Assessment of the fracture patient

Question 1

When should you see a horse with potential fracture? And why?

Answer 1

**Straight away
-Potential serious injury
-early recognition of seriousness
-small wounds on distal limb often more serious than large ones proximally

Question 2

What is the main objective of examination?

Answer 2

Determine the specific injury

Question 3

What are the objectives of examination?

Answer 3

*Is animal safe to examine- restrain
*Determine injury
*Systemic evaluation - Pain / Shock
*Other factors - police involvement
-animal size
-ability to place support / bandage

Question 4

What fractures would you immediately euthanise?

Answer 4

*Complete fracture of femur
*Complete fracture of humerus >300Kg
*Complete fracture of tibia
*Comminuted (Multiple splinters fracture), open + highly unstable

Question 5

Following stabilisation and prior to transport what should be discussed?

Answer 5

*Athletic function + salvage
*Financial implications of short term assessment + long term treatment

Question 6

What are the basic principles of a fracture?

Answer 6

*Stabilise joint above and joint below
*Always extend to top of a long bone - never end in the middle - creates fulcrum + predisposes to fracture
*Do not end splint at fracture site

Question 7

What are the general principles of splinting?

Answer 7

*Bandaging - each layer tighter to conform than last
*Splints - aim to stabilise fracture, prevent displacement + protect soft tissues

Question 8

What should be done when transporting a fracture patient?

Answer 8

*Load as atraumatically as possible
*Loosely tie patient
*Forelimb fracture - travel with horse facing backwards
*Hindlimb fracture - travel with horse facing forwards

Question 9

What should be done when assessing a fracture in a small animal?

Answer 9

*Fractures rarely life threatening
*Full clinical exam - neuro status, urinary status + cardiac status
*Neuro exam can change prognosis
*Urinary tract issues need to be dealt with before fracture stabilisation

Question 10

What should be checked for during radiography of small animals?

Answer 10

*Thoracic radiograph
-pneumothorax
-haemothorax
-diaphragmatic rupture

Question 11

What are the different grades of open fractures?

Answer 11

• 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 12

What should be done with an open fracture if stable enough?

Answer 12

*Flush / debride / swab / prophylactic Antibiotics / dress

Question 13

How should debridement of an open fracture be carried out?

Answer 13

*Lavage - 18G needle + 20ml syringe
*Sharp dissection
*Wet to dry dressings
*silver dressings

Question 14

What needs to be considered with fracture fixation?

Answer 14

*Economics - v expensive
*Expertise - surgeon + equipment
*Welfare
*Travel - referral

Question 15

What are other treatment alternatives to fracture fixation?

Answer 15

*Cast
*Cage rest
*Amputation
*Euthanasia