Fractures Flashcards
Name some challenges when it comes to equine fractures.
Horses need to bear weight on the leg with fracture, when they cant it causes laminitis on the other limb
What are common acute traumas that can cause fractures in horses?
Kick injuries, falls, gunshot wounds
What is the pathogenesis of stress fractures?
High intensity exercise leads to subchondral bone sclerosis leading to microdamage leading to ischemia leading to necrosis leading to osteochondral collapse
What factors are essential for fracture repair?
Location, blood supply, soft tissue damage, contamination, infection, early recognition, first aid, patient behavior, owner compliance
What do the owners need to be aware of before pursuing treatment?
-prognosis for life, athletic prognosis, cost, whether it can be managed conservatively or if its surgical
What is a good initial treatment for a fracture?
NSAIDs, wound care (clip and clean, water soluble dressing), antimicrobials (after culture), feed (dont delay as if referring wont do surgery that day)
Should you apply a splint before or after taking radiographs?
Before! Especially if horse is non weight bearing
T/F What happens before surgery is just as important as what happens in the operating room
True! If fracture is not stabilized early it may become a lot worse
What should always be included in the splint of a horse?
The foot
Name the goals of limb stabalization
- Prevent damage to neurovascular structures
- Prevent skin penetration
- Minimize bone, soft tissue, and articular damage
- Relieve patient anxiety
What attributes should field splints have?
-Easily controlled by patient (lightweight and non-bulky), easy to apply, economical, easily fashioned from common materials
What forces are minimized by splints?
tension, compression, shear, torsion, bending
-function of muscles will be different with splints on
How many splints are required for a mid-forelimb fracture?
2- one caudal and one lateral from the ground all the way to the elbow
With fractures of the mid to proximal radius, which side do you worry about becoming open?
Medial due to minimal soft tissue coverage and abduction of the limb
Can you apply a splint proximal to the elbow?
Not really. Can use in some cases to help with the extensor function of the limb, rather than for stabalization
What can cause the dropped elbow stance?
Radial nerve damage –> triceps apparatus disruption
- caused by humeral fracture, olecranon fracture or radial nerve paralysis
How is splinting of the distal hindlimb different than the forelimb?
limb is flexed due to reciprocol apparatus
If you dont see radiographic changes but a horse is grade 4/5 lame what should be your recommendation to the owner?
Wait 2 weeks on stall rest then repeat radiographs
What are the ideal trailer characteristics when moving horse with a fracture?
- Large trailer
- No stock trailers-need partitions so horses have something to lean on
- Put horse with fracture towards rear of the trailer
What phase of anesthesia is most concerning in horses?
Recovery!
What are the goals of horse orthopedic surgery
Horse must be able to bear weight and walk after surgery, must reconstruct bone column before putting in implants, reconstruct joint surfaces if needed
Goal of casting
To stabalize the fracture post surgery
How long does bone take to heal?
4 months
What are some of the main post-op complications after fracture repair in horses?
Sepsis (most likely if wounds are open), contralateral laminitis, contralateral soft tissue overload, implant/repair instability, implant failure, systemic disease (colitis, pneumonia due to stress/GA/transport)
How do you prevent laminitis post-op?
Even weightbearing, sole support, rockered toe, cryotherapy (best applied when laminitis due to sepsis)
How are coffin bone fractures stabilized?
Lag screw technique- difficult due to inaccessibility but can apply with intraoperative CT
-often managed conservatively with a rim shoe or bar shoe with clips
How do you fix P2 fractures?
Pastern arthrodesis
- joint prone to arthritis without fusion
-if they also affect coffin joint, prognosis greatly decreases (cant arthodese this one)
Long pastern bone fractures- how to repair?
Usually start at sagittal ridge
-use screws! Preserve as much as P1 as possible
What is a breakdown injury of fetlock?
Catastrophic fractures affecting several bones and soft tissues
- fetlock arthrodesis is indicated and athletic performance is poor
Medial condylar fractures (MC III)- treatment
Medial plate with screws preferred
- much more likely to spiral than the lateral
Lateral condylar fracture trt
Lag screw fixation
- unlikely to spiral
-can be done standing if non-displaced
Splint bone fractures-etiologies and trt
Often due to kick injuries
-usually dont have to repair- conservative management when possible
Metacarpal/Tarsal fracture- trt
Need both screws and plates
- plates should be 90 degrees from one another
What carpal fractures do you fix?
Screw repair for slab fractures
-small fragments removed arthoscopically
What causes injury to the sesamoid bones?
Hyperextension injury with various avulsion trauma
-often apical, mid-body, basilar or comminuted fractures
How to treat apical sesamoid fractures?
Remove fracture through arthroscopy or through arthrotomy
-prognosis depends on if there are any suspensory ligament damage
How to treat mid body sesamoid fracture?
Reduce and repair with lag screws, wire or with bone graft
-prognosis is unfavorable for soundness
How to treat basilar sesamoid fracture?
Repair with screws
-distal attachment concern for prognosis
What is the main fracture cause at the olecranon and what are the main forces at play?
A- kick injuries
B- tension from triceps attachment
