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