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Equine LA Sx > Fracture First Aid > Flashcards

Fracture First Aid Flashcards

1
Q

What is the most common cause of acute non-weight bearing lameness?

A. Laminitis
B. Navicular disease
C. Fracture
D. Sole Abscess

A

Sole abscess

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2
Q

What is your number one priority with fracture management?

A. Not look like an idiot
B. Get the horse out of the arena
C. Radiographing fracture to determine extent of the damage
D. Stabilizing the fracture

A

D. Stabilizing the fracture

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3
Q

What three questions do you need to ask over the phone for a suspected fracture?

A
  1. Where is the animal?
  2. Is he bleeding?
  3. Is he controlled?
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4
Q

What should you direct the client to do over the phone for an animal with a suspected fracture?

A
  • KEEP THE ANIMAL IN A SAFE PLACE until you arrive
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5
Q

Objectives for first aid treatment for fracture repair

A
  • Relieve stress, pain, and anxiety
  • Preserve nerves and blood vessels
  • Protect soft tissue and prevent bone penetration of the skin
  • Prevent further damage to bones
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6
Q

What could happen if the vessels on a fracture stretch while it is destabilized?

A
  • Hyperextension of the fetlock that can injure vessels and nerves, ultimately leading to thrombosis of the vessels
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7
Q

Open fracture prognosis decrease automatically

A
  • 50% decrease automatically
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8
Q

Goal of fracture stabilization

A
  • Have the animal arrive at the referral center as healthy as when it left the farm, with no further damage to the leg
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9
Q

Steps when you first arrive at a horse with a fracture

A
  • Remain calm, keep the owner and the horse calm
  • Assess the situation
  • Protective splints and immobilization should be applied immediately
  • Other diagnostics can be carried out with minimal risk of further damage
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10
Q

How to control the patient?

A
  • Good handler!
  • Stabilization
  • Sedation
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11
Q

What are downsides of sedation?

A
  • Ataxia or excitement
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12
Q

What are the main sedatives used for equine med?

A
  • Acepromazine
  • Butorphanol
  • Xylazine
  • Detomidine
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13
Q

Acepromazine use

A
  • limit use to only animals without signs of shock
  • Mares and geldings to decrease ataxia of other sedatives
  • Can cause priapism in stallions
  • No analgesia
  • No ataxia
  • Takes 5-10 min for effect
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14
Q

Butorphanol use

A
  • Good analgesia
  • Fairly high dose used for analgesia
  • May cause excitement if given alone
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15
Q

Xylazine use

A
  • Predictable and safer in animal with shock (alpha-2 agonist)
  • Short duration (20 min)
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16
Q

Detomidine use

A
  • Alpha-2 agonist mixed with alpha-1 agonist
  • Longer duration of action than xylazine
  • ~2 hours
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17
Q

Initial examination of horses with fractures

A
  • Limb involved
  • Region involved
  • Swelling, wounds, crepitus
  • Suspected bone involved
  • Possible neurovascular damage
  • Run through range of motion; feel for abnormal angulations
  • Lift the leg up and pull on it a bit
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18
Q

At what point should you shoot radiographs relative to splint?

A
  • If horse is calm and in a good position, can be before splint
  • If they’re freaking out, splint first and shoot through the splint
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19
Q

What is critical if there is a skin laceration or not?

A
  • Protection of the skin is critical for future fracture repair
  • If skin is penetrated by the bone, it should be cleansed, clipped, and covered with a water soluble dressing and sterile bandage immediately to reduce wound contamination
  • Likely would get on antibiotics as well
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20
Q

What does the ideal splint do?

A
  1. Neutralize damaging forces
  2. Minimally cumbersome
  3. Easy to apply
  4. Does NOT require general anesthesia (don’t want to have to wake them up)
  5. Economical/accessible
  6. PVC or oak board
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21
Q

Should you use metal in a splint?

A
  • NO

- It will bend and not be able to bend back

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22
Q

What is the golden rule of splinting?

A
  • Above and below the joint
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23
Q

What determines the forces to be neutralized for a splint?

A
  • Fracture location
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24
Q

What happens when fractures occur between the origin and insertion of a muscle

A
  • Alters the function of the muscle
  • Suspensory and reciprocal apparatus may no longer function
  • E.g. Extensor muscles become abductors
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25
Q

Stabilization needed for shoulder joint and above

A
  • No immobilization needed
26
Q

Stabilization needed for elbow to shoulder joint

A
  • Caudal splint to lock carpus extension
27
Q

Stabilization needed for carpus to elbow fracture

A
  • Robert-Jones bandage with extended lateral splint
28
Q

Stabilization needed for fetlock to carpus

A
  • Robert-Jones bandage with caudal and lateral splint
29
Q

Stabilization distal to fetlock

A
  • Dorsal splint
30
Q

Stabilization needed for proximal to stifle

A
  • No immobilization needed
31
Q

Stabilization needed for stifle to tarsus

A
  • Robert-Jones bandage with extended lateral splint
32
Q

Stabilization needed for tarsus to fetlock

A
  • Robert-Jones bandage with plantar and lateral splint
33
Q

Stabilization needed for distal to fetlock (hind limb)

A
  • Plantar splint
34
Q

Fractures of phalanges and distal metacarpus

A
  • Unstable fractures of middle and proximal phalanx
  • Proximal sesamoids
  • Distal MC3 (Distal 1/4)
  • Luxation of distal and proximal interphalangeal joints as well as metacarpophalangeal joint
35
Q

What angle biomechanically dominates fractures of the phalanges and distal metacarpus?

A
  • Metacarpophalangeal joint (fetlock joint)
36
Q

What do you want to stabilize for fractures of the phalanges and distal metacarpus?

A
  • Stabilize bending of the fracture as well as bending forces of the fetlock joint
  • Principal bending focus becomes the fracture site rather than the joint
37
Q

What do you need to align for fractures of the distal metacarpus and phalanges?

A
  • Dorsal cortices of P1, P2, and P3 must be aligned for splinting**
38
Q

Methods for splinting phalanges and distal metacarpus

A
  • Pick the horse’s leg up and let it dangle to make it straight
  • Put a standard standing leg wrap on it
  • Traditional casting with normal fetlock angle does not neutralize bending forces
  • Dorsal cortices of the bones (P1, P2, and P3) should be aligned in a straight line for splinting
  • Light bandage (1/2 in thick) is then applied to the distal limb
  • splint is then taped to dorsal aspect of the distal limb from carpus to toe (can be a cast as well)
  • PVC pipe splints or board may be used
  • Splint aligns the dorsal cortices of all bones and suspensory apparatus is neutralized
  • Cast material applied over the splint to maintain the bones in position
  • Medial to lateral and dorsal to palmar support
39
Q

Positioning and sedation for fractures of phalanges and distal metacarpus

A
  • To facilitate placement of the splint cast the horse should be sedated and limb supported by a reliable assistant
  • Leg must be held up until the cast material sets
  • Warm water will decrease the time needed for the cast to set
40
Q

Padding for fractures of phalanges and distal metacarpus

A
  • Small amount of padding accommodates for swelling
  • Too much padding allows for movement within the cast
  • For soft tissue injuries and some nondisplaced fractures, splinting without cast material may be adequate
  • Kimzey splints are good options for all but very unstable fractures
41
Q

What are options of stabilization for fractures of the mid-limb

A
  • Robert jones bandages with rigid external splints (on dorsal cortice and on lateral side)
42
Q

What is a Robert Jones bandage?

A
  • Multiple layers of thin padding and elastic gauze (gauze cling, vetwrap, repeated)
  • Total diameter should be 3x diameter of the limb
  • Splints from elbow to the ground at 90°
  • Splint on the dorsal cortice and on lateral side to make more rigid
43
Q

What is the biggest mistake you can make for a mid-forelimb fracture?

A
  • No going up high enough

- Should go up past the withers

44
Q

Fractures of mid- and proximal- radius

A
  • Not adequately stabilized by Robert Jones
  • Short splints may actually increase stress at the fracture site
  • Medial aspect of the radius is not protected by muscle, and the skin is easily penetrated by the fracture and must be protected
45
Q

Fractures of mid- and proximal radius

A
  • Apply a Robert Jones
  • Apply a lateral splint extended up the lateral side of the shoulder (past the withers!) which is taped securely to the proximal forelimb at the level of the axilla
  • lateral extension splint prevents the distal limb from abducting
46
Q

Fractures proximal to cubital/elbow joint

A
  • Scapula, humerus, and ulna are well protected by muscle that can help stabilize the fracture and protect the skin
  • Fracture of the scapula, humerus, or ulna will disarm the triceps apparatus and make it impossible for the horse to fix the elbow for weight bearing
47
Q

Splinting of fractures proximal to cubital joint

A
  • Splint the carpus in extension to allow the horse to use the limb for balance and ambulation
  • They can use their carpus as a peg
48
Q

Fractures of distal hindlimb considerations

A
  • Same principles apply as in the front limb
  • Slightly more difficult to apply the splint
  • Leg must be held in extension with the leg slightly behind the normal limb
  • Splint is typically applied to the plantar aspect of the limb
49
Q

Lower limb immobilization in the hind leg

A
  • Splint on the plantar aspect
  • Pick up the hock and hold it
  • Foot should lay flat against the splint
  • They use a fair bit of duct tape or white tap as Elastikon and Vetwrap will stretch
50
Q

Fractures of the mid- and proximal metatarsus

A
  • Splints are placed caudally and laterally over a Robert Jones bandage
  • Robert Jones should be less extensive than on the forelimb to help keep the splints in place
  • Splints extend from the calcaneal tuber to the ground
51
Q

Fractures of tarsus and tibia

A
  • Very difficult to adequately stabilize
  • Reciprocal apparatus caused the tarsus to flex and extend each time the stifle flexes and extends
  • Stifle flexion causes fractures of the tibia or tarsus to override
  • Nothing can be done to prevent stifle flexion, however, splinting can minimize lower limb abduction-adduction and trauma
52
Q

What type of splint for fracture of tarsus and tibia?

A
  • Robert Jones with single extended lateral splint prevents rotational forces
  • The splint should extend over the angle of the hock and in proximal fractures should extend to the point of the hip
53
Q

Stabilization for fractures of the femur

A
  • Do not require external stabilization
54
Q

Shock and fracture management

A
  • Shock is rarely a factor with fractures unless accompanied by severe blood loss or prolonged sweating
  • Stabilize patient prior to transport, fractures will not be repaired at 2 AM
  • more important for patient to arrive in good shape than to arrive quickly
55
Q

Diagnostics for fractures

A
  • Radiographs (quality important; do not rush)
  • Multiple views
  • Be able to describe
  • CT
  • Scintigraphy
56
Q

Antibiotics for frcatures

A
  • open wounds that are inside out or outside in (worse to be inside out)
  • Broad spectrum systemic
  • Call your referral center first
57
Q

Which broad spectrum antibiotics are usually a good choice for fractures?

A
  • Penicillin and gentocin

- Cefazolin and gentocin

58
Q

Analgesics

A
  • Definitely NSAIDs
  • Butorphanol
  • IM detomidine
  • CAREFUL WITH LOCAL ANESTHESIA (want them to protect the leg)
59
Q

Questions for referral center with fracture repairs

A
  • Prognosis
  • Cost
  • How to stabilize
  • Antibiotics
60
Q

What type of trailer for transport?

A
  • If you transport in a big trailer, make sure there is something supporting them
  • Want something with sideboards where they have a stall?
  • Large stable vans
61
Q

Transportation orientation

A
  • Forelimbs should be transported backwards and hindlimbs forward
  • Head and neck should be left free or loosely tied for balance

Equine LA Sx (4 decks)

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