Lecture 14 - Splinting & Casting Flashcards
What is a fracture?
Continuity of bone is broken
What is a simple fracture?
One line through bone - fracture of only the bone;
No penetration through the skin
What is a compound fracture?
Fracture in which a broken piece of bone pierces the skin
What is a comminuted fracture?
Breaking of bone into 2+ pieces
What is coaptation?
Joining or reuniting of 2 surfaces;
Often in terms of a splint designed to immobilize a fracture
What are some signs used to diagnose a fracture?
- Severe lameness
- Acute onset of clinical signs
- Swelling
- Pain on palpation
- History of trauma
- Visualize bone
How can shock be dealt with?
IVF and systemic support
(May have other life-threatening injuries such as a diaphragmatic hernia)
How should fractures be evaluated in small animals?
Using heavy sedation or anesthesia
Why should sedation to evaluate a fracture in horses be used with care?
Agitated horses override drug effects; may be ataxic (don’t want the horse to lay down)
What drug should not be used for front limb fracture in horses?
Butorphanol
What are the 5 goals of fracture stabilization?
- Prevent soft tissue damage
- Decrease patient’s anxiety
- Minimize eburnation
- Keep fracture closed
- Protect blood vessels and nerves from stretching
Why is minimizing eburnation important?
Eburnation occurs when jagged bone edges rub against each other and become smooth - makes it harder to put fractured edges back together if they are rounded
What are the 3 goals of first aid?
- Assessment of the animal
- Communication (diagnostics, prognosis)
- Create plan (hospital/farm management, referral)
Prognosis for equine fractures is _____ based on _____.
variable, location
How much does repair of long bone fractures in equines cost?
$5,000 to $10,000
When is prognosis of an equine fracture decreased?
With weight and compound fracture
How much does an adult horse weigh? Foal?
Adult = 1000-1500#
Foal/juvenile = 100-500#
What response do horses usually have when a fracture occurs?
Flight - will continue to try to use fractured limb
Small animal fracture prognosis can be _____ to _____.
good, excellent
What does small weight allow for with SA fractures?
Internal fixation, external fixation, casting, amputation
What 5 things should be considered when thinking about euthanizing an animal with a fracture?
- Responsibility to patient
- Responsibility to client
- Equine insurance
- AVMA guidelines
- AAEP guidelines
How can equine fractures be stabilized?
External coaptation - bandage, splint, cast
What is elastikon used for?
Helps seal top/bottom, holds bandages up
What are the steps to splinting a fracture?
- Place RJ or modified RJ bandage (if open fracture start antimicrobials and wound treatment)
- Attach splint on outside of bandage (elastikon, vetrap)
- Make sure splint ends won’t abrade patient
Where should a fracture be immobilized with a splint?
Joint above and below the fracture
Why should there be lots of padding in a splint?
Splint needs to be tight to limit motion
When would you use 2 splints together and at what orientation?
With a comminuted fracture; 90 degrees to each other
What type of splints are used in SA?
Spoon, quick splint, casting tape
What type of splints are used in equines?
- Homemade (PVC, wood, twitch/broom handle, casting material)
- Commercial (Kimzey)
What materials are used in casts?
- Small bandage
- Stockinette
- Felt padding
- Fiberglass casting tape
- Technovit
What is technovit used for?
Used to reinforce the bottoms of casts - thick epoxy that gives tou wear time
How do you place a cast?
- Soak casting tape
- Shake out water (do not squeeze)
- Lay on casting material (no wrinkles, snug placement, overlap 50%)
What is a complication of casting? What is a disadvantage to having a cast?
Complication = pressure sores
Disadvantage = cannot look at wounds
How often must casts be changed?
Every 2-3 weeks
What things should be monitored when a case is in place?
Heat, drainage, lameness, seal top of cast
What are advantages to placing a bandage cast?
Increases immobilization, not as many complications as a normal cast, acts as a custom splint
How can a cast be removed?
Cast saw, obstetric wire
What is zone 1 for splinting?
Dorsal splint/plantar splint at the hoof level
What is zone 2 for splinting?
RJ bandage with caudal/plantar and lateral splint at the level of the metatarsal bones
What is zone 3 for splinting?
RJ bandage with extended lateral splint at the level of the radius/ulna
What is zone 4 for splinting?
Caudal splint to lock carpus in extension
(at level of shoulder only, not needed in the hip area)
What type of fractures are involved in zone 1 and what direction should the splint be done?
Phalanx fractures;
Splint from ground to proximal MC3/MT3 (want toe facing down)
What type of fractures are involved in zone 2 and in what direction should the splint be placed?
MC3/MT3 fracture;
Splint from ground to elbow/stifle
What type of fracture is involved in zone 3 (front limb)? What direction should the bandage be? What direction should the splint be?
Radial fracture;
RJ bandage ground to elbow;
Splint ground to shoulder
Why is a long splint important in zone 3?
Muscles are all on the lateral side of the leg; when they contract they will push the bone out on the medial aspect of the leg causing an open fracture; long splint keeps muscles from contracting/pushing bones out the medial leg
What type of fracture is involved in zone 3 (back limb)?
Tibial fracture
What fracture is involved with zone 3a/b? What does it cause? Where do you splint?
Olecranon or ulna; locks the carpus in extension; splint back of leg and give them something to stand on - makes them panic less
What fractures are involved in zone 4 and what in animal could you splint this?
Humerus/femur;
May be able to support with high bandage and splint in SA
How should you transport a horse with a front limb fracture? Rear limb?
Front = face backwards
Rear = face forwards
Casts are not a good option for fracture treatment in _____.
equines
What is used for internal fixation of fractures?
plates, screws
(LA usually left with this option)
