Exam 1 - Fracture Stabilization: Lecture & Critical Thinking

Question 1

what are 3 components of emergency coaptation?

Answer 1

bandaging, splinting, & casting

Question 2

what are 2 components of achieving long-term fracture stabilization?

Answer 2

surgical internal fixation or external fixation

Question 3

what are the 3 goals of emergency fracture stabilization?

Answer 3

1. prevent further injury to bone, soft tissues, & neurovascular structures - neutralize forces causing displacement & protect it from becoming open
2. assist weight bearing to reduce support limb complications & reduce stress/anxiety
3. improve outcomes

Question 4

T/F: splinting a fracture won’t transfer weight bearing in a horse

Answer 4

true

Question 5

what are the 5 principles of emergency fracture stabilization?

Answer 5

1. identify the region of instability
2. assess soft tissue integrity (open vs. closed)
3. apply protective bandage
4. apply appropriate splints
5. refer for definitive treatment

Question 6

how is a modified robert jones bandage applied?

Answer 6

multiple layers switching between cotton & brown gauze, applied tightly until the limb is cylindrical

Question 7

why must the splint be applied over the bandage?

Answer 7

risk of pressure points & lack of support

Question 8

what fracture types are included in level 1 distal?

Answer 8

P1, P2, sesamoids, & distal metacarpus

Question 9

what kind of splint is needed for fractures of P1/P2, sesamoids, and the distal metacarpus of the horse?

Answer 9

dorsal splint!!!

Question 10

what is the goal of applying a dorsal splint? why?

Answer 10

achieving dorsal cortical alignment!!

fracture becomes the site of bending instead of the joint - so neutralize the bending by aligning the cortices

Question 11

what are the disadvantages of using a kimzey leg saver splint?

Answer 11

expensive, doesn’t allow equal weight bearing, support limb risk, & very short-term solution

Question 12

what do you do if there is a fracture of P3?

Answer 12

it is stabilized by the hoof capsule - supplement the rigidity of the hoof capsule

Question 13

what fractures are include in level 2 of the forelimb of the horse?

Answer 13

mid/proximal metacarpus & distal radius

Question 14

what fractures are include in level 2 of the hindlimb of the horse?

Answer 14

mid/proximal metatarsus & distal tibia

Question 15

what is important to remember about level 2 fractures when it comes to stabilization?

Answer 15

fracture is unstable in all directions & will require TWO SPLINTS in TWO PLANES!!

Question 16

where should splints be applied for level 2 fractures of the forelimbs?

Answer 16

caudal to the olecranon & lateral to the elbow

Question 17

where should splints be applied for level 2 fractures of the hindlimbs?

Answer 17

caudal to the calcaneus & lateral to the stifle (if needed: distal tibial fracture)

Question 18

what fractures are included in level 3 of the forelimb of the horse?

Answer 18

radius

Question 19

what fractures are included in level 3 of the hindlimb of the horse?

Answer 19

tibia

Question 20

what is important to remember about level 3 fractures when it comes to stabilization?

Answer 20

unstable in all directions!!! very little muscle on the medial aspect of the radius & tibia

lower limb abducts & risks opening the fracture medially

Question 21

what are the goals of immediate fracture stabilization of level 3?

Answer 21

prevent abduction

stabilize in all directions

Question 22

where is the splint placed for a level 3 fracture of the radius & tibia?

Answer 22

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!!

Question 23

when is the use of the thomas schroeder splint best suited?

Answer 23

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

Question 24

what makes up the reciprocal apparatus?

Answer 24

SDF & peroneus tertius

Question 25

what is the goal of fracture stabilization of the olecranon?

Answer 25

fix the carpus in extension - not spanning the fracture

Question 26

why are olecranon fractures a big problem for horses?

Answer 26

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

Question 27

where is the splint placed for olecranon fractures?

Answer 27

splint is placed on the palmar aspect of the limb & goes from the ground to the proximal radius

Question 28

why not splint a femur fracture?

Answer 28

don’t want the animal to try & use the leg because of risk of hemorrhage

Question 29

what do you do if there are fractures of the upper limb including the humerus, scapula, femur, or pelvis?

Answer 29

musculature often adequately stabilizes & splinting may create distraction

Question 30

what is the risk of humeral fractures in horses?

Answer 30

radial nerve injury

Question 31

what is your plan if there are fractures of the upper limb including the humerus, scapula, femur, or pelvis?

Answer 31

refer ASAP for internal fixation

Question 32

what does a ‘dropped elbow’ of a horse make you suspect as far as fractures go?

Answer 32

olecranon fracture

Question 33

what is the drug class of trimethoprim sulfa?

Answer 33

potentiated sulfonamide

Question 34

what is the drug class of penicillin G?

Answer 34

natural penicillin

Question 35

what is the drug class of gentamicin?

Answer 35

aminoglycoside

Question 36

what is the drug class of ceftiofur?

Answer 36

3rd generation cephalosporin

Question 37

what is the spectrum of activity of trimethoprim sulfa?

Answer 37

gram positive aerobes, pasteurellaceae, & enterobacteriaceae

Question 38

what is the spectrum of activity of penicillin G?

Answer 38

gram positive aerobes, gram positive obligate anaerobes, some pasteurellaceae, & gram negative obligate anaerobes

Question 39

what is the spectrum of activity of gentamicin?

Answer 39

gram positive aerobes, pasteurellaceae, enterobacteriaceae, & pseudomonas

Question 40

what is the spectrum of activity of ceftiofur?

Answer 40

gram positive aerobes, gram positive obligate anaerobes, pasteurellaceae, enterobacteriaceae, some pseudomonas, & some gram negative obligate anaerobes

Question 41

what is the mechanism of action of trimethoprim sulfa?

Answer 41

sulfa - competes with PABA in production of nucleic acids

trimethoprim - inhibits dihydrofolate reductase

Question 42

what is the mechanism of action of penicillin G?

Answer 42

inhibits cell wall synthesis by binding to transpeptidase or other cell wall synthesis enzymes

Question 43

what is the mechanism of action of gentamicin?

Answer 43

protein inhibition via binding of 30s ribosomal subunits

Question 44

what is the mechanism of action of ceftiofur?

Answer 44

inhibits cell wall synthesis by binding to transpeptidase or other cell wall synthesis enzymes

Question 45

what is the route of administration of trimethoprim sulfa?

Answer 45

injectable & oral

Question 46

what is the route of administration of penicillin G?

Answer 46

IM strictly if it contains procaine - can do potassium penicillin IV very slowly

Question 47

what is the route of administration of gentamicin?

Answer 47

IM/IV extra label

Question 48

what is the route of administration of ceftiofur?

Answer 48

*

Question 49

why not use coastal hay for horses recovering from a fracture? how can you address it?

Answer 49

jams the colon/ileum

mix with alfalfa or feed timothy hay

Question 50

if you suspect a horse is getting right dorsal colitis, what should you monitor on the horse’s chemistry panel?

Answer 50

decreased albumin! monitor proteins