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
2
Q
Primary goal for fractures and catastrophic traumas
A
stabilize limb for transport
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
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
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
6
Q
Sedation
don’ts
A
- Avoid excessive ataxia
- Avoid acepromazine: hypotension
7
Q
Goals of fracture stabilization
A
- Reduction of pain & anxiety
- Immobilize adjacent joints if possible
- Essential before transport, radiographs
8
Q
Fracture stabilization chart
TQ
A
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
10
Q
A
- Kimzey ‘leg saver’ splint
- suspensory breakdown
- catastrophic fracture P1
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
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
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
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
15
Q
Barring catastrophic rupture, which two joints flex/extend together
A
Hock and stifle
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
- Some is ALWAYS provided
- 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
- Isotonic bolus
- 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
- Type, number & location of fractures
- Open vs Closed
- Degree of soft tissue damage/vascular injury
- Age, breed and weight of horse
- Nature of patient
- Time between injury and repair
- 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
- Phalanges
- Sesamoids
- MC/MT
- Carpal
- Tarsal
- Patella
- Ulna
32
Q
Bones adverse to fracture repair
A
- Radius
- Humerus
- Scapula
- Calcaneus
- Tibia
- Femur
- Pelvis
