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Surgery 1 > Lecture 29: Management of Orthopedic Emergencies - LA (Exam 3) > Flashcards

Lecture 29: Management of Orthopedic Emergencies - LA (Exam 3) Flashcards

1
Q

List causes of severe single limb lameness in equine

A
  • Foot abscess (subsolar abscess)
  • Fracture
  • Cellulitis
  • Septic synovial structure
  • Nerve injury
  • Other crazy horse injuries (joint luxation & tendon laceration)
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2
Q

Describe a 0 on the AAEP lameness grading scale

A

Lameness not perceptible under any circumstances

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3
Q

Describe a 1 on the AAEP lameness grading scale

A

Lameness is difficult to observe & is not consistently apparent regardless of circumstances (under saddle, circling, inclines, hard surface, etc)

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4
Q

Describe a 2 on the AAEP lameness grading scale

A

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)

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5
Q

Describe a 3 on the AAEP lameness grading scale

A

Lameness is consistently observable @ a trot under all circumstances

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6
Q

Describe a 4 on the AAEP lameness grading scale

A

Lameness is obvious @ a walk

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7
Q

Describe a 5 on the AAEP lameness grading scale

A

Lameness produces min weight bearing in motion &/or @ rest or a complete inability to move

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8
Q

T/F: It is normal for a horse to rest their front & hind limbs

A

False they can not rest their front limbs but can rest their hind limbs

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9
Q

What should be done in triage of severe lameness

A
  • Assess px level of pain
  • Hx
  • PE (+/- TPR & examine lame limb)
  • If cannot determine cause treat as a fracture
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10
Q

What should be done during an exam of the limb

A
  • Digital pulses (increased in the foot)
  • Swelling
  • Wounds
  • Crepitus
  • Pain on palpation
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11
Q

What should dx always start with

A

Hoof testers

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12
Q

T/F: Never attempt to block out a lameness that has a high likelihood of having a fracture

A

True

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13
Q

Describe diagnostic imaging

A
  • 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
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14
Q

What should be done if a horse has a possible fracture

A
  • Stabilization
  • Analgesia
  • Supportive care
  • Treatment options
  • Transportation considerations
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15
Q

What is the number one rule for fracture stabilization

A

Immobilize the joint above & below the fracture

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16
Q

What are the goals of fracture stabilization

A
  • Reduction of pain & anxiety
  • Prevention of further trauma
  • Immobilization of the joint above & below the fracture
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17
Q

Describe a robert jones bandage

A
  • 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
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18
Q

Describe a splint

A
  • 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)
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19
Q

Describe a kimzey leg saver

A
  • Necessity in equine practic
  • Still stabilizing the joint above & below
  • Used for P1, P2, or distal cannon (condylar)
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20
Q

What are the advantages of a bandage cast or regular cast

A
  • Very strong
  • Easy to apply
  • Light
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21
Q

What are the disadvantages of a bandage cast or regular cast

A
  • Difficult w/ unstable fracture or nervous horse
  • More expensive
22
Q

Describe what mobilization should be used in each region

23
Q

Describe region 1

A
  • 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
24
Q

Describe region 2

A
  • Fracture of the 3rd MC or MT bones
  • Full limb RBJ bandage
  • Splints - from the hoof to the elbow/stifle; caudal & lateral
25
Describe region 3A
* Fractures of the tibia or radius * Full limb RBJ * Splint - lateral & extends to proximal scapula or hip (prevent lateral displacement)
26
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
27
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
28
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
29
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
30
When are antimicrobials given
* Indicated for open fractures * Closed fractures - wait til sx * IV - K-pen & gentamicin
31
When are IV fluids given
* Rarely hemorrhagic shock * Sometime neurogenic shock is secondary to pain
32
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
33
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
34
Describe cast application
* Helps w/ immobilization of the limb * Lots of complications * Careful cast application & good follow up is necessary
35
What are the indications of applying a cast
* Support for internal fixation * Wound protection * Soft tissue damage (tendon laceration) * Triage for fracture
36
What cast is this
Foot cast
37
What cast is this
Half limb cast
38
What cast is this
Full limb/bandage cast
39
What cast is this
Transfixation pin cast
40
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
41
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
42
Describe the steps of cast application
43
What should be considered when determining the time frame for which a cast can be removed
* Condition * Age of px * Complications
44
When should the cast be checked in growing animals
Every 2 - 3 W
45
When should the cast be checked for adults
Every 6 to 8 weeks
46
How can a cast be removed
* Cast saw (be careful around hoof & bony prominences) * OB wire w/in cast
47
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
48
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
49
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
50
What is the main complication associated w/ casts in LA
Cast sores
51
What are the sx of cast sores
* Staining of cast * Increased lameness * Exudate coming out the top of the cast
52
What are some common locations of cast sores in equine
* Dorsal cannon @ the top of cast * Palmar aspect of fetlock * Coronet & heel bulbs

Surgery 1 (25 decks)

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