Fractures 1 and 2

Question 1

What are some causes of fractures?

Answer 1

Acute Trauma or Chronic Changes in Bone

Question 2

What are some factors that may affect how successful your repair is?

Answer 2

Location, configuration, blood supply, soft tissue damage, contamination, infection, early recognition, behavior of patient and owner compliance

Question 3

How should you manage the owners expectations?

Answer 3

Tell them…
-prognosis for life
-athletic prognosis
-cost
-referral for surgery versus conservative

Question 4

You have a horse with a fracture, what is the initial treatment you plan to perform?

Answer 4

NSAIDs, Wound care/Stabilization, antimicrobials (open), feed, referral and timing of surgery (may need 2 weeks to show up on x-ray if small and also a poor candidate for surgery day of due to adrenaline)

Question 5

You have discovered a fracture after a radiograph. What do you do next?

Answer 5

Apply a splint!

Question 6

What happens before surgery may be …. important than the surgery

Answer 6

more

Question 7

If the fracture is in the distal limb, should you apply a splint? Proximal?

Answer 7

Distal yes
Proximal maybe

Question 8

What is the key to splinting and casting?

Answer 8

Involve the joint above and below

Question 9

Before applying the splint, make sure the bandage is….

Answer 9

thin, uniform and sung

Question 10

What are the goals of limb stabilization?

Answer 10

Prevent damage to neurovascular system, prevent skin penetration, minimize bone, soft tissue and articular damage, relieve patient anxiety

Question 11

What are some attributes of field splints?

Answer 11

Light weight so easily controlled by patient, easy to apply, economical, can make out of common materials

Question 12

What are some of the forces that act on bones?

Answer 12

Tension, compression, torsion, shear, bending

Question 13

What materials should you collect for your splint?

Answer 13

Bandage material (vet wrap), non-adherent dressing, splint (PVC, wood, rod), saw and inelastic tape or casting tape

Question 14

What is considered the distal forelimb and where should the splint be applied to this injury?

Answer 14

-Distal 1/4 of MCIII to the coronary band
-Splint from foot up to just distal to the carpus
-Alight cortices of phalanges and metacarpus
-Apply dorsally

Question 15

How do you apply a splint?

Answer 15

Bandage the leg first, then apply splint to opposite side as force and duct tape away!

Question 16

What is considered the mid forelimb and where should the splint be applied to this injury?

Answer 16

-Distal 1/4 of radius to mid MCIII
-2 Splints, 90 degrees, caudal and lateral, elbow to ground

Question 17

What do you do if the injury is proximal to the elbow?

Answer 17

No splint is needed, muscle takes care of it
-splint if dropped elbow stance though cause no extensor working and cant keep straight)

Question 18

What is considered the mid to proximal radius of the forelimb and where should the splint be applied to this injury?

Answer 18

-Distal 1/4 femur to proximal radius
-Love to fracture oblique and make sharp point of bone
-Minimal soft tissue coverage medial radius
-Flexors and extensors become abductors
-Full limb Robert jones bandage
-Lateral splint
-ground to lateral aspect of chest
-goal to prevent open fracture

Question 19

What are 3 differentials for triceps apparatus disruption or dropped elbow? How do you treat?

Answer 19

1. Radial Nerve Paralysis
2. Olecranon Fracture
3. Humerus Fracture

Full limb bandage, single caudal splint

Extensors not working

Question 20

What is considered distal hindlimb?
How do you splint it?

Answer 20

-Distal 1/4 of MTIII to coronary band
- 1 splint on plantar side, sole part of foot up to calcaneus

Question 21

What is considered mid to proximal metatarsus of the hindlimb?
How do you splint it?

Answer 21

-Proximal 2/3 of the metatarsus
-Thin compressed bandage, 2 splints 90 degree one caudal and one lateral
-Ground to the tuber calcaneus

Question 22

What is considered tarsus and tibia hindlimb?
How do you splint it?

Answer 22

Ex. ruptured collateral ligament
-1 splint, sharp bone medial side of tibula and not much soft tissue, careful, foot to gluteal region

Question 23

Do you apply a splint proximal to the stifle?

Answer 23

No, well muscled

Question 24

How does one transport and animal with a fracture?

Answer 24

-Find trailer that is larger and more stable, keep the partitioners in it (no stock trailer), place the fracture towards the REAR of the trailer
-Foal can be recumbent if possible with someone attending with them (partition from mare)

Question 25

Which direction should the fracture go in the trailer?

Answer 25

Fracture to rear (can control your acceleration)

Question 26

What happens when the animal arrives at the referral locaiton?

Answer 26

Evaluation of splint, rads then surgery if stable
-General Anesthesia (Usually recumbent but some can be done standing)
-Surgery
-Recovery

Question 27

Why do we worry about recovery?

Answer 27

Can become dysphoric and reinjure themselves, break an implant or harm another area of their body
-Mitigate with pool, or prolonged recovery, ropes on head and tail

Question 28

What is different about fixing a fracture on a horse versus a human?

Answer 28

Horse must immediately bear weight on it and walk post surgery

Question 29

Does every horse get a cast?

Answer 29

internal fixation option, cast after surgery

Question 30

Under ideal conditions, how long does it take bone to heal?

Answer 30

4 months

Question 31

How long does the internal fixation need to last?

Answer 31

until the bone has healed

Question 32

What are possible post operative complications?

Answer 32

Sepsis, contralateral laminitis, contralateral soft tissue overload, implant/repair instability, implant failure, systemic disease (colitis and pneumonia)

Question 33

How do we prevent laminitis?

Answer 33

Even weightbearing, sole support, rockered toe, cryotherapy (ice and water)

Question 34

What is the most common fracture location?

Answer 34

Distal limb (distal to carpus and tarsus)

Question 35

How do you manage a coffin bone (P3) fracture?

Answer 35

Surgical - lag screw
Conservatively - rim shoe, bar shoe with clips

Question 36

How do you manage a Pastern (P2) fracture?

Answer 36

Surgical: Arthrodesis - fuse together
-Prognosis for soundness: 60-65% fore, 75-80% hind
-Common in flat track race (Thoroughbred and standardbred)
- reconstruct and stabilize P1, preserve fetlock and pastern joint anatomy and function

Question 37

What happens if you have a fetlock breakdown? Multiple bones fractured, loss of ligament and tendinous support

Answer 37

Arthrodesis and guaranteed mechanical lameness

Question 38

How do you manage a MC3/MT3 Lateral Condylar Fracture?

Answer 38

If incomplete can fix standing, displaced need anesthesia
-Like to spiral
-Lag screws

Question 39

How do you manage splint bone, metacarpal/tarsal 2 and 4?

Answer 39

Forgiveness in choices, internal fixation not required, conservative

Question 40

How do you manage metacarpal and tarsal 3 diaphyseal fracture?

Answer 40

Screw and plate -2 plates 90 degrees

Question 41

How do you manage carpus fracture?

Answer 41

Screw slabs, remove fragments with arthroscopy

Question 42

How do you manage sesamoid bone fracture?

Answer 42

Hyperextension injury with avulsion trauma
-Apical: Remove the fragment, arthroscopy
-midbody: reduce and repari - lag screw, cerclage, bone
-basilar: repair, remove none (poor prognosis loss attachment distal sesamoideum ligaments)
-comminuted

Question 43

How do you manage olecranaon of elbow fracture?

Answer 43

Tension main force so band

Question 44

What if the fracture is proximal in the limb?

Answer 44

Good prognosis