Exam 1 - Equine Common Fractures

Question 1

what are the 3 big options for a horse with a fracture?

Answer 1

conservative treatment

surgery

euthanasia

Question 2

what are the objectives of any surgical repair of a fracture?

Answer 2

want appropriate biological viability - intact blood supply

mechanical strength - strong enough fixation post-op for weight bearing

stability!!!!!

Question 3

why is fracture stability so important in equine fracture repair?

Answer 3

stability = comfortable horse

uncomfortable horse = likely to founder

need to have a stable fracture that is non-infected & get horse comfortable to avoid any support limb issues

Question 4

what are the 3 main types of fractures discussed in this lecture?

Answer 4

nondisplaced - incomplete or complete

displaced

articular

Question 5

when do we commonly see non-displaced fractures in adult horses?

Answer 5

blunt force trauma from kicking

look for external evidence - wound

Question 6

where are the most common locations in adult horses for non-displaced fractures?

Answer 6

ulna, metatarsal IV, & radius

Question 7

why should you always radiograph a horse with a kick injury upon initial exam and then follow up days later with recheck rads?

Answer 7

you need to treat the wound for any infection & evaluate for any fracture

look a few days later for radiographic evidence of a fracture - if you miss it, you run the risk of the fracture becoming displaced & unsalvagable

Question 8

horses with kick injuries that are housed adjacent to each other typically have a fracture in what location?

Answer 8

mt 4

Question 9

horses with kick injuries that are housed with each other typically have fractures in what locations?

Answer 9

radius/ulna/mt 4

Question 10

T/F: horses with fractures will present with an acute 4/5 lameness

Answer 10

true

Question 11

what is the typical pattern seen in horses with non-displaced fractures?

Answer 11

wound treatment & NSAIDS initially decrease their lameness with fx undiagnosed - which is why you repeat rads a few days later

Question 12

how are non-displaced fractures managed in horses?

Answer 12

wound therapy & confinement

prevent recumbency - risk of becoming displaced

monitor them for displacement & healing

Question 13

what is the major complication of non-displaced fractures?

Answer 13

fractures become displaced - catastrophic results

Question 14

T/F: with displaced & articular fractures, there is a necessity for surgical repair

Answer 14

true

Question 15

what is the biggest cause for seeing a horse with a ‘dropped elbow’?

Answer 15

olecranon fracture - disrupts the triceps attachment, so the horse can no longer hold the elbow/carpus in extension or engage their stay apparatus

can’t bear weight

Question 16

what is a flail limb fracture?

Answer 16

animal has no control on the limb whatsoever

Question 17

what are common causes of olecranon fractures in horses?

Answer 17

adults - kick

foals - fall

Question 18

which one of this horses has a displaced olecranon fracture?

Answer 18

horse on the left - significant effusion/swelling

both have dropped elbow

Question 19

what do you think this foal has fractured? why?

Answer 19

humerus - big swelling in the brachial region, can see well in the cranial aspect

Question 20

what are some differentials for olecranon fractures?

Answer 20

humeral fracture

radial neuropathy

scapular neck fracture

Question 21

what is the emergency coaptation indicated for an olecranon fracture?

Answer 21

full limb bandage & caudal splint - need to fix the knee in extension so the horse can bear weight

Question 22

this is a foal with a humeral fracture - is this okay coaptation?

Answer 22

nope - don’t splint humeral fractures, risk of radial neuropathy

Question 23

T/F: fractures at the olecranon in foals are not salter harris fractures

Answer 23

true - traction epiphysis fractures

Question 24

what specific olecranon fracture can you choose conservative treatment for? what does that entail?

Answer 24

non-displaced & non-articular fractures

stall +/- splint bandage

Question 25

what is the most common treatment used for olecranon fractures?

Answer 25

ORIF plate fixation - useful for displaced/articular fractures, but most are non-articular & non-displaced

Question 26

what are some complications of conservative management of olecranon fractures?

Answer 26

displacement, pseudoarthrosis, & prolonged lameness

Question 27

T/F: surgery for olecranon fractures has a high success rate & low complication rate

Answer 27

true - internal fixation, tension band plate to neutralize the forces of distraction being placed on the triceps long term soundness prognosis

Question 28

what long bones are commonly seen for fracture repair in horses?

Answer 28

phalanges, mc/mt 3, radius/tibia, & humerus/femur

Question 29

what components make up case selection for equine fractures?

Answer 29

patient - age, size, & temperament fracture - bone affected, location of fracture, & configuration of fracture (need purchase above & below the fracture & can't be highly comminuted)

Question 30

T/F: olecranon, phalanges, & mc/mt 3 fractures are very repairable on adult horses

Answer 30

true

Question 31

what biological injuries should be considered in equine fractures?

Answer 31

soft tissue envelope, contamination, & neurovascular supply

Question 32

when do we commonly see humeral/femoral fractures in horses?

Answer 32

weanling quarter horse had an accident during halter breaking or when out on the pasture

Question 33

T/F: temporary stabilization for humeral/femoral fractures can increase soft tissue damage

Answer 33

true

Question 34

how are humeral fractures fixed surgically?

Answer 34

interlocking nail & plate combo that watkins made

Question 35

what emergency management is indicated for radial/tibial fractures in horses?

Answer 35

modified rj bandage & splint radial - caudal & lateral splints tibial - lateral splint try to protect the medial soft tissue envelope from a displaced fracture

Question 36

when may conservative therapy be indicated for a radial/tibial fracture in a horse?

Answer 36

if it is a fissure line fracture

Question 37

what surgical repair is commonly performed for radial/tibial fractures?

Answer 37

ORIF - double plating

Question 38

what emergency management is indicated for mc/mt 3 fractures in horses?

Answer 38

splint cast forelimb - up to the elbow hindlimb - to the tuber calcanei caudal & lateral splints!!!

Question 39

what surgical repair is commonly done for diaphyseal fractures of mc/mt 3 in horses?

Answer 39

double plate correction

Question 40

T/F: fractures of the distal 1/3 of the splint bones do well with removal & have a good prognosis

Answer 40

true

Question 41

what emergency management is indicated for phalangeal fractures in horses?

Answer 41

distal limb splint cast with minimal padding from the hoof to proximal mc/mt use a dorsal splint for axial alignment of the dorsal cortices

Question 42

what surgical procedures can be used for phalangeal fracture repairs?

Answer 42

simple - lag screw comminuted - intact strut with lag screw & cast or if no bone strut - transfixation cast & bridging plate

Question 43

T/F: for middle phalanx fractures, palmar/plantar stability is very important, & unstable fractures affect this

Answer 43

true

Question 44

which fracture is unstable?

Answer 44

the one on the right - needs double plate fixation stable fracture only needs single plate fixation/transarticular lag screws