Lecture 29: Management of Orthopedic Emergencies - LA (Exam 3) Flashcards
List causes of severe single limb lameness in equine
- Foot abscess (subsolar abscess)
- Fracture
- Cellulitis
- Septic synovial structure
- Nerve injury
- Other crazy horse injuries (joint luxation & tendon laceration)
Describe a 0 on the AAEP lameness grading scale
Lameness not perceptible under any circumstances
Describe a 1 on the AAEP lameness grading scale
Lameness is difficult to observe & is not consistently apparent regardless of circumstances (under saddle, circling, inclines, hard surface, etc)
Describe a 2 on the AAEP lameness grading scale
Lameness is difficult to observe @ a walk or when trotting in a straight line but consistently apparent under certain circumstances (weight carrying, circling, inclines, hard surfaces)
Describe a 3 on the AAEP lameness grading scale
Lameness is consistently observable @ a trot under all circumstances
Describe a 4 on the AAEP lameness grading scale
Lameness is obvious @ a walk
Describe a 5 on the AAEP lameness grading scale
Lameness produces min weight bearing in motion &/or @ rest or a complete inability to move
T/F: It is normal for a horse to rest their front & hind limbs
False they can not rest their front limbs but can rest their hind limbs
What should be done in triage of severe lameness
- Assess px level of pain
- Hx
- PE (+/- TPR & examine lame limb)
- If cannot determine cause treat as a fracture
What should be done during an exam of the limb
- Digital pulses (increased in the foot)
- Swelling
- Wounds
- Crepitus
- Pain on palpation
What should dx always start with
Hoof testers
T/F: Never attempt to block out a lameness that has a high likelihood of having a fracture
True
Describe diagnostic imaging
- First choice if fracture is suspected
- only radiograph once the limb is stable
- Can take radiographs through PVC splints or wood
- Incomplete fractures may become more visible in 7 to 10 D
What should be done if a horse has a possible fracture
- Stabilization
- Analgesia
- Supportive care
- Treatment options
- Transportation considerations
What is the number one rule for fracture stabilization
Immobilize the joint above & below the fracture
What are the goals of fracture stabilization
- Reduction of pain & anxiety
- Prevention of further trauma
- Immobilization of the joint above & below the fracture
Describe a robert jones bandage
- 10 to 15 rolls of cotton for a full sized horse
- each layer should be no more than 1 to 2 cm thick
- Each layer is applied tighter than the one before
- End goal is 3x the diameter of the limb
- Need splints to be stable
Describe a splint
- Apply in 2 planes
- Shorter term: apply w/ duct tape
- Long term: apply w/ elastikon or white tape
- Sometimes whatever you can find (PVC or broom handles)
Describe a kimzey leg saver
- Necessity in equine practic
- Still stabilizing the joint above & below
- Used for P1, P2, or distal cannon (condylar)
What are the advantages of a bandage cast or regular cast
- Very strong
- Easy to apply
- Light
What are the disadvantages of a bandage cast or regular cast
- Difficult w/ unstable fracture or nervous horse
- More expensive
Describe what mobilization should be used in each region
Describe region 1
- Fractures of the proximal & middle phalanx
- Raise the heel *wedge or hang leg)
- Provide a dorsal (fore) or plantar (hind) flat surface to align the boney column
Describe region 2
- Fracture of the 3rd MC or MT bones
- Full limb RBJ bandage
- Splints - from the hoof to the elbow/stifle; caudal & lateral
Describe region 3A
- Fractures of the tibia or radius
- Full limb RBJ
- Splint - lateral & extends to proximal scapula or hip (prevent lateral displacement)
Describe region 3B
- Loss of triceps fxn/dropped elbow (olecranon fracture or radial nerve paralysis)
- Full limb RBJ
- Caudal full length splint to fix the carpus
Describe region 4
- Fracture of the humerus, scapula, femur, or pelvis (large hematoma &/or swelling)
- No external coaptation (will weigh down the leg & stress the fracture further)
- Muscle mass protects the fracture
What if there is an associated wound
- open fractures mean it is a worse prognosis, increased expense, & is really only treated in foals
- Prevent an open fracture w/ stabilization
- Proper wound management prior to stabilization
When is analgesia given & what can be given
- After the fracture is stabilized (don’t provide too much pain relief before it is stable)
- phenylbutazone or flunixin meglumine
- Alpha-2 agonists for sedation & analgesia
- Control of inflammation improves the outcome of sx
When are antimicrobials given
- Indicated for open fractures
- Closed fractures - wait til sx
- IV - K-pen & gentamicin
When are IV fluids given
- Rarely hemorrhagic shock
- Sometime neurogenic shock is secondary to pain
Describe stabilizing a horse for referral
- Safe transport of the horse
- Reparable injuries end up being euthanized if not stabilized properly
- Ask the referral center how to stabilize
Describe safe transport
- Gooseneck is more stable than bumper
- Small confined area w/ head & neck free
- Face them backwards if they have a fore limb fracture
- Face them forward if the have a hind limb fracture
Describe cast application
- Helps w/ immobilization of the limb
- Lots of complications
- Careful cast application & good follow up is necessary
What are the indications of applying a cast
- Support for internal fixation
- Wound protection
- Soft tissue damage (tendon laceration)
- Triage for fracture
What cast is this
Foot cast
What cast is this
Half limb cast
What cast is this
Full limb/bandage cast
What cast is this
Transfixation pin cast
What are the guidelines for cast application
- Don’t end a cast in the middle of a long bone (fulcrum to cause a fracture)
- Cast should fit snugly - pressure & sweat wraps to reduce limb size prior to casting & don’t use much padding unless doing a bandage cast)
- Should be applied in the norm wgt bearing angle (reduce formation of cast sores
What should be done to prep the px for a cast
- Pull the shoe on the limb you are casting - Leave the contralateral shoe on to help w/ height disparity
- Clean & trim the foot
- Dress any wound that is present
Describe the steps of cast application
What should be considered when determining the time frame for which a cast can be removed
- Condition
- Age of px
- Complications
When should the cast be checked in growing animals
Every 2 - 3 W
When should the cast be checked for adults
Every 6 to 8 weeks
How can a cast be removed
- Cast saw (be careful around hoof & bony prominences)
- OB wire w/in cast
What are the advantages or a cast over well-applied bandage
- Easy to apply
- Can bi-valve & still access the wound
- Can apply in the field for emergency fracture immobilization
What are the disadvantages or a cast over well-applied bandage
- Not as stable as a half limb or full limb cast
- Can be difficult to make your bandage fit again
Elaborate on cast care
- Use NSAIDs sparingly
- Examine horse 2x daily for use of limb, heat, exudate, pressure sores, & fever
- Change cast @ the first indication of a prob
- Hospitalize when poss
What is the main complication associated w/ casts in LA
Cast sores
What are the sx of cast sores
- Staining of cast
- Increased lameness
- Exudate coming out the top of the cast
What are some common locations of cast sores in equine
- Dorsal cannon @ the top of cast
- Palmar aspect of fetlock
- Coronet & heel bulbs
