Exam 3: Lecture 29 - Management of Orthopedic Emergencies LA Flashcards
what is the most common cause of severe single limb lameness
foot abscess (subsolar abscess)
what are the other common causes of severe single limb lameness in horses (other than foot abscess)
- fracture
- cellulitis
- septic synovial structure
- nerve injury
- other crazy injury like joint luxation or tendon laceration
what are the numbers of the AAEP lameness grading scale
0-5
what is AAEP lameness scale 0 described as
lameness not perceptible under any circumstances
what is AAEP lameness scale 1 described as
lameness is difficult to observe and is not consistently apparent, regardless of circumstances
what is AAEP lameness scale 2 described as
lameness is difficult to observe at a walk or when trotting in a straight line but consistently apparent under certain circumstances
what is AAEP lameness scale 3 described as
lameness is consistently observable at a trot under all circumstances
what is AAEP lameness scale 4 described as
lameness if obvious at a walk
what is AAEP lameness scale 5 described as
lameness produces minimal weight bearing in motion and/or at rest or a complete inability to move
T/F: It is normal for horses to rest their front legs
FALSE!! not normal
If a horse is resting its front leg, what does that mean
they are usually lame in the leg they are resting
are these normal stances for forelimbs
no! they usually rest hindlimb, not FORELIMBS
what are the steps of triaging of severe lameness
assess patient pain level, history, PE (+/- TPR, examine lame leg)
what should we do if we cannot determine the cause of lameness
TREAT AS A FRACTURE until proven otherwise
what do we look for when we examine the limb for lameness
digital pulses, swelling, wounds, crepitus, or pain on palpation
why do we use hoof testers when looking at a lame horse
always start with these because can determine if there may or may not be an abscess…..also saves owners money before taking rads!
what is diagnostic anesthesia
a nerve block to determine the cause of severe lameness
when should we NEVER do a nerve block
if there is a high likelihood that there is a fracture…..if they feel better they bear weight and then can make the fx WORSE
when is imaging the first choice for diagnostics
if there is a high chance of fracture
when do we do radiographs on the limb
only once the limb is stable
why would it take 7-10 days for an incomplete fracture to become more visible
The fracture has osteoclastic activity that extends the fracture line making it more visible over time
what are the 5 things we should do if we suspect there is a fracture
- stabilization
- analgesia
- supportive care
- treatment options
- transportation considerations
what is the NUMBER ONE rule for fracture stabilization
immobilize the joint above AND below the fracture!!!
what joints should we stabilize for this fracture
stifle and tarsus
what joints should we stabilize for this fracture
carpus and metacarpus
what are the goals for fracture stabilization
- reduction of pain and anxiety
- prevention of further trauma (do not want an open fracture… leads to euth)
- immobilization of the joint above and below the fracture
describe a robert jones bandage
- 10-15 rolls of cotton for a full sized horse
- each layer should be no more than 1-2cm thick
- each layer is applied tighter than the one before
- end goal is 3x the diameter of the limb
- need splints to be stable
T/F: We should apply a splint in 2 planes 90 degrees from each other
true!!
if we are doing a short term splint application, should we use duct tape or elastikon
duct tape
if we are doing a long term splint application, should we use duct tape or elastikon
elastikon or white tape
what are some things that can be used as a splint
PVC pipe, 2x4 boards, broom handles, metal rods
what type of splits are these
kimzey splint
why are kimzey splits a leg savor
stabilized the joint above and below
what type of fractures can we use kimzey splits for
P1, P2, distal cannon fractures
what type of splint is this
kimzey splint
what is a bandage cast
when you apply cast tape directly over a bandage
what are the advantages of a bandage cast
very strong, easy to apply, light
what are the disadvantages of a bandage cast
difficult with unstable fracture or nervous tissue, more expensive
what type of immobilization should we do for 1
no immobilization necessary
what type of immobilization should we do for 2
caudal splint to lock carpus in extension
what type of immobilization should we do for 3
robert-jones bandage with extended lateral splint
what type of immobilization should we do for 4
robert-jones bandage with caudal and lateral splint
what type of immobilization should we do for 5
dorsal splint
what type of immobilization should we do for 6
no necessary immobilization
what type of immobilization should we do for 7
robert-jones bandage with extended lateral splint
what type of immobilization should we do for 8
robert-jones with plantar and lateral splint
what type of immobilization should we do for 8
plantar splint
what fractures are usually found in region 1
fractures of proximal and middle phalanx
why do we raise the heel for a region 1 fracture
to provide a dorsal or plantar flat surface to align the boney column
what type of fractures are found in region 2
fx of 3rd metacarpal bone or metatarsal bones
what type of fractures are found in region 3A
fractures of the tibia or radius
what type of injury do we see in region 3B
loss of triceps function, dropped elbow, olecranon fracture, or radial nerve paralysis
what type of injury do we see in region 4
fracture of humerus, scapula, femur, or pelvis
what does it mean if there is an associated wound with a fracture
open fractures have worse prognosis and increased cost!
how do we prevent an open fracture
with stabilization
T/F: You should give analgesics prior to stabilizing the fracture
false! You should provide after
when are antimicrobials indicated
for open fractures
What do we need to decide what the horse and fracture is stablizied
treatment vs euthanasia
T/F: Safe transport of the horse is essential to being able to fix the fracture
true!!
T/F: Gooseneck trailers are less stable than bumper pull
false! Gooseneck are MORE stable
if the hose has a forelimb fracture, how should the horse face in the trailer
backwards
if the horse has a hindlimb fracture, how should the horse face in the trailer
face forwards
T/F: There can be a lot of complications with casts
true!
when are casts indicated
support for internal fixation, wound protection, soft tissue damage, and triage for fracture
what type of cast is this
foot cast
what type of cast is this
half-limb cast
what type of cast is this
full limb cast / bandage cast
what type of cast is this
transfixation pin cast
what are some guidelines for cast application
- do not end a cast in the middle of a long bone
- cast should fit snug
- cast should be applied at the normal weight bearing angle
what things should we do in prep for a cast
pull the shoe on the limb you are casting, clean and trim the foot, and dress any wound that is present
what are the advantages of casting over a well-applied bandage
- easy to apply
- can bi-valve and still access the wound
- can apply in the field for emergency fracture immobilization
what are the disadvantages of casting over a well-applied bandage
- not as stable as a half limb or full limb cast
- can be difficult to make your bandage fit again
how often should you examine a horse with a cast
2x a day!
what should you look for when examining a horse with a cast
- willingness to bear weight/use of leg
- heat
- exudate
- pressure sores
- fever
what are the signs of the cast sore
straining of cast, increase lameness, and exudate coming out the top of the cast
where are common locations of cast sores in horses
dorsal cannon at top of cast, palmar aspect of fetlock, and coronet and heel bulbs
