Equine External Coaptation and Emergencies Flashcards
Assorted layers of bandaging?
- vet gammgee (padding)
- non adherent wound dressing
- orthopeadic padding
- cohesive bandage tape
- conforming bandage
- adhesive bandage
- white tape
What types of limb bandage can be applied to horses?
- lower limb bandange
- foot bandage
- full limb (fore/hind)
> start with lower limb and then add another section higher up, then cover both - RObert-Jones (fx support before surgery/if sugery not possible)
> multiple layers of thick padding, getting tighter -> provides support
How is a lower limb CAST applied?
- minimal orthopeadic padding
- cotton stockingette
- fix cast felt to proximal mrgin
- apply casting tape
- apply heel wedge
+- encorporate Gigli wire (facilitates easy cast removal)
What is transfixation casting? Indications?
> transosseal pins cemented in cast
- repaired or conservatively treated distal limb fx that is unstable under axial loading
- fetlock breakdown
- often salvage
How can setting time of cast be altered?
- hotter the water, faster it sets
What is a large animal external fixator also known as?
Walking cast
What Hx must be found out about the Fx patient?
- what happened? How long ago ?
- was the trauma observed?
- has the horse been moved since?
- did it have to be caught after the trauma?
- did the horse lose a lot of blood?
- did the horse sweat excessively?
- has any medication been given?
Kit necessities to be prepared for fx
> bandage material - wound dressing - conforming gauze - sheet cotton - casting tape - duct tape > splints - 2"x4" slats, boards - light metal rods - PVC pipes - Kimzey leg saver splint > Chemical restraint - Xylazine - detomidine - romifidine - butorphanol > Abx - Procaine Penicillin G - K-Penicillin - Gentamicin > other - flunixin - bute - tetanus toxoid vax - IV fluids
Initial steps to tx of emergency patient?
> take charge > assess condition - shock - blood loss > localise and assess damage - tx v euthanasia > correct immobilisation - always 1st, before radiographs etc. > radiographs > referral
Which drugs can be used for chemical restraint inthe mergency situation? Which should not be used?
> A2s - xylazine 0.2-1.1mg/kg IV - detomidine 10-25ug/kg IV - romifidine 0.05mg/kg IV > A2 + Narcotic - detomidine \+ Butorphanol 0.020.1mg/kg IV - never use narcotics alone -> excitement > AVOID ACP d/t hypotensive effects in the presence of circulating catecholamines
Outline initial examination of an injured limb
> visual - deviation axial/abaxial - hyperextension - swelling/haematoma - open wound > palaption - crepitus - fx fragments - open wound/moist spot - stress tests -> localisation and classification of fx - incomplete v complete - simple v comminuted - closed v open - articular v non-articular - tendon/lig disruption? - status of soft tissue
Outline classification of a fracture. LEARN THIS FOR ROTTIONS!!
- closed/open
- incomplete/complete
- simple/comminuted
- articular/nonarticular
- tendon/ligament disruption?
- status of surrounding soft tissues
How do the biomechanics of a limb change when fx?
- muscles acting over a fx bone exert different action to what they are intended to do
> eg. digital extensors and flexors in proximal radius -> abduction
> passive action structures counter their action - suspensory aparatus
- reciprocal apparatus
Outline the ideal splint
- neutralises forces
- not too cumbersoe (pendulum effect)
- applicable under difficult circumstances (no GA)
- economical and accessible
What are the functional divisions of the equine limb?
- Coronary band to distal MC / MT
- Distal MC/MT to distal radius/proximal MT
- Distal radius/prox MT to elbow/stifle
- elbow/stile to distal scapula/hip
What biomechanical acts on division 1 of the forelimb? What effect does this have clinically and so what are the goals of immobilisation?
> angle of the fetlock - suspensory apparatus - flexor tendons - bending focus over fx site > counteract bending forces > axial alignment of dorsal cortices
What immobilisation technique would be appropriate for division 1 forelimb fx?
debatable
- padded bandage/cast bandage with dorsal splint
- Kimzey leg saver splint
- can keep up on tippytoe but some argue immobilisation of the fetlock in flexion is counterproductive, can result in displacement of a fx that is otherwise stable under axial loading eg. condylar fx 3rd MC/MT, proximal phalanx fx
- rigid external coaptation with limb weight bearing may be better
> avoid excessive padding
- slipping
- pendulum effect
What biomechanical acts on division 2 of the forelimb? What effect does this have clinically and so what are the goals of immobilisation? Methods of immobilisation?
- use bones proximal and distal to attach splints bridging fx site
> immobilisation - RObert Jones bandage (2/3x diameter of limb @ fx site, multiple layers of individually confoming padding)
+ rigid splints up to elbow laterally and caudally
What biomechanical acts on division 3 of the forelimb? What effect does this have clinically and so what are the goals of immobilisation? Methods?
- digital extensors and flexors act as abductors of the limb (prox radius)
- inadequate stabilisation with RJB splints up to elbow
> goal of immobilisation - prevent abduction and soft tissue damage on medial aspect of the limb
> methods - RJB with extended lateral splint
What biomechanical acts on division 4 of the forelimb? What effect does this have clinically and so what are the goals of immobilisation?
- triceps apparatus disabled -> dropped elbow (cannot be flexed for weight bearnig)
- but humerus, radius and ulna (bones affected) are well protected by soft tissue so no need for direct protection
> goal - splint carpus in extended position to allow for weight bearing and blanace
> method - padded bandage
- splint caudally orcranially over carpus
- walking may be difficult and foals may be too weak to ambulate
> may not require immobilisation
What biomechanical acts on division 1 of the hindlimb? What effect does this have clinically and so what are the goals of immobilisation?
debatable as for forelimb - maintain in extension or flexion?
- reciprocal apparatus
- plantar cortices easier aligned
> method
- bandage/cast bandage with plantar splint
- ANGLED Kimzey leg aver splint
What biomechanical acts on division 2 of the hindlimb? What effect does this have clinically and so what are the methods of immobilisation?
> angulation of tarsus
- prox tarsus difficult to bandage and splints difficult to apply
immobilisation
- RJB with spints to tuber calcaneous (lateral and plantar)
- usually less voluminous than forelimb to allow movement!
3 main purposes of bandages?
- cover wounds protected by dressing
- prevent swelling/oedema
- immobilisation (+splinting)
What biomechanical factor acts on division 3 of the hindlimb? What are the components of this? Effects clinically? Immobilisation technique?
(prox metatarsal to stifle)
> reciprocal apparatus
- peroneus tertius m.
- fllexor digitalis superficialis m.
- gastrocnemius m.
> overriding at fx site instead of hock flexion
+ stifle joint cannot be immobilised
+ muscles laterally over tibia act asabductors
> RJB with extended lateral splint up to coxofemoral joint (wide board splint, light metal [modified Schroeder-Thomas without groin bar]
- prevents lower limb instability
- angulation at tarsus and stifle prevents paplication of cranial or caudal splint
How are fx of division 4 of the HL treated? Clinical signs? Prognosis?
(femur and pelvis, stifle to coxofemoral joint)
> non-weight bearing lameness
- limb remains controllable d/t more distal muscle insertions
- impossible to stabilise by external means
- poor prognosis (unstable fx, fx involving acetabulum)
See lecture for good summary of tx of each division
> FL 1. dorsal splint 2. RJB caudal and lateral splint 3. RJB with extended lateral splint 4. caudal splint to lock carpus in extension/no immobilisation necessary > HL 1. plantar splint 2. RJB with plantar and lateral splint 3. RJB with extended lateral splint 4. no immobilisation necessary
What are the best ways to transport a fx patient?
> shorten the distance to get to trailer
use goose neck trailers or large vans
- put sound legs at the FRONT to allow them to compensate for breaking forces
limit space to allow for leaning
leave head and neck free
young foals will travel recumbent
