Lecture 33 4/14/25 Flashcards
What are the aims of fracture first aid?
-relieve anxiety of the horse
-sedation
-application of twitch to provide safety
What is the limiting factor in large animal fracture repair?
*condition of the soft tissues
-preservation of vasculature and innervation
-preservation of skin integrity
What are the biggest components of fracture first adi?
sedate, bandage, and splint
What are the characteristics of a good splint?
-must neutralize damaging forces of normal muscular contraction
-must be well-tolerated by horse
-must be easy to apply with horse standing
-must be economical and easily accessible
What are the four segments of the forelimb?
-foot to distal portion of metacarpus [1]
-distal portion of metacarpus to distal portion of radius [2]
-distal to proximal portion of radius [3]
-proximal to elbow joint [4]
What are the characteristics of the forelimb section 1?
-foot to distal portion of metacarpus
-dorsal cortices should be aligned in a straight line to neutralize bending forces at fetlock and fracture
-bending force moves from fetlock to fracture
How are fractures in forelimb section 1 stabilized?
-use thin padding
-apply splint dorsally from carpus to toe
-can apply a cast over padding/bandage
What are the characteristics of the forelimb section 1b?
-sagittal fracture of distal aspect of metacarpus or phalanx
-results in lateromedial instability
-want to use lateral and medial splints at level of carpus to neutralize lateromedial instability
What are the characteristics of forelimb section 2?
-lateromedial instability
-apply a Robert-Jones bandage and rigid splints
-splints must extend from elbow
-want caudal and lateral splints
What are the characteristics of forelimb section 3?
-extensor muscles become abductors
-similar treatment to section 2, except the lateral splint extends up to the chest and lies against the ribs
-want to apply a Robert-Jones bandage
What are the characteristics of forelimb section 4?
-proximal to elbow
-fracture disables triceps apparatus
-elbow drops and carpus flexes
-treated by extending carpus with a bandage and splint so horse can balance
-full Robert-Jones bandage not required
What are the four segments of the hindlimb?
-foot to distal portion of metatarsus [1]
-metatarsus [2]
-hock and tibia [3]
-proximal to stifle [4]
What are the characteristics of hindlimb section 1?
-foot to distal aspect of metatarsus
-splint works better if placed on plantar surface due to reciprocal apparatus
What are the characteristics of hindlimb section 2?
-calcaneus can be used as an extension of the metatarsus
-want to apply a Robert-Jones bandage with lateral and caudal splints
What are the characteristics of hindlimb section 3?
-hock stays in a fixed position and the fracture flexes
-adult horses with a complete tibial fracture rarely survive; hard to stabilize due to reciprocal apparatus
-craniocaudal instability
-can only use a lateral splint with a Robert-Jones bandage, no caudal splint
What are the characteristics of hindlimb section 4?
-proximal to stifle
-fractures of the femur cannot be immobilized
-grave prognosis for fracture in adults
-can do internal fixation in adults
-large muscle mass acts as a splint; conservative therapy possible but often fails due to support limb laminitis
What are the characteristics of medications and supportive care for fracture first aid?
-broad-spectrum antimicrobials if treatment is anticipated
-NSAIDs to reduce swelling and pain
-analgesia and sedation with xylazine and detomidine; repeated as needed
-fluid therapy rarely necessary; shock and hemorrhage not typically factors
-provide hay net for distraction
What are the characteristics of transport of animals with fractures?
-use sidebars and partitions for support
-leave head and neck free for counterbalance
-restrain/carry foals
-try to place fractured limb at back of trailer to counterbalance braking
-provide a hay net
-accelerate and decelerate gradually
-back horse out of trailer for forelimb fx; lead horse out of trailer for hindlimb fx
-slant load trailers may be best
What are the steps to assessing a horse with fracture?
-initial assessment
-action plan, either euthanasia or first aid and referral
How should a horse with a fracture be approached?
-approach cautiously to reduce further damage to fracture area
-avoid tranquilizers that cause hypotension
-use twitch as necessary for better control
What aspects of a fracture need to be determined when assessing a fracture?
-overall state of hore
-site of fracture
-open vs closed
-horse’s temperament
-state of soft tissues
radiographs can be done after stabilization to best assess
What are the characteristics of young horses as fracture patients?
-technically easier to repair fractures in younger horses
-younger horses are spared the considerable mechanical load that occurs in adults
-young horses are more susceptible to post-op infection and repair failure
Why is euthanasia often considered in fracture cases?
-financial constraints
-gender/breeding value
-poor to hopeless prognosis even with treatment in many cases
