EQUINE FRACTURE REPAIR Flashcards
Fracture occur in horses of all ages and involve almost any bone
- causes, broadly:
- External trauma
- Stress injury
- Pathologic fracture
Fracture classification
- Complete or incomplete
- Nondisplaced or displaced
- Open or closed
- Configuration
- Diaphyseal, metaphyseal, physeal, or epiphyseal (including
Salter–Harris physeal fractures, types I to VI) - Other (pathological fracture; multiple bone involvement).
fracture configurations
a) Greenstick or fissure
b) Transverse
c) Oblique
d) Spiral
e) Comminuted
f) Multiple
g) Impacted
h) Avulsion
Fracture management in the field
Main goals
- Immobilize the fracture
- Stabilize the patient
- Relieve anxiety, pain
- Prevent further damage
- Provide safe transportation
Fracture management in the field
A. Physical exam, what to look for?
- Thorough clinical exam
- Lacerations can affect the diagnosis and prognosis
- Hemorrhage
- Vascular compromise of the distal limb
- A fracture should be suspected with severe lameness
<><><><> - Demeanor
- Vital parameters: heart rate, respiratory rate
- Mucous membranes color, capillary refill time
- Estimate blood loss
- Estimate hydration status
- Evaluate the affected limb
Fracture management in the field
A. Physical exam
- what findings mean we need to stabilize the patient?
- what are our priorities in serious cases?
Stabilization:
- Pale mucous membranes
- Increased CRT
- Tachycardia (>60bpm), tachypnea (>32brpm)
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In cases of:
- Unstable limb fracture
- Ongoing blood loss
Priority:
- Stabilization of the fracture
- Stop the blood loss
Fracture management in the field
A. Physical exam
- how is the accuracy of our injury assessment? what are problem areas for this?
- Often the assessment of injuries underestimates the extent of the injury
- Especially after trauma in horses that have been kicked in areas such as:
- Scapular spine
- Major tubercle of the humerus, deltoid tuberosity
- Cutaneous plane of the radius
- Metacarpus, tuber coxae
Fracture management in the field
- Treatment or euthanasia?
- Despite great advances in veterinary orthopedic surgery – some injuries and fractures in horses cannot be treated successfully
- If prognosis is hopeless – euthanasia should be recommended
Fracture management in the field
B. Emergency treatment, protocol overview
B1. Sedation
B2. Initial wound management
B3. Fracture stabilization
B4. Administration of proper analgesia and anti-inflammatory medication
B5. Antimicrobial prophylaxis
B6. Intravenous fluid therapy
B7. Safe transportation of the horse
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order can be different
Fracture management in the field
- Emergency treatment sedation
- Dictated by circumstances
- Alpha-2 agonist drug of choice:
> Few side effects
> Provide reliable sedation and some analgesia - Combination with opioids – butorphanol
- Acepromazine – avoid in compromised patient – vasodilatory effects
Fracture management in the field
- Emergency treatment
B2. Wound management
- Skin wounds must be treated with care
- Cover the wound with water soluble gel
- Clip the hair around the wound
- Clean the skin around the wound
- Clean and disinfect the wound
- Cover the wound with a sterile dressing and bandage the limb
Fracture management in the field
- Emergency treatment
B3. Fracture Stabilization
- how to? goals?
- Stabilization in an anatomically normal position - most important
- It should be applied to allow the patient to bear some weight without
excessive damage - Distal limb support that does not contribute to stabilization should be
avoided
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Goals
1. Reduction of pain and anxiety and facilitation of partial weight bearing
2. Prevention of further compromise of the patient
3. Immobilization of the adjacent joints
<><> - The joints above and below the fractured bone should be immobilized
- Stabilization should extend well beyond the fracture line
- Never end of the coaptation near the fracture line – it act as a lever
B3. Fracture Stabilization
Types of stabilization
- Robert Jones Bandage–3 times the diameter of the limb
- Splints
- Bandagecast
- Cast
B3. Fracture Stabilization
Principles of stabilization
- Prevention of soft tissue damage
- Regional immobilization
fracture stabilization - considerations for prevention of soft tissue damage
- Stabilization may result in pressure and friction
- Padding should be layered. Each layer tightened
Regional stabilization front limb
1. Fractures of the distal phalanx
- The hoof capsule prevents marked displacement
- cast on the foot ideally
Regional stabilization front limb
2. Fractures of the navicular bone
- Support with an elevated heel position
- prevent DDF pulling navicular bone
Regional stabilization front limb
3. Fractures of the middle phalanx
- Immobilization in flexed position
Regional stabilization front limb
4. Fractures of the proximal phalanx
- Straight immobilization
- Robert Jones + splints, Cast
- avoid lateral and medial forces
Regional stabilization front limb
5. Fractures of the 3rd Metacarpus
- Distracting forces lateromedial
- Straight immobilization
Regional stabilization front limb
6. Fractures Proximal sesamoid bones
- Flexed
- avoid proximal and distal forces
Regional stabilization front limb
7. Stable fracture of the carpus
- The majority do not compromise axial limb stability
- Care of the soft tissues with a light conforming bandage
- Fractures of the accessory carpal bone can distract.
- Adding a splint to prevent carpal flexion
Regional stabilization front limb
8. Fracture of the radius
- Prevent abduction
- usually mid-diaphysis
- medial radius less covered by muscle, can open
Regional stabilization front limb
9. Fracture of the olecranon
- what do we observe? what do we do?
- The triceps apparatus is disarmed
- The horse cannot fix the limb in extension
- Result:
- Drop elbow
- Flexed carpus
- Toe drag
<><><> - splint in the back, put leg in extension to help triceps?
Regional stabilization front limb
10. Fracture of the humerus
- No benefits from temporary external support
- Limb mechanics preclude effective immobilization and the
surrounding muscle masses protect the fractured bone.
Regional stabilization hind limb
11. Fracture of the 3rd Metatarsus
- Immobilization with splints to the talocentral-calcaneoquartal joint
- Coaptation placed further proximal can be resented
Regional stabilization hind limb
12. Fracture of the tarsus and tibia
- Long lateral splint
- Reach the coxofemoral joint
- tibia has less muscle cover on iside, prevent abduction to stop fracture from becoming open
Regional stabilization hind limb
14. Stable fracture of the tarsus
(small bone fractures)
- Attempts at immobilization can be counterproductive
- Care of the soft tissues with a light conforming bandage
Regional stabilization hind limb
15. Fracture of the femur
- Marked hemorrhage frequently associated
- The femur is surrounded by muscles and cannot be stabilized
Regional stabilization hind limb
16. Pelvic fracture
- Manage with caution
- The decision to move horses with pelvic fracture is difficult
- Fractures of the ilial shaft are life threatening.
- Displaced fracture can lacerate iliac/femoral arteries
B4. Analgesia and Anti-inflammatories
- when should we administer?
- Overriding principle of analgesia in fracture management:
- Most effective when administered early in the pain cycle
- Should be given as soon as the fracture is stabilized
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Overriding principle of analgesia in fracture management: - No medication can provide the same level of analgesia and reduction
anxiety as that delivered by proper support and immobilization - Analgesics are never an adequate substitute for immobilization
B4. Analgesia and Anti-inflammatories
- what drugs are useful?
Non-steroidal anti-inflammatories,
examples:
- Phenylbutazone 4.4 mg/kg IV
- Flunixin meglumine 1.1 mg/kg IV
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Opiod analgesia,
examples:
- Morphine 0.1 mg/kg IM
- Hydromorphone 0.03-0.06 mg/kg
B5. Antimicrobials for fractures
- when do we give them? what do we give?
- Immediate administration is indicated in open fractures
- Otherwise, antibiotic therapy can be delayed until the time of surgery.
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Broad spectrum antibiotics - Penicillin 22,000 IU/kg IV
- Gentamicin 6.6 mg/kg IV
B6. Intravenous fluid therapy for fractures
- when do we give and why? what do we give?
- Hypovolemic shock – result of a volume deficit because of blood loss
- Distributive shock – occurs when vasomotor tone is lost
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Fluid therapy is indicated to help restore perfusion:
1. Hypertonic saline solution 7.2%, 2 to 4mL/kg - Expand the intravascular space
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2. Isotonic crystalloids – balanced electrolyte solution lactated Ringer - Designed to be replacement of fluids
- Fluid deficit replaced initially with 20mL/kg bolus
- Followed by maintenance requirement 2-4 mL/kg/h
B7. Transportation for fracture cases
- how do we orient the standing horse?
Standing horse
- Front limb fracture – face backwards
- Hind limb fracture – face forward
- Placed in a partition
- Aid of a harness
