Fractures 1 and 2 Flashcards
What are some causes of fractures?
Acute Trauma or Chronic Changes in Bone
What are some factors that may affect how successful your repair is?
Location, configuration, blood supply, soft tissue damage, contamination, infection, early recognition, behavior of patient and owner compliance
How should you manage the owners expectations?
Tell them…
-prognosis for life
-athletic prognosis
-cost
-referral for surgery versus conservative
You have a horse with a fracture, what is the initial treatment you plan to perform?
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)
You have discovered a fracture after a radiograph. What do you do next?
Apply a splint!
What happens before surgery may be …. important than the surgery
more
If the fracture is in the distal limb, should you apply a splint? Proximal?
Distal yes
Proximal maybe
What is the key to splinting and casting?
Involve the joint above and below
Before applying the splint, make sure the bandage is….
thin, uniform and sung
What are the goals of limb stabilization?
Prevent damage to neurovascular system, prevent skin penetration, minimize bone, soft tissue and articular damage, relieve patient anxiety
What are some attributes of field splints?
Light weight so easily controlled by patient, easy to apply, economical, can make out of common materials
What are some of the forces that act on bones?
Tension, compression, torsion, shear, bending
What materials should you collect for your splint?
Bandage material (vet wrap), non-adherent dressing, splint (PVC, wood, rod), saw and inelastic tape or casting tape
What is considered the distal forelimb and where should the splint be applied to this injury?
-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
How do you apply a splint?
Bandage the leg first, then apply splint to opposite side as force and duct tape away!
What is considered the mid forelimb and where should the splint be applied to this injury?
-Distal 1/4 of radius to mid MCIII
-2 Splints, 90 degrees, caudal and lateral, elbow to ground
What do you do if the injury is proximal to the elbow?
No splint is needed, muscle takes care of it
-splint if dropped elbow stance though cause no extensor working and cant keep straight)
What is considered the mid to proximal radius of the forelimb and where should the splint be applied to this injury?
-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
What are 3 differentials for triceps apparatus disruption or dropped elbow? How do you treat?
- Radial Nerve Paralysis
- Olecranon Fracture
- Humerus Fracture
Full limb bandage, single caudal splint
Extensors not working
What is considered distal hindlimb?
How do you splint it?
-Distal 1/4 of MTIII to coronary band
- 1 splint on plantar side, sole part of foot up to calcaneus
What is considered mid to proximal metatarsus of the hindlimb?
How do you splint it?
-Proximal 2/3 of the metatarsus
-Thin compressed bandage, 2 splints 90 degree one caudal and one lateral
-Ground to the tuber calcaneus
What is considered tarsus and tibia hindlimb?
How do you splint it?
Ex. ruptured collateral ligament
-1 splint, sharp bone medial side of tibula and not much soft tissue, careful, foot to gluteal region
Do you apply a splint proximal to the stifle?
No, well muscled
How does one transport and animal with a fracture?
-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)
Which direction should the fracture go in the trailer?
Fracture to rear (can control your acceleration)
What happens when the animal arrives at the referral locaiton?
Evaluation of splint, rads then surgery if stable
-General Anesthesia (Usually recumbent but some can be done standing)
-Surgery
-Recovery
Why do we worry about recovery?
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
What is different about fixing a fracture on a horse versus a human?
Horse must immediately bear weight on it and walk post surgery
Does every horse get a cast?
internal fixation option, cast after surgery
Under ideal conditions, how long does it take bone to heal?
4 months
How long does the internal fixation need to last?
until the bone has healed
What are possible post operative complications?
Sepsis, contralateral laminitis, contralateral soft tissue overload, implant/repair instability, implant failure, systemic disease (colitis and pneumonia)
How do we prevent laminitis?
Even weightbearing, sole support, rockered toe, cryotherapy (ice and water)
What is the most common fracture location?
Distal limb (distal to carpus and tarsus)
How do you manage a coffin bone (P3) fracture?
Surgical - lag screw
Conservatively - rim shoe, bar shoe with clips
How do you manage a Pastern (P2) fracture?
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
What happens if you have a fetlock breakdown? Multiple bones fractured, loss of ligament and tendinous support
Arthrodesis and guaranteed mechanical lameness
How do you manage a MC3/MT3 Lateral Condylar Fracture?
If incomplete can fix standing, displaced need anesthesia
-Like to spiral
-Lag screws
How do you manage splint bone, metacarpal/tarsal 2 and 4?
Forgiveness in choices, internal fixation not required, conservative
How do you manage metacarpal and tarsal 3 diaphyseal fracture?
Screw and plate -2 plates 90 degrees
How do you manage carpus fracture?
Screw slabs, remove fragments with arthroscopy
How do you manage sesamoid bone fracture?
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
How do you manage olecranaon of elbow fracture?
Tension main force so band
What if the fracture is proximal in the limb?
Good prognosis
