught owner
(2) assess the condition of the patient
- shock presentation
- blood loss
(3) localize and assess degree of damage
- treatment vs. euthanasia
(4) correct Immobilization
- always first thing to do!
(5) radiographs
(6) referral for further evaluation / treatment
What are drugs to use in equine orthopedic emergencies?
chemical Restraint
- Xylazine HCl
- Detomidine HCL
- Romifidine HCl
- Butorphanol tartrate
antibiotics
- ß-Lactam antibiotics
- Aminoglycosides
other
- Flunixin meglumine
- Phenylbutazone
- Tetanus Toxoid vaccine
- IV fluids
a2-agonist +/- opioid
- Detomidine HCl 10-25 µg/kg IV
- Butorphanol tartrate 0.02 -0.1 mg/kg IV
NEVER use narcotics alone (causes excitement)
avoid phenothiazine tranquilizers (Acepromazine maleate etc.): causes hypotensive effects in the presence of circulating catecholamines, and can cause priapism
How are fractures classified?
- incomplete / complete fracture
- simple / comminuted fracture
- closed / open fracture
- articular / non-articular fracture
- tendon / ligament disruption
- status surrounding soft tissues
others: transverse, spiral, oblique, etc.
What is the reciprocal apparatus?
know general only: all info here for exam
the reciprocal mechanism made largely of tendinous muscles on either side of the tibia
(1) cranial aspect: peroneus tertius
- origin between the trochlea and lateral condyle. It bifurcates distally, both parts inserting in the tarso-metotarsal region
- fibrous muscle ensures that flexion of the stifle is accompanied by flexion of the hock
(2) caudal aspect: superficial digital flexor and the associated fibrous band of the gastrocnemius
- the band of the gastrocnemius orginates on the lateral supracondyloid tuberosity of the femur and inserts on the calcaneus
- superficial digital flexor originates from the caudal aspect of the femur between the two heads of the gastrocnemius and runs distally covering the gastrocnemius tendon and partially attaches to the point of the hock; it continues distally and inserts as in the forelimb
these two muscles ensure that when the stifle is in extension the hock is also in extension
- this apparatus also ensures that when the patella is
- locked the hock is also immobilized
- these results are obtained with no muscle fatigue.
What is the suspensory apparatus?
know general only: all info here for exam
Associated ligaments:
- Collateral sesamoid ligaments - connect the abaxial surface of the sesamoid to the metacarpus and proximal phalanx.
- Palmar ligaments - connect the sesamoid bones together.
- Distal sesamoidean ligaments - connect the sesamoids to the proximal and middle phalanges. This ligament can be seen as a direct continuation of the interosseous muscle with the sesamoids emdedded in it.
Thus by virtue of the ligamentous arrangement, the suspensory apparatus without any muscular action can resist extension of the fetlock and pastern through the distal sesamoidean ligaments and resist flexion of the pastern and coffin joints through the common digital extensor tendon.
What is the stay aparatus?
know general only: all info here for exam
The serratus ventralis supports the cranial part of the body, and connects the costal side of the scapula to points of attachment on the caudal cervical vertebrae and cranial ribs. It contains a tendinous layer that suspends the body once the muscles relax
- this will, however, cause flexion of the shoulder which needs to be balanced by the extensors of the shoulder
The Biceps brachii fulfils this role. Its collagenous tendon extends the length of the muscle and divides near the elbow. The short tendon inserts on the radial tuberosity, the long tendon (lacertus fibrosus) continues distally and blends with the tendon of the extensor carpi radialis and forearm fascia. Combined, these insert on the proximal end of the metacarpus
- thus, the biceps have provision to be able to relax without the collapse of the shoulder, elbow and carpal joints
How are immobilization techniques divided?
they are split into forelimb and hindlimb, and further didived by the anatomical region of destabilization
- elbow to distal scapula
- distal radius to elbow
- etc
What are the forelimb and hindlimb immobilization techniques?
FORELIMB:
(1) coronary band to distal metacarpus
- plantar splint (kimzey, monkey, farley brace)
(2) distal metacarpus to diatal radius
- RJB with extended lateral splints up to elbow
(3) distal radius to elbow
- RJB with extended lateral splints up to shoulder and down to hoof (prevents abduction: digital extensors and flexors become abductors of the proximal radius in the presence of a fracture)
(4) elbow to scapula
- no immobilization necessary
HINDLIMB:
(1) coronary band to distal metatarsus
- plantar splint (kimzey, monkey, farley brace)
(2) distal to proximal metatarsus
- RJB with splints up to tuber calcaneus (lateral and plantar)
(3) proximal metatarsus to stifle
- RJB with extended lateral splint up to coxofemoral joint and down to floor
- use wide board splint on lateral leg NOT schroeder-thomas splint (goes medial and horses do not like things touching medial leg - reserve for calf)
- can use modified schroeder-thomas splint (without groin bar)
(4) stifle to coxofemoral joint
- no immobilization necessary
