Approach to common fractures in the horse

Question 1

What are the three most common fractures in the horse?

Answer 1

• Distal phalanx fracture
• Limb fractures
• Pelvic fractures

Question 2

What do you have to be aware of when doing radiography?

Answer 2

Be aware of the lag period (Hairline fractures are often not visible initially)

Question 3

What is Nuclear Scintigraphy?

Answer 3

Can assess areas which are not possible to radiograph
Highlights the areas of increased bone turnover
Useful for pelvic fractures

Question 4

What is computed Tomography useful for?

Answer 4

• For skull and standing vertebrae
• Clearer 3D picture of limbs prior to surgery

Question 5

What does a pedal bone fracture look like?

Answer 5

• acute, moderate to severe lameness
• warm hoof and increased digital pulse
• tests positive to hoof testers
• DIP joint synovitis

Question 6

What is the normal treatment for a fracture?

Answer 6

• Usually conservative management
• Box rest for 2-4 months
• NSAIDS in the acute stage
• Remedial farriery
• Surgical fixation is rarely required

Question 7

What are the 4 main objectives of temporary immobilisation

Answer 7

• Neutralisation of distracting forces
• Relief of pain and anxiety
• Application of counter pressure
• Protection of soft tissues

Question 8

How would you consider stabilising a fracture?

Answer 8

Robert Jones Bandage
* Splints
* Casts
* Bandage casts
* Compression boots

Question 9

What is a Robert Jones Bandage?

Answer 9

• 3x the diameter of the limb
• Parallel sided tube
• Progressively tighter
• Wide conforming gauze compresses the cotton wool layers
• Elasticated bandage to finish

Question 10

What is a modified Robert Jones Bandage?

Answer 10

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

Question 11

What is a bandage cast?

Answer 11

• Fibreglass casting tape can be applied over a distal limb bandage to provide 2 dimensional immobilisation
• Less bulk than RJB
• well-tolerated

Question 12

What are compression boots?

Answer 12

• 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

Question 13

What is the aim of splinting the zone 1 forelimb?

Answer 13

Eliminates bending forces at the fetlock by straightening the limb
Aligns bones in a column

Question 14

What are the 4 appropriate immbolisations of a zone 1 forelimb?

Answer 14

1. Splint on the dorsal aspect extending from toe to proximal metacarpus
2. Kimzey leg saver splint
3. Monkey splint
4. Compression boots

Question 15

What would you use to immobilise the zone 1 hindlimb?

Answer 15

• Plantar board splint
• Modified Kimzey leg saver splint
• RJB or bandage cast sometimes used

Question 16

What is a zone 3 fracture?

Answer 16

Fractures of the mid to proximal radius
Muscles become abductors of the limb rather than effectors of extension/ flexion

Question 17

How would you stabilise a zone III fracture?

Answer 17

Full limb Robert Jones Bandage
- caudal splint to elbow
- Extended lateral splint from the ground to the level of the withers

Question 18

What is a zone IV fracture?

Answer 18

• 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

Question 19

What are the three types of pelvic fracture?

Answer 19

• Tuber coxae
• Illiac wing
• Illiac shaft

Question 20

How would you diagnose a pelvic fracture?

Answer 20

• Palpation per the rectum
• Ultrasonography
• Nuclear scintigraphy
• Radiography

Question 21

How would you treat a pelvic fracture?

Answer 21

Cross tie to reduc erisk of displacement

Question 22

What five fractures warrant immediate destruction?

Answer 22

1. Multiple tarsal/ carpal bone fractures
2. Compound long bone fractures
3. Adult humeral displaced fractures
4. Pelvic fractures if the horse is recumbant
5. Pastern fracture

Question 23

What are the objectives of temporary immobilisation?

Answer 23

• neutralisation of distracting forces
• relief of pain and anxiety
• application of counter pressure
• protection of soft tissues

Question 24

What is a bandage cast?

Answer 24

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

Question 25

How do the normal casts work?

Answer 25

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

Question 26

What should you use for a zone 1 forelimb

eliminate bending forces on the fetlock

Answer 26

Compression boots -> good circumferential support
supports limb in a neutral position

Question 27

What would you use for zone 1 hindlimb?

Answer 27

• align the bony column
• protect the plantar soft tissues
• plantar board splint
• Modified kimzey leg saver splint
  *

Question 28

What are the exceptions for zone 1 fractures?

Answer 28

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

Question 29

How might you immobilise a zone II fracture?

forelimb + hindlimb

Answer 29

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

Question 30

How might you stabilise a zone III forelimb fracture?

Answer 30

Full limb robert jones bandage

Question 31

How might you stabilise a zone IV fracture?

Answer 31

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

Question 32

What parts of the horse are not possible to stabilise with splints?

Answer 32

Femur and Pelvis

Question 33

What are the three types of pelvic fractures?

Answer 33

1. Tuber coxae (knocked down hip)
2. Illiac wing ( most common, most likely due to muscle wastage)
3. illiac shaft (painful, damage to illiac arteries)

Question 34

What is the prognosis for a pelvic fracture?

Answer 34

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