Equine Orthopaedic Surgery Flashcards
What surgeries can be performed electively?
Arthroscopy/tenoscopy (for OCD/tendon sheath disease)
Angular limb deformities in foals
Soft tissue surgery (neurectomy/fasciotomy, desmotomy)
What emergency surgeries might be carried out?
Arthroscopy/tenoscopy (for synovial sepsis or intra-articular fracture repair)
Fracture repair
+/- sequestrum removal
Describe arthroscopy for osteochondritis dissecans (OCD).
Common elective arthroscopy
Developmental defects in cartilage and bone - youngish horses
Chips of bone removed to prevent degeneration of joint/development of arthritis
Describe arthroscopy for synovial sepsis.
Bacterial infection leading to septic arthritis - not treatable with antibiotics alone
Dilution is solution to pollution! - flush the joint with lots of fluid
Describe sequestrum removal.
Trauma (e.g. kick wound) resulting in damage to periosteum can result in death of bone in this region
Necrotic bone separates (sequesters) and becomes a FB - often infected
Non-healing wounds and draining tracts
Remove sequestrum and any active involucrum (encasing bone that surrounds infected dead bone within compromised soft tissue envelope)
Describe angular limb deformities.
‘Bendy legs’ - laterally/medially
Foals
Different factors e.g. nutrition, incomplete ossification, tendon/ligament laxity etc.
How can we correct angular limb deformities?
Operate between 6-18 months old
Growth arresting techniques e.g. transphyseal screw, plating
Growth accelerating techniques e.g. periosteal transection
Slow growth on side growing too fast OR speed up growth on side growing too slow (usually a problem with growth plates!
What are some challenges with fracture repair in horses?
Horse average weight 500kg - stress on repair site
Athletes - repair needs to be strong
Recovery from GA - flight animal (use LA and sedation in distal limbs)
Lack of soft tissue on distal limb - potential contamination
Huge cost of surgery and potential for horse to not be rideable post-op
How will elective patients usually present?
Already have a diagnosis
Likely to be weight-bearing on all four limbs
May require additional imagine before surgery
Prep - pre-op exam, IV catheter in jugular, clip as much as possible before moving to prep
Often come in night before to settle/reduce stress before GA
How might an emergency patient present?
If in doubt, treat like a fracture!
Is the patient stable? - shock, blood loss
Sedation required?
IV catheter
Wound care - chlorhexidine, isotonic saline
What medications should we consider pre-op for emergency patients?
Antimicrobial drugs
Tetanus antitoxin
Analgesia
Is the horse vaccinated?
What are the goals of fracture stabilisation prior to surgery?
Stabilise fracture
Reduce discomfort and distress
Minimise further trauma to bone ends, soft tissues and vasculature
Prevent further contamination
How can we stabilise distal limb fractures?
Kimsey splint
How can we stabilise limb fractures?
Robert Jones bandage
How do we prep patients for theatre?
Cover feet and tail - remove shoes if possible to prevent trauma in recovery
Antibiotics, medications, fluids
Urinary catheter
Clip and prep
