Emergency Fx management and external coaptation

Question 1

Orthopedic emergency

Answer 1

Acute onset, severe lameness

Question 2

Non-weight bearing Musculoskeletal emergencies

Answer 2

1. Fracture
2. Luxation
3. Infection of synovial structure
4. Sole Abscess

Question 3

Nerve damage Weight-bearing Musculoskeletal emergencies

Answer 3

1. Non-displaced fracture
2. Laceration
3. Tendon/Ligament injury
4. Puncture wound
5. Laminitis

Question 4

Emergency treatment plan

Answer 4

1. Restrain horse
2. Cursory exam-assess shock
3. Sedation and analgesics
4. Examine affected limb
5. Apply external coaptation
6. HX
7. More thorough PE
8. Rads
9. +/- fluids

Question 5

Fluid therapy indicated if

Answer 5

Patient in shock

• rare to have sig. blood loss
• Fluid/electrolyte loss through sweat can be significant
• Massive vasoconstriction from pain=> distributive shock

Question 6

Considerations in open fractures

Answer 6

1. Clean carefully before bandaging
2. Keep exposed flesh moist
3. Start broad spectrum abx immediately
4. Tetanus toxoid booster if vax > 6 mo ago

Question 7

Scapular fx coaptation

Answer 7

None

Question 8

Humeral fx coaptation

Answer 8

Caudal splint to lock carpus in extension

Question 9

Radial fx coaptation

Answer 9

Robert-Jones bandage with extended lateral splint

Question 10

Metacarpal 3/carpus fx coaptation

Answer 10

Robert-Jones bandage with caudal and lateral splint

Question 11

fore fetlock fx coaptation

Answer 11

Dorsal splint

Question 12

Femur fx coaptation

Answer 12

No immobilization necessary

Question 13

Tibia fx coaptation

Answer 13

Robert-Jones bandage with extended lateral splint

Question 14

Metatarsal 3 fx coaptation

Answer 14

Robert-Jones bandage with extended lateral splint

Question 15

hind fetlock fx coaptation

Answer 15

Plantar splint

Question 16

Extended lateral splint prevents

Answer 16

abduction

Question 17

Fractures of the ulna disable

Answer 17

Triceps apparatus
(also humeral/scapular fractures can do this)
-elbow drops, carpus flexes
-cant fix limb in extention

Question 18

Splinting carpus in extension

Answer 18

Allows weight bearing but walking difficult

-only for transport, not young foals

Question 19

Fractures of tibia/tarsus goas

Answer 19

1. Minimize lower limb instability (reduces trauma when stifle flexed)
2. Prevent abduction

Question 20

Femur fracture splinting is

Answer 20

NOT ADVISED

-May cause more harm than good

Question 21

Factors determining prognosis

Answer 21

1. Type and location
2. Open/closed**
3. Degree tissue damage**
4. Age/breed/weight**
5. personality of horse
6. Number of fractures
7. Amount of time between injury and repair
8. Effectiveness of field first aid

Question 22

Classification of fractures

Answer 22

1. Complete/incomplete
2. Stable/unstable
3. Open/closed
4. Configuration
   - Greenstick/fissure
   - Transverse
   - Oblique
   - Spiral comminuted
   - Multiple
   - Impacted
   - Avulsion
   - Diaphyseal/metaphyseal/physeal/apophyseal/articular

Question 23

Criterial for repair

Answer 23

1. Minimal comminution
2. Closed
3. Suitable equiptment/implants
4. Calm, sensible horse
5. Speedy surgery
6. Adequate Recovery System

Question 24

Salter-Harris fx classification

Answer 24

Type 1: 
-thru zone of hypertrophy of physis
-no involve epiphysis/metaphysis
Type 2:
-physis and part of metaphysis
-leaves segment of metaphysis attached to epiphysis
Type 3:
-thru physis and epiphysis, enters joint
Type 4:
-across epiphysis, physis and portion of metaphysis
-perpindicular to plane of physis
-enters joint (I think)
Type 5:
-compression fx of physis
-minimal displacement

Question 25

Prolonged periods of casting/bandaging

Answer 25

Leads to flexor tendon laxity

-gradual reduction in support necessary