Equine Ortho Emergencies Flashcards
DDx for Severe Lameness
- Fracture
- Infection in a closed space
- hoof abscess
- septic synovial structure
- cellulitis - Laminitis
- Severe soft tissue injury
- tendon/ligament
- luxations
Difference between foals and adults with septic arthritis
Foals:
- hematogenous
- multiple jts can be affected
Adults:
- traumatic (wound)
- IA: e.g. injections for OA
- Single joint (can have multiple jt spaces affected ini same region)
Risk factors for Septic arthritis?
- recent IA injection
- recent sx
- puncture wounds near jt
Foals: failure of passive transfer, sepsis and/or umbilical infection, GI tract (colitis)
How do we dx septic arthritis?
- Arthrocentesis - cytology
- Culture - synovial, blood (foals)
- Rads
- US
Normal Joint Fluid
- Appearance
- Protein
- Nucleated cells
- Neuts
- pale yellow, clear
- < 2.5 g/dL
- < 1000
- < 10% neuts (mononuclear)
Septic Joint Fluid
- Appearance
- Protein
- Nucleated cells
- Neuts
- Turbid, yellow to orange
- > 4 g/dL
- > 30,000
- > 90% neuts (degenerative or nondegen)
How do we treat Septic Arthritis?
The solution to pollution is dilution!
- Abx
- Jt irrigation/arthroscopy!**
- Anti-inflammatories
- Limb support (bandage, cast, splint)
Septic Cellulitis - acute infection with assoc’d inflammation of the dermis and SQ tissues
Dx, Tx
Dx:
- CS
- US
- Rads
- FNA or biopsy
- Culture of abscess drainage (staph or strep common)
Tx:
- systemic Abx
- regional perfusion
- anti-inflammatories
- analgesics
- bandaging
- hydrotherapy/cryotherapy
Bacterial myositis
Rapidly progressing necrosis of mm due to bacterial infection
- wound, IM injection (banamine!), or hematogenous
- Clostridium (anaerobic!), strep, staph, coryne, salmonella
Bacterial myositis
Dx, Tx
Dx:
- US and gram stain
Tx:
- systemic Abx
- anti-inflam/pain meds
- sx fenestration and debridement
- wound management
- maggots
- hyperbaric O2 therapy (clostridium)
- supportive care
Casts…. if you have a fracture the ____ must be in the cast!
Foot! must be covered!
Cast care
- Rechecks
- 2x daily eval –> check for heat, drainage, comfort
- STRICT stall rest - Changes
- splints: _____ wks
- casts: _____ wks (adults)
- casts: ____ wks (foals)
1-2
3-4
1-2
Fracture immobilization - Hoof to distal MC
Bandage and apply DORSAL splint with leg non-WB
Fracture immobilization - Distal MC to distal Radius
Thick bandage (2 layers, RJ) and apply LATERAL and CAUDAL splint
Fracture immobilization - Distal radius to elbow
Bandage and apply CAUDAL splint to point of elbow and LATERAL splint extending above the point of the shoulder
Fracture immobilization - Elbow to scapula
No coaptation necessary and could make fracture worse
Exception: triceps app disable resulting in “dropped elbow” with olecranon fractures. CAUDAL splint will help fix carpus and make horse more comfortable
Fracture immobilization - Fetlock and distal
Plantar splint
Fracture immobilization - MT and tarsal fractures
Plantar splint to level of calcaneus and LATERAL splint up to stifle
Fracture immobilization - Tibial fractures
Extended LATERAL splint
Fracture immobilization - stifle, femur, hip
No coaptation necessary!
Which direction should a horse face in trailer…
forelimb injury?
hindlimb injury?
Forelimb = face backward
Hindlimb = face forward
Flexor Tendon Lacerations…
- Fetlock dropped, toe normal
- Fetlock dropped, toe pointed up
- Fetlock on ground, toe up
- SDF
- SDF and DDF
- SDF, DDF, and Suspensory ligament
Images on slide 45
Flexor Tendon Lacerations…
Tx, Outcome
Tx:
- +/- tendon suturing
- tenoscopy if in DFT sheath
- casting 6-8 wks +
- shoe support
Outcome:
- 50% return to work
- depends on structures involved
- worse in sheath? ADHESIONS!!!
Treatment and Outcome of Extensor Tendon Lacerations?
Lacerations over dorsal cannon/fetlock
Tx:
- +/- tendon suturing
- bandage, splint, and/or cast (prevent knuckling)
- stall rest 6-8 wks
Outcome:
75% return to full work
- stringhalt (hindlimbs)
