Emergency fractures in the horse

Question 1

List 7 things fractures are classified by

Answer 1

location
structures involved
contamination
extent of damage
size of fragment
fracture configuration
displacement, fracture fragments and margins

Question 2

what is a simple fracture

Answer 2

single fracture line

Question 3

what is a comminuted fracture

Answer 3

multiple fracture lines

Question 4

List the causes of fractures in horses

Answer 4

Trauma- stress fractures
developmental- OCD
secondary to other disease e.g. neoplasia or infection

Question 5

List the places you would expect a fracture in kick injuries

Answer 5

splint bone
stifle bone (tibia, patella)
olecranon
head

Question 6

what bones can get fractured if horse falls during anaesthetic recovery

Answer 6

femoral or cannon fractures

Question 7

where do race hprses most commonly get stress fractures

Answer 7

carpal bones
third metacarpal bone
middle phalangeal bone

Question 8

What do we see with acute, severe, or displaced fractures

Answer 8

will have obvious conformational abnormalities, severe lameness, pain and crepitus at the fracture site

Question 9

what do articular fractures usually have

Answer 9

joint effusion

Question 10

List 4 red flags for fractures in horses

Answer 10

are history of trauma (e.g. kick or fall)
acute onset severe lameness
acute onset joint effusion- heat, pain, swelling
palpable crepitus

Question 11

How can non-displaced stress fractures present

Answer 11

acute onset lameness following exercise which resolves over a few days
can progress to catastrophic fractures is not recognised and treated appropriatley

Question 12

Decsribe how to tell the difference between crepitus due to air or bone fragments

Answer 12

air under skin- usually diffuse and non-painful
bone fragments- is painful and localised

Question 13

What is the first line diagnostics for fractures

Answer 13

radiography - minimum of 2 views
ultrasound- main use is in pelvic fractures in racehorses

Question 14

What is most common cause of acute onset severe lameness in the horse?

Answer 14

Pus in the foot

Question 15

what can be a complication of articular involvement in fractures

Answer 15

degenerative joint disease

Question 16

List 6 potential complications of fractures

Answer 16

articular involvement
contamination
soft tissue involvement
unstable
damage to periosteal vascular supply
mechanical overload of contrlateral limb–> laminitis

Question 17

if you have a small articular fracture what should you do

Answer 17

if not integral part of joint - remove it

Question 18

Which fractures should you euthanase?

Answer 18

Open comminuted long bone fractures
Complete fractures of the scapula, humerus, radius, femur and tibia in horses over 500kg

Question 19

when should you consider euthanasia

Answer 19

Fracture is irreparable
Horse cannot be stabilised / transported for appropriate treatment
Quality of life in long term will be poor
Owner can’t afford
Horse won’t tolerate box rest
Horse will not return to previous work

Question 20

What do fracture classifications help us to do

Answer 20

The classifications help us both plan what to repair or treatment options are, but also what the prognosis is

Question 21

what structures have specific fracture classifications

Answer 21

pedal bone
navicular bone
olecranon
sesamoid bone
growth plates

Question 22

what is the gold standard for fracture diagnosis

Answer 22

CT scan