Assessment of the Fracture Patient

Question 1

Fractures as often associated with..?

Answer 1

Significant trauma

Question 2

What should suspected fracture patients be assessed for?

Answer 2

• Evidence of external trauma
• Lameness/non-weight bearing
• Any other injuries

Question 3

What are the objectives of the examination?

Answer 3

• Determine specific injury (and likely outcome)
• Systemic evaluation
• Determine specific injury
• Location; type; can the horse bear weight; is it hopeless?

Question 4

What considerations should be made when examining and managing a horse with a potential fracture?

Answer 4

• 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

Question 5

Describe the initial exam of a suspected fracture patient

Answer 5

• Airway, Breathing and Circulation
• Shock therapy and venous access: IVFT, Analgesia
• Antibiotics
• Oxygen
• Some fractures require immediate humane destruction

Question 6

Following stabilisation and before transport what must be discussed with an owner?

Answer 6

Discuss prognosis with owner/agent:
• Athletic function
• Salvage
Discuss financial implications:
• Short term assessment
• Longer term treatment

Question 7

What are the basic principles in stabilising a fracture?

Answer 7

• 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

Question 8

Describe the steps and bandaging layers to stabilise a fracture

Answer 8

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)

Question 9

What is the aim of using splints?

Answer 9

To stabilise fracture/subluxation, prevent displacement and protect soft tissues

Question 10

What materials are needed for splinting?

Answer 10

Guttering; wood/broomstick; casting material; blocks

Question 11

What are the considerations/steps taken to transport a horse with a fracture?

Answer 11

• 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

Question 12

Although uncommon, what clinical signs can be associated with thoracic trauma in fractures of small animals?

Answer 12

• Pneumothorax – Tachypnoea
• Pulmonary contusions
• Diaphragmatic hernia

Question 13

The status of which systems needs to be assessed in small animals with suspect fractures? Why?

Answer 13

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

Question 14

Describe the initial stabilisation of a small animal with a suspected fracture

Answer 14

• 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

Question 15

What are the 4 considerations when managing a fracture in small animals?

Answer 15

• Financial
• Expertise
• Equipment
• Timing of the fracture

Question 16

Describe the 3 grades of open fractures

Answer 16

• Grade I: Bone punctured through skin and retracted back beneath the skin
• Grade II: Exposure of the bone with soft tissue damage, and a wound of >1cm
• Grade III: High energy trauma, extensive soft tissue damage, loss of soft tissues and often high contamination

Question 17

If a patient is stable what are the first 5 steps of fracture management?

Answer 17

Flush
Debride
Swab
Prophylactic AB’s
Dress

Question 18

What are the considerations regarding fracture fixation?

Answer 18

• Economics: Trauma patients often very expensive, Orthopaedic surgery is expensive
• Expertise: ‘Give it a go’ vs Certificate holder vs Diploma holder Specialist Surgeon
• Welfare: is it in the best interest of the patient

Question 19

What are the 4 non-surgical fixing treatment options for a fracture?

Answer 19

• Cast
• Cage rest
• Amputation
• Euthanasia