La Ortho - Severe Lameness /emergency Flashcards
Types of orthopedic emergencies
Foot abscess
Fracture
Joint lux
Septic synovial structure
Deep soft tissue abscess
Flexor disruption
Navicular bursa nail
Wounds
Mechanical
Neuro
Muscular
Colic
Initial assessment key factors
Severity of lameness matching observed injury
What structures are involved? Soft tissue, open/closed, synovial structures, joints?
Brief cardiovascular/hydration
Twitch /sedation
Imaging modalities
Radiology
Ultrasound
Nuclear scintigraphy
Computed tomography
Magnetic resonance imaging
Radiography
Used to evaluate bone, soft tissue
Limited to 2-d imagine, 30-50% of changes in bone density required to be visible
Superimposition of structures
How many days does no displaced fractures take to become visible on a radiograph ?
10-14 days
Focal demineralization occurs with what pathogenesis
Infection
Osseous cyst like lesions
Chronic pressure
OC defect
Neoplasia
Sclerosis
Response to chronic mechanical stress/inflammation
Types of contrast radiography
Venogram, arthrogram, bursogram, fistulogram
Modalities for laminitis prognosis
Venogram
Usefulness of scintigraphy
Early detection of bone disease
Localizing lesion prior is not important - scintigraphy is useful for localizing lesions
Ct scan
Useful, removing 2-d dimension aspect
Most common causes of severe lameness
Foot abscess
Fracture
Laminitis
Synovial sepsis
Periarticular cellulitis
Foot abscess
If abscess is caused by nail, leave nail in for radiography
Observed heat, pain,m swelling, drainage
Laminitis
Shifting weight, observable stance, elevated DP
Synovial sepsis
Effusion + periarticular edema + heat
- NOT cellulitis
Severe lameness
Synoviocentesis
Considerations with soft tissue /acute lacerations
Blood flow to effected area
Nerve damage
Ligament /tendon damage
which tendons have a worse prognosis if they’re cut or damaged
Flexor tendons - they take the majority of weight bearing
Differentiating lameness from neurological disease
Neuro horses may have
Muscle atrophy
Cranial nerve deficits
Cutaneous sensory deficits
Muscle fasciculations
Ataxia
Abnormal posture
Altered skin temp /sweat patterns
Abnormal head/neck movement
Limb knuckling, dragging, stumbling
Weakness
Racehorse breakdown injuries
Combo of injuries = loss of stability
Equine fracture repair factors
Location/config
Blood supply
Soft tissue damage
Contamination
Key for equine fracture repair
Early recognition
- immediate stabilization, to reduce secondary damage
- compliance from owner & horse
- behavior of animal
Laminitis prevention
Sole support
Rockered toe
Cryotherapy
- can develop due to contralateral limb issues
Importance of timing of surgery
Field radiography
Apply split first
Splinting
Dress wounds
Bandage - thin, uniform, snug
Splits - various length & locations
Goals for limbs stabilization
Prevent damage to neuro /vascular structures
Prevent skin penetration
Minimize bone, soft tissue & articular damage
Relieve patient anxiety
Attributes of field splints
Easily controlled - light weight
Easy to apply
Economical friendly
Easily fashioned
- select proper location & length for application
Splint materials
Cotton, nonadherent dressing
Splints: PVC, wood, metal rods, fiberglass tape
Saw - for removal /conformation
Inelastic tape or casting tape
Distal forelimb
Includes P2, P1 and distal cannon bone (condylar fractures)
Don’t need to splint coffin bone (p3)
Neutralize bending - align dorsal cortices of phalanges & metacarpus, apply single splint dorsally
Applying distal forelimb splint
Suspend limb to align dorsal coritcies
Apply single splint dorsally
Toe (include foot) to just below the carpus
Mid forelimb
Distal 1/4 radius to mid MCIII
Requires two splints keep leg at 90*
Caudal and lateral
Mid forelimb bandage application
Mid to proximal radius - consider soft tissue coverage /damage of medial radius
Flexors and extensors becoming abductors
Extend splint proximal to elbow - counter act tendency for abduction
Distal hindlimb splint
Thin tight bandage
Splint on plantar surface
Limb in flexion for application (reciprocal apparatus)
Just higher than calcanean tuberosity
Mid to proximal metatarsus
Thin compressed bandage
Two splints at 90* - caudal & lateral
Ground to tuber calcanean
Tarsus and tibia
Little soft tissue coverage medially - risk of opening medially. Similar to forelimb fracture
Extensors act as abductors if bone column is unstable
Tarsus and tibia splint application
Bandage ground to stifle
Single lateral splint - placed proximally toward the hip to prevent limb abduction
Proximal to stifle
No splint
Be aware of arterial laceration - can bleed out internally
Transportation
Larger trailers are more stable
Leave partitions in for stability
Stock trailers are NOT ideal
Place Fracture toward the rear of the trailer - taking into consideration for breaking/weight distribution
Foal transportation
Foals will trailer in recumbent position
Attended ride if possible
Partition from mare for safety
