Exam 1 - Fracture Stabilization: Lecture & Critical Thinking Flashcards
what are 3 components of emergency coaptation?
bandaging, splinting, & casting
what are 2 components of achieving long-term fracture stabilization?
surgical internal fixation or external fixation
what are the 3 goals of emergency fracture stabilization?
- prevent further injury to bone, soft tissues, & neurovascular structures - neutralize forces causing displacement & protect it from becoming open
- assist weight bearing to reduce support limb complications & reduce stress/anxiety
- improve outcomes
T/F: splinting a fracture won’t transfer weight bearing in a horse
true
what are the 5 principles of emergency fracture stabilization?
- identify the region of instability
- assess soft tissue integrity (open vs. closed)
- apply protective bandage
- apply appropriate splints
- refer for definitive treatment
how is a modified robert jones bandage applied?
multiple layers switching between cotton & brown gauze, applied tightly until the limb is cylindrical
why must the splint be applied over the bandage?
risk of pressure points & lack of support
what fracture types are included in level 1 distal?
P1, P2, sesamoids, & distal metacarpus
what kind of splint is needed for fractures of P1/P2, sesamoids, and the distal metacarpus of the horse?
dorsal splint!!!
what is the goal of applying a dorsal splint? why?
achieving dorsal cortical alignment!!
fracture becomes the site of bending instead of the joint - so neutralize the bending by aligning the cortices
what are the disadvantages of using a kimzey leg saver splint?
expensive, doesn’t allow equal weight bearing, support limb risk, & very short-term solution
what do you do if there is a fracture of P3?
it is stabilized by the hoof capsule - supplement the rigidity of the hoof capsule
what fractures are include in level 2 of the forelimb of the horse?
mid/proximal metacarpus & distal radius
what fractures are include in level 2 of the hindlimb of the horse?
mid/proximal metatarsus & distal tibia
what is important to remember about level 2 fractures when it comes to stabilization?
fracture is unstable in all directions & will require TWO SPLINTS in TWO PLANES!!
where should splints be applied for level 2 fractures of the forelimbs?
caudal to the olecranon & lateral to the elbow
where should splints be applied for level 2 fractures of the hindlimbs?
caudal to the calcaneus & lateral to the stifle (if needed: distal tibial fracture)
what fractures are included in level 3 of the forelimb of the horse?
radius
what fractures are included in level 3 of the hindlimb of the horse?
tibia
what is important to remember about level 3 fractures when it comes to stabilization?
unstable in all directions!!! very little muscle on the medial aspect of the radius & tibia
lower limb abducts & risks opening the fracture medially
what are the goals of immediate fracture stabilization of level 3?
prevent abduction
stabilize in all directions
where is the splint placed for a level 3 fracture of the radius & tibia?
splint extends proximal to the elbow & is touching the horse
splint goes all the way up to the level of the stifle
splint in 2 planes if possible!!
when is the use of the thomas schroeder splint best suited?
splint used in ruminants to neutralize the reciprocal apparatus because the stifle & tarsus are linked, so if one flexes, so does the other
foot is fixed to the bottom bar & the ring is in the inguinal region
what makes up the reciprocal apparatus?
SDF & peroneus tertius
what is the goal of fracture stabilization of the olecranon?
fix the carpus in extension - not spanning the fracture
why are olecranon fractures a big problem for horses?
the olecranon is the attachment site of the triceps, so the animal can’t use the limb to try to extend & can’t hold the carpus in extension, so it CAN’T BEAR WEIGHT
horse becomes panicked
where is the splint placed for olecranon fractures?
splint is placed on the palmar aspect of the limb & goes from the ground to the proximal radius
why not splint a femur fracture?
don’t want the animal to try & use the leg because of risk of hemorrhage
what do you do if there are fractures of the upper limb including the humerus, scapula, femur, or pelvis?
musculature often adequately stabilizes & splinting may create distraction
what is the risk of humeral fractures in horses?
radial nerve injury
what is your plan if there are fractures of the upper limb including the humerus, scapula, femur, or pelvis?
refer ASAP for internal fixation
what does a ‘dropped elbow’ of a horse make you suspect as far as fractures go?
olecranon fracture
what is the drug class of trimethoprim sulfa?
potentiated sulfonamide
what is the drug class of penicillin G?
natural penicillin
what is the drug class of gentamicin?
aminoglycoside
what is the drug class of ceftiofur?
3rd generation cephalosporin
what is the spectrum of activity of trimethoprim sulfa?
gram positive aerobes, pasteurellaceae, & enterobacteriaceae
what is the spectrum of activity of penicillin G?
gram positive aerobes, gram positive obligate anaerobes, some pasteurellaceae, & gram negative obligate anaerobes
what is the spectrum of activity of gentamicin?
gram positive aerobes, pasteurellaceae, enterobacteriaceae, & pseudomonas
what is the spectrum of activity of ceftiofur?
gram positive aerobes, gram positive obligate anaerobes, pasteurellaceae, enterobacteriaceae, some pseudomonas, & some gram negative obligate anaerobes
what is the mechanism of action of trimethoprim sulfa?
sulfa - competes with PABA in production of nucleic acids
trimethoprim - inhibits dihydrofolate reductase
what is the mechanism of action of penicillin G?
inhibits cell wall synthesis by binding to transpeptidase or other cell wall synthesis enzymes
what is the mechanism of action of gentamicin?
protein inhibition via binding of 30s ribosomal subunits
what is the mechanism of action of ceftiofur?
inhibits cell wall synthesis by binding to transpeptidase or other cell wall synthesis enzymes
what is the route of administration of trimethoprim sulfa?
injectable & oral
what is the route of administration of penicillin G?
IM strictly if it contains procaine - can do potassium penicillin IV very slowly
what is the route of administration of gentamicin?
IM/IV extra label
what is the route of administration of ceftiofur?
*
why not use coastal hay for horses recovering from a fracture? how can you address it?
jams the colon/ileum
mix with alfalfa or feed timothy hay
if you suspect a horse is getting right dorsal colitis, what should you monitor on the horse’s chemistry panel?
decreased albumin! monitor proteins
