La Ortho - Severe Lameness /emergency

Question 1

Types of orthopedic emergencies

Answer 1

Foot abscess
Fracture
Joint lux
Septic synovial structure
Deep soft tissue abscess
Flexor disruption
Navicular bursa nail
Wounds
Mechanical
Neuro
Muscular
Colic

Question 2

Initial assessment key factors

Answer 2

Severity of lameness matching observed injury
What structures are involved? Soft tissue, open/closed, synovial structures, joints?
Brief cardiovascular/hydration
Twitch /sedation

Question 3

Imaging modalities

Answer 3

Radiology
Ultrasound
Nuclear scintigraphy
Computed tomography
Magnetic resonance imaging

Question 4

Radiography

Answer 4

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

Question 5

How many days does no displaced fractures take to become visible on a radiograph ?

Answer 5

10-14 days

Question 6

Focal demineralization occurs with what pathogenesis

Answer 6

Infection
Osseous cyst like lesions
Chronic pressure
OC defect
Neoplasia

Question 7

Sclerosis

Answer 7

Response to chronic mechanical stress/inflammation

Question 8

Types of contrast radiography

Answer 8

Venogram, arthrogram, bursogram, fistulogram

Question 9

Modalities for laminitis prognosis

Answer 9

Venogram

Question 10

Usefulness of scintigraphy

Answer 10

Early detection of bone disease
Localizing lesion prior is not important - scintigraphy is useful for localizing lesions

Question 11

Ct scan

Answer 11

Useful, removing 2-d dimension aspect

Question 12

Most common causes of severe lameness

Answer 12

Foot abscess
Fracture
Laminitis
Synovial sepsis
Periarticular cellulitis

Question 13

Foot abscess

Answer 13

If abscess is caused by nail, leave nail in for radiography
Observed heat, pain,m swelling, drainage

Question 14

Laminitis

Answer 14

Shifting weight, observable stance, elevated DP

Question 15

Synovial sepsis

Answer 15

Effusion + periarticular edema + heat
- NOT cellulitis
Severe lameness
Synoviocentesis

Question 16

Considerations with soft tissue /acute lacerations

Answer 16

Blood flow to effected area
Nerve damage
Ligament /tendon damage

Question 17

which tendons have a worse prognosis if they’re cut or damaged

Answer 17

Flexor tendons - they take the majority of weight bearing

Question 18

Differentiating lameness from neurological disease

Answer 18

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

Question 19

Racehorse breakdown injuries

Answer 19

Combo of injuries = loss of stability

Question 20

Equine fracture repair factors

Answer 20

Location/config
Blood supply
Soft tissue damage
Contamination

Question 21

Key for equine fracture repair

Answer 21

Early recognition
- immediate stabilization, to reduce secondary damage
- compliance from owner & horse
- behavior of animal

Question 22

Laminitis prevention

Answer 22

Sole support
Rockered toe
Cryotherapy
- can develop due to contralateral limb issues

Question 23

Importance of timing of surgery

Question 24

Field radiography

Answer 24

Apply split first

Question 25

Splinting

Answer 25

Dress wounds
Bandage - thin, uniform, snug
Splits - various length & locations

Question 26

Goals for limbs stabilization

Answer 26

Prevent damage to neuro /vascular structures
Prevent skin penetration
Minimize bone, soft tissue & articular damage
Relieve patient anxiety

Question 27

Attributes of field splints

Answer 27

Easily controlled - light weight
Easy to apply
Economical friendly
Easily fashioned
- select proper location & length for application

Question 28

Splint materials

Answer 28

Cotton, nonadherent dressing
Splints: PVC, wood, metal rods, fiberglass tape
Saw - for removal /conformation
Inelastic tape or casting tape

Question 29

Distal forelimb

Answer 29

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

Question 30

Applying distal forelimb splint

Answer 30

Suspend limb to align dorsal coritcies
Apply single splint dorsally
Toe (include foot) to just below the carpus

Question 31

Mid forelimb

Answer 31

Distal 1/4 radius to mid MCIII
Requires two splints keep leg at 90*
Caudal and lateral

Question 32

Mid forelimb bandage application

Answer 32

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

Question 33

Distal hindlimb splint

Answer 33

Thin tight bandage
Splint on plantar surface
Limb in flexion for application (reciprocal apparatus)
Just higher than calcanean tuberosity

Question 34

Mid to proximal metatarsus

Answer 34

Thin compressed bandage
Two splints at 90* - caudal & lateral
Ground to tuber calcanean

Question 35

Tarsus and tibia

Answer 35

Little soft tissue coverage medially - risk of opening medially. Similar to forelimb fracture
Extensors act as abductors if bone column is unstable

Question 36

Tarsus and tibia splint application

Answer 36

Bandage ground to stifle
Single lateral splint - placed proximally toward the hip to prevent limb abduction

Question 37

Proximal to stifle

Answer 37

No splint
Be aware of arterial laceration - can bleed out internally

Question 38

Transportation

Answer 38

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

Question 39

Foal transportation

Answer 39

Foals will trailer in recumbent position
Attended ride if possible
Partition from mare for safety