Approach to common fractures in the horse Flashcards
What are the three most common fractures in the horse?
- Distal phalanx fracture
- Limb fractures
- Pelvic fractures
What do you have to be aware of when doing radiography?
Be aware of the lag period (Hairline fractures are often not visible initially)
What is Nuclear Scintigraphy?
Can assess areas which are not possible to radiograph
Highlights the areas of increased bone turnover
Useful for pelvic fractures
What is computed Tomography useful for?
- For skull and standing vertebrae
- Clearer 3D picture of limbs prior to surgery
What does a pedal bone fracture look like?
- acute, moderate to severe lameness
- warm hoof and increased digital pulse
- tests positive to hoof testers
- DIP joint synovitis
What is the normal treatment for a fracture?
- Usually conservative management
- Box rest for 2-4 months
- NSAIDS in the acute stage
- Remedial farriery
- Surgical fixation is rarely required
What are the 4 main objectives of temporary immobilisation
- Neutralisation of distracting forces
- Relief of pain and anxiety
- Application of counter pressure
- Protection of soft tissues
How would you consider stabilising a fracture?
Robert Jones Bandage
* Splints
* Casts
* Bandage casts
* Compression boots
What is a Robert Jones Bandage?
- 3x the diameter of the limb
- Parallel sided tube
- Progressively tighter
- Wide conforming gauze compresses the cotton wool layers
- Elasticated bandage to finish
What is a modified Robert Jones Bandage?
Similiar but less bulky
* Less effective for immobilisation but will provide counter pressure and stable pase for the application of externally applied rigid splints
* Better tolerated in HL’s
What is a bandage cast?
- Fibreglass casting tape can be applied over a distal limb bandage to provide 2 dimensional immobilisation
- Less bulk than RJB
- well-tolerated
What are compression boots?
- Circumferential distal limb support
- Fetlock angle of 135 degrees to support limb in a neutral position
- Ski boot clips
- Foam lining
- Robust and long lasting
- Expensive
What is the aim of splinting the zone 1 forelimb?
Eliminates bending forces at the fetlock by straightening the limb
Aligns bones in a column
What are the 4 appropriate immbolisations of a zone 1 forelimb?
- Splint on the dorsal aspect extending from toe to proximal metacarpus
- Kimzey leg saver splint
- Monkey splint
- Compression boots
What would you use to immobilise the zone 1 hindlimb?
- Plantar board splint
- Modified Kimzey leg saver splint
- RJB or bandage cast sometimes used
What is a zone 3 fracture?
Fractures of the mid to proximal radius
Muscles become abductors of the limb rather than effectors of extension/ flexion
How would you stabilise a zone III fracture?
Full limb Robert Jones Bandage
- caudal splint to elbow
- Extended lateral splint from the ground to the level of the withers
What is a zone IV fracture?
- Fracture of the Humerus
- Fractures of this region disable the triceps apparatus making it impossible for the horse to fix its carpus
- Not splinted at the fracture site
- Stabilised by fixing the carpus in extension
- Gives greater control of the limb and assists with balance
- Some fractures do not benefit from temporary immobilisation
- Can assist protration of limb using a rope around the pastern
What are the three types of pelvic fracture?
- Tuber coxae
- Illiac wing
- Illiac shaft
How would you diagnose a pelvic fracture?
- Palpation per the rectum
- Ultrasonography
- Nuclear scintigraphy
- Radiography
How would you treat a pelvic fracture?
Cross tie to reduc erisk of displacement
What five fractures warrant immediate destruction?
- Multiple tarsal/ carpal bone fractures
- Compound long bone fractures
- Adult humeral displaced fractures
- Pelvic fractures if the horse is recumbant
- Pastern fracture
What are the objectives of temporary immobilisation?
- neutralisation of distracting forces
- relief of pain and anxiety
- application of counter pressure
- protection of soft tissues
What is a bandage cast?
Fibreglass casting tape can be applied over a distal limb bandage (modified RJB) to provide 2-
dimensional immobilization.
* Less bulk than RJB
* Well-tolerated
* Once cured, foot can be enclosed with a further roll of fiberglass tape
How do the normal casts work?
Best immobilization/stabilization and counter pressure of all temporary immobilization techniques
* Fibreglass tape impregnated with water-activated polyurethane resin
* Resin activated by dipping in tepid water (21-25oC)
* Keep wet during curing to assist in bonding
* Conforming bandage underneath
* Inner conforming later of cast material (plaster of paris) under approx. 6 layers of fibreglass tape
* Padding with cast felt/foam at proximal margin
What should you use for a zone 1 forelimb
eliminate bending forces on the fetlock
Compression boots -> good circumferential support
supports limb in a neutral position
What would you use for zone 1 hindlimb?
- align the bony column
- protect the plantar soft tissues
- plantar board splint
- Modified kimzey leg saver splint
*
What are the exceptions for zone 1 fractures?
Metacarpal/ Metatarsal condylar fractures
Medial and lateral splints to carpus over RJB (solar surface flat on floor)
* To counteract risk of medial or lateral displacement
* Compression boots are suitable
* Bandage cast or casts are suitable
How might you immobilise a zone II fracture?
forelimb + hindlimb
Robert jones bandage from the ground surface to as far proximal as possible (elbow)
* With lateral and caudal rigid splints applied
* Alternative = lateral and cranial
* Tube/sleeve cast can be used
How might you stabilise a zone III forelimb fracture?
Full limb robert jones bandage
How might you stabilise a zone IV fracture?
Stabilised by fixing carpus in extension
* Full leg (light) bandage to minimise pendulum effect
* Caudal splint to elbow previously described, but dorsal splint better tolerated (also less bulk)
* Proximal antebrachium to distal metacarpus
What parts of the horse are not possible to stabilise with splints?
Femur and Pelvis
What are the three types of pelvic fractures?
- Tuber coxae (knocked down hip)
- Illiac wing ( most common, most likely due to muscle wastage)
- illiac shaft (painful, damage to illiac arteries)
What is the prognosis for a pelvic fracture?
Dependent on region affected and displacement
* Survival rate 50-70%
* Fracture tuber coxae > Good
* Involve ilial shaft or acetabulum > Poor px for return to athletic career
