Assessment of the Fracture Patient Flashcards
Fractures as often associated with..?
Significant trauma
What should suspected fracture patients be assessed for?
- Evidence of external trauma
- Lameness/non-weight bearing
- Any other injuries
What are the objectives of the examination?
- Determine specific injury (and likely outcome)
- Systemic evaluation
- Determine specific injury
- Location; type; can the horse bear weight; is it hopeless?
What considerations should be made when examining and managing a horse with a potential fracture?
- Is it safe to examine the horse? Restraint (is it safe to sedate?)
- Pain (consider NSAIDs/α-2 agonists)
- Shock (hypovolaemic e.g. pelvic/femoral fracture)
- Police involvement/legal/insurance aspects
- Temperament/size of animal
- Ability to move the horse/referral centre location
- Ability to place support/bandage
Describe the initial exam of a suspected fracture patient
- Airway, Breathing and Circulation
- Shock therapy and venous access: IVFT, Analgesia
- Antibiotics
- Oxygen
- Some fractures require immediate humane destruction
Following stabilisation and before transport what must be discussed with an owner?
Discuss prognosis with owner/agent: • Athletic function • Salvage Discuss financial implications: • Short term assessment • Longer term treatment
What are the basic principles in stabilising a fracture?
- Stabilise joint above and joint below
- Always extend to top of long bone: never end in the middle of a long bone, creates fulcrum and predisposes to fracture
- Do not end splint at the fracture site
Describe the steps and bandaging layers to stabilise a fracture
Each successive layer tighter to conform more than last:
- Primary layer (e.g. Allevyn for wound/soft-ban)
- Secondary layer (cotton wool/conforming layer e.g. knit-firm)
- Tertiary layer (e.g. Co-plus)
- Apply splint and tape/secure in place (protect ends of splints/avoid contact with floor/skin)
What is the aim of using splints?
To stabilise fracture/subluxation, prevent displacement and protect soft tissues
What materials are needed for splinting?
Guttering; wood/broomstick; casting material; blocks
What are the considerations/steps taken to transport a horse with a fracture?
- Load as atraumatically as possible
- Bring trailer close to horse
- Get someone who knows what they are doing!
- Horse ambulance (experience)
- Loosely tie patient
- Allow use of head and neck for balance
- Narrow confinement
Although uncommon, what clinical signs can be associated with thoracic trauma in fractures of small animals?
- Pneumothorax – Tachypnoea
- Pulmonary contusions
- Diaphragmatic hernia
The status of which systems needs to be assessed in small animals with suspect fractures? Why?
Neurological status, Urinary status, Cardiac status
• Neuro examination can change a prognosis from good to grave!
• Urinary tract issues need to be dealt with before fracture stabilisation
Describe the initial stabilisation of a small animal with a suspected fracture
- Airway, Breathing and Circulation
- Shock therapy and venous access: IVFT, Analgesia
- Antibiotics
- Oxygen
- Thoracic radiograph (check for pneumothorax, haemothorax, etc)
- Secondary assessment of any open wounds
What are the 4 considerations when managing a fracture in small animals?
- Financial
- Expertise
- Equipment
- Timing of the fracture
