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Ortho sx > Equine orthopedic emergencies (Bauck) > Flashcards

Equine orthopedic emergencies (Bauck) Flashcards

1
Q

What is an orthopedic emergency?

A
  • Any acute-onset, severe lameness
    • Fracture
    • Joint lux
    • Synovial infection
    • Tendon rupture/laceration
    • Laceration and puncture wound
    • Sole abscess or laminitis
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2
Q

Primary goal for fractures and catastrophic traumas

A

stabilize limb for transport

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3
Q

Fracture Patient First Aid

A
  • Physical restraint
  • Relevant history and rapid examination
  • Sedation and analgesics
  • Examination & Immobilization of affected limb
  • Trasport to hospital
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4
Q

Physical Exam

A
  • Assess cardiovascular status
  • Affected limb or limbs
    • Is the horse bearing weight
    • Is the skin intact?
    • Presence of heat, pain, swelling, instability, crepitus
  • Evidence of trauma at other locations
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5
Q

Sedation

Dos

A
  • Alpha-2 agonists primary drugs (xylazine or detomidine)
    • +/- butorphanol
  • May need higher/more frequent doses
    • avoid ataxia
  • Example initial dose for 500kg horse
    • 200mg xylazine + 5mg butorphanol
    • 5mg detomidine + 5mg butorphanol
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6
Q

Sedation

don’ts

A
  • Avoid excessive ataxia
  • Avoid acepromazine: hypotension
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7
Q

Goals of fracture stabilization

A
  • Reduction of pain & anxiety
  • Immobilize adjacent joints if possible
  • Essential before transport, radiographs
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8
Q

Fracture stabilization chart

TQ

A
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9
Q

Section 1: Distal Fractures

A
  • Distal MC/MT3, P1, P2
    • breakdown injuries & fetlock luxations
  • Align dorsal cortices into straight line
    • Neutralizes bending forces at fetlock joing and fracture site
    • Apply dorsal splint
  • Apply light compression bandage (1/2” thick)
    • NOT Robert Jones
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10
Q
A
  • Kimzey ‘leg saver’ splint
    • suspensory breakdown
    • catastrophic fracture P1
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11
Q

Section 1: Distal hindlimb

A
  • Same as front
  • Light bandage and plantar splint

*something about a little bit of extension in the toe

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12
Q

Section 2: mid-forelimb

A
  • Proximal 2/3 metacarpus, carpus, distal radius
  • Maintain bony alignment and immobilize distal to fracture site
  • Robert Jones, ground to elbow
  • Caudal & Lateral splints
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13
Q

Robert Jones Bandage

A
  • Multiple layers of rolled cotton
  • Layers compressed by brown gauze
  • 1 inch/layer
  • Final diameter = 3x limb
  • Apply splints with duct tape or white tape (NO STRETCH)
    • NOT ELASTICON
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14
Q

Section 2: Mid & Proximal Metatarsus

A
  • Stabilize by using the calcaneal tuberosity (point of hock) as extension of MT3
  • Apply lateral and plantar splints over padded bandage
  • Caudal splints should extend from calcaneus to ground
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15
Q

Barring catastrophic rupture, which two joints flex/extend together

A

Hock and stifle

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16
Q

Section 3: Mid & Proximal radius

A
  • Goal
    • prevent abduction
  • Lateral pull of antebrachial muscles distal to fracture site
  • Can lead to open fracture
  • Robert Jones bandage
  • Caudal splint-elbow to the ground
  • Lateral splint-whithers to the ground
  • Extended lateral splint prevents abduction
17
Q

Very little soft tissue on which aspect of forelimb?

A

medial aspect

18
Q

Section 3: Tarsus and Tibia

A
  • Problem: Reciprocal apparatus and minimal soft tissue coverage
  • Goal: prevent abduction of limb
  • RBJ from stifle to ground
  • Lateral splint-tuber coxae to ground
  • Wide Wooden board or contoured metal rod
  • Width = resistance to rotational forces
  • Length prevents abduction
19
Q

Section 4

Proximal to Elbow

A
  • Includes humerus and scapula
  • Well protected by muscle
  • No coaptation
  • Splinting actually contraindicated
20
Q

Olecranon fractures

about

A
  • Special case
  • Complete olecranon fractures and some humoral fractures
  • Disrupt triceps apparatus
  • Apply splint to align bone column and fix carpus
  • This allows weight bearing on limb
21
Q

Olecranon fractures

Bandage

A
  • Goal:
    • align bones
    • fix carpus in extension
    • allow weight bearing
  • Padded bandage (NOT RJB)
  • Caudal splint
    • Olecranon to fetlock/or ground
22
Q

Section 4: Proximal to Stifle

A
  • Coaptation NOT performed (contraindicated)
    • Could inc traum from pendulum effect
  • Protected by musculature
23
Q

Open Fracture

A
  • any break in skin
  • Clean wound before bandaging
  • Keep moist
  • Initiate broad spectrum antibiotics
  • Tetanus toxoid
    • any laceration ask about tetanus vaccination status
24
Q

After limb is stabilized

A
  • Analgesia
    • Some is ALWAYS provided
      • bute or banamine
    • Does NOT create more damage
    • Avoid corticosteroids
  • Flunixin meglumine: 1.1 mg/kg
  • Phenylbutazone IV: 4.4 mg/kg
25
Q

Fx complications/

post stabilization care

A
  • Hypotensive shock (rare)
    • lacerated artery and blood loss
    • dehydration/loss of circulating volume
  • IV fluids
    • Isotonic bolus
      • NormR
      • Plyte
  • Nephrotoxic drugs
    • be conscientious of dehydration + NSAIDS + aminoglycosides
26
Q

Radiographs

A
  • Not always possible/necessary
  • Better at referral hospital
  • Perform when affects decision to transport
  • Can perform with splint in place
27
Q

Transport

A
  • Large vans and gooseneck trailers
  • Keep dividers in place
    • use chest/rump bars for support
  • Untied head, neck free for balance
  • NO STOCK TRAILORS
  • NO LOOSE BOX STALLS
  • Minimize distance the horse must walk
28
Q

Position on trailor

A
  • Easier for the driver to control acceleration, not breaking
    • HINDLIMB fractures: FACE FRONT
    • FRONT LIMB fractures: FACE BACK
29
Q

Fracture prognosis

Categories

A
  1. Type, number & location of fractures
  2. Open vs Closed
  3. Degree of soft tissue damage/vascular injury
  4. Age, breed and weight of horse
  5. Nature of patient
  6. Time between injury and repair
  7. Effectiveness of first aid before referral
30
Q

Reparability of fractures

A

More distal and less weight bearing fractures easier to repair, better prognosis

31
Q

Amenable bones for repair

A
  1. Phalanges
  2. Sesamoids
  3. MC/MT
  4. Carpal
  5. Tarsal
  6. Patella
  7. Ulna
32
Q

Bones adverse to fracture repair

A
  1. Radius
  2. Humerus
  3. Scapula
  4. Calcaneus
  5. Tibia
  6. Femur
  7. Pelvis

Ortho sx (11 decks)

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