Assessment Fracture

Question 1

Objectives of equine fracture examination

Answer 1

1. is it safe to examine? can you sedate?
2. specific site of injury
3. pain?- analgesia to get paid. Need to treat pain or shock? unless huge bleed won’t be in hock
4. can move horse

Question 2

Which fractures are immediate euthanasia in horses?

Answer 2

Proximal limb:

• complete fracture femur
• complete fracture humerus >300kg
• complete fracture of tibia
• comminutes, open, highly unstable
• economics

Question 3

If fracture patient with huge bleed out what shock therapy

Answer 3

IVFT
crystalloids at 60-90ml/kg/hour
10 – 15ml/kg over 10 minutes and reassess bp, hr, rr, crt

analgesia - opioids
antibiotics if oopen
oxygen

Question 4

What changes fracture from conservative to surgical to euthanasia?

Answer 4

depends on many diff things:

1. Type of fracture
2. Presence of complicating factors e.g. contamination, damage, blood, nerves
3. economics
4. expertises and equipment
5. welfare

Question 5

Basic principles of splint

Answer 5

Stabilise joint above and joint below fracture
never end in middle of ling bone, always extend to top
aim = stabilise fracture/subluxation, prevent displacement and protect soft tissues – spot fracture worsening while transporting
materials
Guttering; wood/broomstick; casting material; blocks

Question 6

Bandaging

Answer 6

Each successive layer tighter to conform more than last
Primary layer (e.g. Allevyn for wound/soft-ban) especially open wound – protects it
Secondary layer (cotton wool/conforming layer e.g. knit-firm) – repeat 4-5 times
Tertiary layer (e.g. Co-plus, vet wrap)
Apply splint and tape/secure in place (protect ends of splints/avoid contact with floor/skin)
Robert-Jones bandages (6 layers) alone rarely immobilise fractures effectively (Reduce movement by 33%)
Don’t really reduce movmenet of bone and healing
Provide support and pain relief as stop leg swinging

Question 7

Transportation equine fracture

Answer 7

forelimb fracture have horse facing backwards
hindlimb- face forwards
loosely tie patient so can use head and neck for balance
narrow confinement so can lean on dividers but can’t turn around

Question 8

Why are fracture prognosis in horses diff to small animals

Answer 8

all fractures fixable but need to think about whole leg and movement after

SA can cope with loss of function of a limb, large can’t

Below stifle or elbow = no muscle distal, just tendons and ligs, not much protection
SA can get away, joint can be non functional
Large animal can’t as function gone, cannot walk

Question 9

SA initial assessment fracture patient

Answer 9

Airway, Breathing and Circulation

Pneumothorax – Tachypnoea
Air in chest
Pulmonary contusions
Brusing lung
Diaphragmatic hernia
Pic on rhs
Neurological status, Urinary status, Cardiac status
Neuro examination can change a prognosis from good to grave!
Urinary tract issues need to be dealt with before fracture stabilisation

Question 10

What is a compound fracture

Answer 10

open

Question 11

3 classifications open/compound fracture

Answer 11

Type 1 = bone punctures through skin and goes back in
Treat as a closed fracture
Type 2 – still open but minimal soft tissue damage and no bone loss wound<1cm
Type 3 – significant soft tissue damage and bone loss
Slide 15
Often RTA dog stuck under car
6-8 weeks bandaging + expensive

Question 12

How do we stabilise an open fracture

Answer 12

ESF
Internal fixation
IM pin
Cast

Question 13

alternative treatment operation

Answer 13

• cast
• cage rest
• amputation
• euthanasia