Fractures 1 And 2

Question 1

If you’re taking radiographs when should you apply the splint?

Answer 1

Before rads!

Question 2

In the distal limb which bone does not need a splint?

Answer 2

Coffin bone

Question 3

Splint for the distal forelimb

Answer 3

Apply a single dorsal splint from the foot to the proximal cannon bone just below the carpus

Question 4

Splint for the mid forelimb (distal 1/4 radius to mid MCIII)

Answer 4

2 splints will be placed at 90 degrees laterally and caudally to the limb from the elbow to the ground

Question 5

Splint for the mid to proximal radius (distal 1/4 to prox radius)

Answer 5

Full limb Robert jones bandage with a lateral splint should be placed from the ground up the lateral aspect of the chest

Question 6

How does a mid to proximal radius splint prevent open fracture?

Answer 6

The medial side of the limb has less soft tissue coverage so the splint is placed laterally to prevent abduction

Question 7

Splint for proximal to elbow

Answer 7

No splint in most cases

Dropped elbow is the exception

Question 8

What 3 things cause a dropped elbow? How would you splint it?

Answer 8

1. Radial nerve injury
2. Olecrannon fracture
3. Humeral fracture

Splint full limb caudally with one splint to keep the limb straight

Question 9

Splint proximal to stifle

Answer 9

None

Question 10

How can you transport an adult horse with fractures more safely?

Answer 10

1. Use a larger trailer
2. Keep the partitions in so they can lean against the walls and bare weight if needed
3. Place the fracture near the end of the trailer so it doesn’t bare weight at hard stops

DO NO USE A STOCK TRAILER

Question 11

Splint Distal Hindlimb (distal 1/4 of MTIII to Coronary Band)

Answer 11

Similar to forelimb

Question 12

Mid to proximal metatarsus (proximal 2/3 of the metatarsus)

Answer 12

thin compressed bandage with two sprints caudally and laterally from the ground to the tuber calcaneus

Question 13

Splint Tarsus and Tibia

Answer 13

Similar to fracture of radius where there isn’t a lot of soft tissue coverage so we’re still concerned about abduction of the limb. The splint goes up to the gluteal region to prevent abduction.

Question 14

Splint Proximal to Stifle

Answer 14

No splint

Question 15

During anesthesia what phases is it more likely for the horse to make their fracture site worse?

Answer 15

Induction and recovery because they have less control over their bodies and may become dysphoric. Before induction make sure the limb is stabilized. During recovery you should try to prolong their recovery so they have proprioception, use pool recovery, or have pulls attached to the tail and head.

Question 16

Goals for horses recovery after fracture surgery

Answer 16

1. They need to be able to bear weight and walk after surgery unlike humans
2. Must reconstruct the bone column
3. Reconstruct joint surfaces
4. Athletic prognosis
5. Prognosis for life

Question 17

After surgery bone takes __ to heal under ideal circumstances

Answer 17

4 months

Question 18

Why do open wounds reduce the prognosis for athletics and survivial by as much as 50%?

Answer 18

Sepsis/infection is more common

Question 19

List a few post op complications from fracture repair surgery

Answer 19

• contralateral laminitis
• contralateral soft tissue overload
• implant/repair instability
• implant failure
• colitis or pneumonia

Question 20

After Tx repair surgery, how can we try to prevent laminitis?

Answer 20

Even the weight-bearing, provide sole support, rockered toe and cryotherapy (ice +water slurry or ice bag). Make sure you’re giving prevention to the other 3 feet!

Question 21

Coffin bone splint

Answer 21

This can be surgically repaired with a lag screw but is difficult. Many of these are managed conservatively by stabilizing the hoof

Question 22

A fractured pastern P2 typically results in ___ with a __ chance of being athletic again, especially if in the __limbs

Answer 22

Arthrodesis, good, hind

Question 23

What are the goals for a 1st phalanx pattern fracture repair?

Answer 23

Anatomical reconstruct and stabilize P1 and preserve the fetlock + pastern joint anatomy and function

Question 24

If fetlock breakdown occurs and arthrodesis is needed, will the horse be athletic?

Answer 24

NO, it’s guaranteed mechanical lameness

Question 25

In a MC3/MT3 lateral condylar fracture you should place __ to while in a medial condylar fracture you should place ___. Why?

Answer 25

A couple screws, a couple screws and a plate

The medial condylar fractures behave differently propagating further up the cannon bone and spiraling. If it ends up displacing then you’ll have a very unstable limb so place both screws and a plate.

Question 26

What is the preferred tx for splint bone fracture 2 and 4?

Answer 26

Conservative management

Question 27

Metacarpal/Tarsal 3 Diaphyseal fractures typically use __ implant and plate in foals and __ in adult horses. The prognosis is __ based on the higher risk of re-injury, infection and implant failure. If it does heal they can be __ again.

Answer 27

1, 2 90 degrees to eachother, low, athletic

Question 28

Carpal fractures may require screw repair for __ fractures or removal of fragments by __

Answer 28

Slab fractures, arthroscopy

Question 29

Sesamoid bones apical fracture treatment is to __ while mid Body is __

Answer 29

Apical: Remove the fragment or arthroscopy

Mid body: reduce/repair with lag screw/cerclage wire/bone graft (bad prognosis)

Basalar: repair/remove/none (guarded prognosis)

Question 30

In elbow fractures (Olecrannon of the ulna) the main force is the __ on top of the __ because the __ are attached to the top of the ulna. This force is __ for plates.

Answer 30

Tension force, ulna, triceps, good

Question 31

The __ limb typically has more success in fracture repairs

Answer 31

Proximal (radius, humerus, scapula, tibia, femur, pelvis)