26.5.1: Emergency radiography

Question 1

What sedation could you use to sedate an anxious and painful horse for radiography?

Answer 1

• Detomidine and butorphanol IV
• Could also consider acepromazine but care in males

Question 2

What is the problem and how could this have happened?

Answer 2

Complete parasagittal intraarticular pedal bone fracture
This often caused by kicking hard or stamping

Question 3

What is the radiographic view and what problem is visible?

Answer 3

Dorsopalmar view of the pastern. There is an incomplete fracture of the pastern (P1) in the sagittal plane.

Question 4

What radiographic view is shown here and what problem is visible?

Answer 4

Dorsopalmar view of fetlock. There is a fracture of the distal metacarpus/ tarsus (third metacarpal bone) which runs from between the lateral condyle and mid-sagittal ridge and extends up and exits via the lateral cortex.

Question 5

What radiographic view is shown here and what problem is visible? How could this injury have happened?

Answer 5

Dorsolateral palmaromedial oblique (DLPMO)
* There is a comminuted fracture of the lateral splint bone
* This usually happens as a result of direct trauma e.g. a kick

Question 6

What radiographic view is shown here and what problem is visible? Which horses is this injury common in? What other radiographic views would be helpful?

Answer 6

Lateromedial view of flexed carpus
* Shows a complete, minimally displaced frontal plane biarticular (slab) fracture of the third carpal bone
* Common in racehorses
* Other views that would be useful: dorsoproximal, dorsodistal oblique view, and skyline view of third carpal bone looking a dorsal aspect of carpus

Question 7

Which radiographic view is shown here and what problem is visible?

Answer 7

Mediolateral view of extended elbow
* There is a comminuted fracture of the olecranon

Question 8

What complications of fracture repair are possible when implants or screws are used?

Answer 8

• Osteomyelitis
• Screw loosening
• Implant failure

Fracture repair = race between fracture healing and implant failure

Question 9

What is the problem and what will you do about it?

Answer 9

Osteomyelitis
* Can see bone lysis as radiolucency
* Might see wound discharge
* Must remove this screw; may be able to leave the rest of the plate

Question 10

What is the problem here and what will you do about it?

Answer 10

Screw loosening
* Remove and replace with a larger screw

Question 11

What is the problem here?

Answer 11

Implant failure - screw head has snapped off

Question 12

What is the problem here?

Answer 12

Delayed union / non-union
* There was a transverse fracture of the distal radius and the body is trying to form a callus
* However this is a large, weight-bearing bone so it will never form a stable callus

Question 13

What is the problem here? How could it have been prevented?

Answer 13

Ring sequestrum
* Thermal injury as a result of drilling before screw placement
* This will lead to screw loosening and infection
* Prevention: clean drill bit regularly and lubricate it as you drill

Question 14

What is the problem here and why might it have happened if the original injury was not in this leg?

Answer 14

Support limb laminitis
Overload on this leg due to pain on injured leg -> inappropriate blood flow in hoof with no release of pressure -> rotation of pedal bone