Eq2-mid1- fractures in horses

Question 1

Main points of emergency help in fractures

Answer 1

• to help on providing a later surgical intervention
• to avoid further injuries
• allow a partial weight bearing of the fractured limb
• to avoid wear off the fractured ends
• to avoid an opened fracture
• allow of a partial weight bearing of the fractured limb
• to avoid an opened fracture

Question 2

Fracture regions of frontlimb

Answer 2

• 1.: Hoof - dist. MCIII
• 2: Dist McIII - dist. radius
• 3: Dist. Radius - Elbow joint
• 4. Elbow joint - dist. Scapula

Question 3

Fracture regions of the hindlimb

Answer 3

• 1: Hoof - dist MtIII
• 2: Dist MtIII - Hock
• 3: Hock - stifle
• 4: Prox from stifle

Question 4

Fracture region 1 - technique

Answer 4

you have to stabilise the phalangies

technique:

• little polster, but even surface (about 1cm cotton-wool) up to carpus - tarsus
• Elastic or Gaze bandage strongly pulled
• Fiberglas-cast
• aline the dorsal aspect with the cannon bone
• elevate the heels
• it must be able to flex the carpus

Kimzey splint: first aid for disruption of the susp. apparatus.

Monkey splint: align the phalanges and McIII onto the plane. More convinient and comfertable because it has elevation

Question 5

Fracture region III and IV - frontlimb

Answer 5

• e. g distal radius fracture
• Splint should reach the withers to avoid abaxial motion of the limbs.
• the cast should be to the level of olecranon
• splint lateral bc og the planum cutaneum and to avoid abaxial movement.

Question 6

Main points of transport

Answer 6

• transporting vehicle as near as possible
• you can carry foals
• wide transporting vehicle
• during transport on both sides polster
• head loosed fasten
• Fracture infront: head directed backwards
• Fracture behind: head directed in travel direction
• foals should be seprated from their mother, but visible
• Medications:
  
  • NSAID
  • sedatives and analgesics: Xylasin or DEtomidin
  • Haynet: good “tranquillizer” for horses

Question 7

Basic principles of AO-ASIF

Answer 7

• Anatomic reduction (put the fracture back to normal anatomical position)
• stable internal fixation
• preservation of blood supply
• early acitve, painfree mobilisation

Question 8

With regards to strength, the bone is….

Answer 8

• bone is strongest in compression
• weakest in shear
• intermediate in tension

Question 9

Fracture classification

Answer 9

• Based on relationship with the environment (open or closed)
• based on displacement
• based on fracture pattern
• based on etiology

Question 10

Fracture classification

• based on relationship with the environment

Answer 10

• Open: Grade 1, 2 and 3
• Closed: do not underestmate soft tissue damage.
  
  • you will see a huge swelling. Locus minoris resistance for infection due to concusion

Question 11

Fracture classification

• based on displacement

Answer 11

• Undisplaced (usually young foals. Periosteum is holding the fracture lika a cast)
• Displaced
  
  • A: translation
  • B: Angulation
  • C: Shortening

Question 12

Fracture classification

• Based on etiology

Answer 12

• Trauma
• Pathological

Question 13

Fracture classification

• Based on fracture pattern

Answer 13

• Simple: little or no bone displacement
• Compound: fracture ruptures the skin and bone protrudes
• Green stick: occurs mostly in foals, whose bone have not calcified or hardened
• Transverse: crack perpendicular to long axis of the bone - displacement may occur (mainly in foals)
• Oblique: diagonal crack across the long axis of the bone
• Sprial: diagonal crack involving a “twisting” of the bone about the longitudinal axis
• Comminuted: “crushing” fracture - more common in adults (the worst type)
• Impacted: one end of bone is driven up into the other
• Depressed: broken bone is pressed inward (skull fracture)
• Avulsion: fragment of bone is pulled away by tendon

Question 14

Internal fixation

• techniques

Answer 14

• Lag screw technique
• bone plate
• DCS (Dynamic Condylar Screw), DHS
• Cerclage wire
• Medullar pins
• Kirschner wire

Question 15

Lag screw technique

Answer 15

Step 1:

• Glide hole (outside dm (4.5mm) of the screw. on the far side you need a drill hole to get the core dm (3.2mm).
• Drill through the fracture
• flush
• = pull the fractured pieces together

Step 2:

• Concentric thread hole
• flush
• thread hole

Step 3:

• Countersinking: gives a “bed” for where your screw can sit

Step 4:

• Measuring with Depth gauge

Step 5:

• Tap

Step 6:

• Screw insertion

Question 16

External fixations

Answer 16

• “Walking cast” bovine
• “Transfixation cast” horse
• Fixateur externa
• Sling (e.g distal radius fissure only need sling, no surgery)