Equine Ortho Flashcards
what are the main categories of equine orthopedic surgery?
elective
emergency
what sorts of elective surgery may be performed on horses?
arthroscopy/tenoscopy
angular limb deformities
soft tissue surgery
what elective soft tissue surgery may be performed on horses?
neurectomy
fasciectomy
desmotomy
what emergency surgery may be performed on horses?
arthroscopy - synovial sepsis and fracture repair
fracture repair
sequestrum removal
what fractures may be repaired using arthroscopy?
intra-articular
what is a common reason for elective arthroscopy?
OCD management
what is the aim of arthroscopy for OCD management?
stop further degeneration of developmental defects within the cartilage and bone of the joint
what is synovial sepsis?
bacterial infection leading to septic arthritis
what is the best method of treating synovial sepsis?
arthroscopy to flush joint
antibiotics
what can trauma resulting in damage to the periosteum lead to?
death of the bone in the region and then formation of a sequestrum
what is a sequestrum?
bone that has become necrotic due to trauma separates (sequesters) and becomes a foreign body which is often infected
what may indicate a horse has a sequestrum?
non healing wound
draining tract
how are sequestrum treated?
removed along with any active involucrum to allow wound and bone to heal
what is the involucrum?
bed of bone surrounding region sequestrum formed
what are angular limb deformities?
laterally or medially bent legs
in what animals are angular limb deformities seen?
foals under 18 months
what may cause angular limb deformity?
nutrition
incomplete ossification
tendon / ligament laxity
how can angular limb deformities be treated?
growth arresting techniques
growth accelerating techniques
what growth arresting techniques are available for angular limb deformities?
transphyseal screw in side that is overgrowing
plating
what growth accelerating techniques are available for angular limb deformities?
periosteal transection
what is the importance of treating angular limb deformities?
protection of joints from OA in the future
what are the challenges associated with fracture repair in horses?
size of horse and stress on repair
need to return to athletic ability
recovery from GA is dangerous
lack of soft tissue on distal limb
what is the issue with the lack of soft tissue on the equine distal limb in terms of fracture repair?
often open
contamination likely
what is the preferred method for fracture repair?
standing under sedation / LA
what may be needed prior to elective orthopedic surgery?
x ray
ultrasound
what must be checked prior to elective patient admission?
vaccine status (flu and tetenus)
what is involved in ortho patient prep?
pre-op exam
IV catheter
clip as much of site if possible
what is involved in prep of the emergency ortho patient?
clinical exam
ensure haemodynamically stable
sedate if necessary
IVC
wound care
what may be used to sedate horses with suspected fractures?
alpha 2
butorphanol
what does wound care depend on?
presentation of wound
what equipment may be needed for wound care?
clippers
swabs
hibi
warm water
sterile saline
needles
syringes
what medications may need to be given to ortho patients pre-op?
antibiotics
tetanus vaccine / antitoxin
analgesia
will imaging be needed prior to emergency ortho surgery?
depends on case
referring vet may have done already
if fracture is suspected what may be done before surgery?
limb support to stabilise
what are the goals of fracture stabilisation?
stabilise
reduce discomfort and distress
minimise futher trauma to bone ends, soft tissues and vasculature
prevent further contamination
what is the issue with too much padding round a fracture?
allows movement of bone fragments or slippage of splint
what areas of the body may be splinted?
proximal areas no
distally yes
site depends on location on leg
what type of splint can be used on the distal limb?
kimsey splint
where are Kimsey splints often used?
racehorses - distal fractures
what is a robert jones bandage made up of?
many layers of cotton
held in place and tightened by elastic gauze
what diameter should a finished robert jones bandage be?
3x diameter of the limb
what is the role of the nurse during ortho surgery?
scrub nurse
circulating nurse - run theatre
what are the general equipment requirements for theatre?
clippers
scrub
fluids for IVFT and lavage
medication
U cath
anaesthetic machine
imaging needed and PPE
positioning aids
post op bandage or casting materials
when will a u cath be placed?
all surgeries
sheath sutured closed in male horses
should horses shoes be removed before entry to theatre?
if possible yes - unlikely in an emergency
why is horse shoe removal before surgery preferred?
protection of equipment
reduction of trauma in recovery
what is involved in equine patient prep?
cover feet and tail
clip
clean skin
disinfect skin
where should clipping be performed?
outside theatre
what size of clip should be performed?
10-15 cm outside surgical site
what is used for skin prep in horses?
chlorhexidine
povidone iodine (round face)
what is the benefit of chlorhexidine for scrub?
residual activity as binds to protein in skin
low toxicity
why is chlorhexidine not suitable for open wounds?
toxic to fibroblasts found beneath the skin surface
what are the issues with povidine iodine for skin prep?
inactivated in presence of organic debris
when is alcohol commonly used for skin prep?
rinse after surgical scrub
what are the downsides to using alcohol for skin prep?
only effective against bacteria
inactivated by organic debris
no residual activity
how may horses be positioned for surgery?
ropes or support stands for legs
cushioning and padding essential
what imaging equipment is used in equine ortho?
fluro (PPE)
arthroscopy tower
what are the main considerations for positioning of horses in theatre?
surgeon comfort
access to surgical sites
horse comfort
myopathy / neuropathy risk
what positioning aids may be used in theatre?
stands
ropes
padding
cushions
fluid bags
what are the main risks associated with patient positioning in theatre?
myopathy / neuropathy from maintained pressure of the horses bodyweight on one area for an extended period
what is vital if imaging will be used during ortho surgery?
PPE available
what is critical about bandages placed after surgery?
need to be strong enough to withstand a dramatic recovery
is casting material often used in equine ortho surgery?
uncommon
what are the main options for equine recovery from GA?
unassisted
rope recovery
sling
pool
what is involved in rope and sling recovery?
rope attaches to headcollar and tail to direct
sling works in a simular way but bodyweight can be supported
what are the risks associated with pool recovery?
infection
pulmonary oedema
what must be monitored in orthopedic post op care?
analgesia
antibiotics
TPR
assessing faecal output and consistency
appetite
IV catheter patency and health
bandage strike through or slipping
why must faecal output be monitored post op?
impactions are common due to drugs and reduced movement
what is involved in post op care for synovial sepsis?
antibiotics
repeat synoviocentesis
wound managment
what route of antibiotics may be used for synovial sepsis?
systemic
intrasynovial
intravenous regional perfusion
what is intravenous regional perfusion?
toniquet placed above the joint or wound
high dose antibiotics injected into vein below
what parameters will be assessed in synoviocentesis?
WBC
TP
serum amyloid A
what can be decided based on repeat synoviocentesis?
if second wound lavage is needed
what are the main complications seen with orthopedic surgery?
post-op infections
incision breakdown
unacceptable pain
bandage sores
cast sores
supporting limb laminitis
how can supporting limb laminitis be prevented?
frog support in opposite limb
deep bedding
rubber mats
bandage good leg
effective analgesia
how is supporting limb laminitis caused?
laminae and vascular compression on opposing limb as it is taking most of the body weight
leading to inflammation and separation
how can laminitis be detected?
bounding digital pulse
when are bandage complications more common?
if the horse is hot/sweating
horse is moving a lot
bandage poorly applied (rare)
incorrect tension
what may be done to reduce risk of bandage complications?
cross tie
how often should casts be checked?
BID
what are you monitoring with regards to casts?
sudden or gradual changes in comfort
fever
discharge or staining
wear on sole
cast breakage
heat
flies sitting on one area
smell in first few days
what are the complications with fracture fixation?
postoperative infection
breakage of implants or implant failure
further limb fracture
what fracture fixation complications are seen in recovery?
breakage of implants or implant failure
further limb fracture
what is the impact of post op fracture fixation infection?
causes unstable fixation
results in pain and slowed healing
what equipment is required for fracture fixation?
drill
plates and screws
general kit and drapes
bone reduction forceps
plate bender
fracture kit
identify this instrument
drill
identify this ortho equipment
plate
identify this instrument
bone reduction forceps
identify this instrument
plate bender
what size fracture kit is used in equine ortho?
4.5mm
5.5mm
identify this instrument
Mathieu retractor
identify this instrument
Weitlaner retractor
identify this instrument
synovial resector
identify these instruments
trocar (top two)
cannula
what must you do before induction of an arthroscopy case?
ensure equipment is working
identify this instrument
bruns curette
what is the Bruns curette used for?
atraumatic removal of fragments within the joint
identify these instruments
Ferris Smith Rongeurs - straight or curved
why are iodine compounds not used for skin prep?
staining
radiopaque
smell
only free iodine is bacteriocidal
is free iodine used in skin prep?
only if diluted or combined with detergent
