Emergency field radiography

Question 1

Patient Preparation

Answer 1

§ Patient is in pain and anxious
§ Often unable to weight bare and limb is shaking
§ Radiography sometimes unnecessary, e.g. complete open displaced long bone fracture

§ Restraint
§ Analgesia – NSAIDs & opiates
§ Sedation – alpha 2 agonist, opiates & acepromazine (anxiolytic)
§ Remove bandages
§ Tail bandage

Question 2

Location Preparation

Answer 2

§ Sufficient space
§ Flat firm floor
§ Out of direct sunlight (makes it easier to see the beam and makes interpretation easier)
§ Enclosed
§ Private
§ Electricity supply

§ May not be easy to move the horse

Question 3

Safety Equipment

Answer 3

§ 3 lead gowns
§ 3 thyroid protectors
§ lead gloves (for plate holder)
§ ‘Local Rules’ document
§ dosimeter badge
§ radiation warning signs

3 sets of protective equipment: vet, person restraining the horse, person holding plates

Question 4

Image Production Equipment

Answer 4

§ X-ray generator, laptop & plate(s)
§ extension lead
§ foot blocks
§ plate holder
§ generator stand
§ ‘L’ & ‘R’ markers
§ exposure chart

Question 5

Complications of fracture repair

Answer 5

§ Osteomyelitis
§ Screw loosening
§ Implant failure
§ Delayed / non union
§ Ring sequestrum
§ Support limb laminitis

Question 6

Radiographic evidence of osteomyelitis (& how to attempt resolution)

Answer 6

• might see discharge around the wounds
• can see lysis around (or areas of increased or decreased radiodensity) around the screws
  – indicates infection around the screw
• Only way to try resolve it would be to remove the screw.

Question 7

What is ring sequestrum? How to prevent

Answer 7

• basically a thermal injury from where been drilling
• clean drill bit regularly and lubricate it as we drill

Question 8

What is support limb laminitis? How does it occur?

Answer 8

• overload laminitis
• lot of pain in 1 leg so spend all their time on the other leg
• therefore blood flow through the hoof is inappropriate as there’s not a time when there’s a release of pressure within the hoof

Question 9

How to fix screw loosening

Answer 9

• remove and replace the screw with a different (larger) screw

Question 10

Most common causes of pedal bone fracture

Answer 10

• kicked a wall
• stamped hard on something

Question 11

Splint bone fractures (common cause, radiographic view)

Answer 11

• usually a result of trauma
• dorsolateral palmar-medial oblique

Question 12

3rd carpal bone slab fracture (common breed, radiographic views)

Answer 12

• common injury in racehorses
• Flexed lateral view of knee & skyline view of 3rd carpal bone (leg lifted and flexed and looking at the dorsal aspect of the knee) = dorsoproximal dorsodistal oblique view

Question 13

Olecranon fracture radiographic view

Answer 13

• Leg pulled out
• X-ray beam coming from medial side
• Mediolateral image.