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3. Equine 3 > EQUINE FRACTURE REPAIR > Flashcards

EQUINE FRACTURE REPAIR Flashcards

1
Q

Fracture occur in horses of all ages and involve almost any bone
- causes, broadly:

A
  • External trauma
  • Stress injury
  • Pathologic fracture
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2
Q

Fracture classification

A
  1. Complete or incomplete
  2. Nondisplaced or displaced
  3. Open or closed
  4. Configuration
  5. Diaphyseal, metaphyseal, physeal, or epiphyseal (including
    Salter–Harris physeal fractures, types I to VI)
  6. Other (pathological fracture; multiple bone involvement).
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3
Q

fracture configurations

A

a) Greenstick or fissure
b) Transverse
c) Oblique
d) Spiral
e) Comminuted
f) Multiple
g) Impacted
h) Avulsion

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4
Q

Fracture management in the field
Main goals

A
  • Immobilize the fracture
  • Stabilize the patient
  • Relieve anxiety, pain
  • Prevent further damage
  • Provide safe transportation
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5
Q

Fracture management in the field
A. Physical exam, what to look for?

A
  • Thorough clinical exam
  • Lacerations can affect the diagnosis and prognosis
  • Hemorrhage
  • Vascular compromise of the distal limb
  • A fracture should be suspected with severe lameness
    <><><><>
  • Demeanor
  • Vital parameters: heart rate, respiratory rate
  • Mucous membranes color, capillary refill time
  • Estimate blood loss
  • Estimate hydration status
  • Evaluate the affected limb
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6
Q

Fracture management in the field
A. Physical exam
- what findings mean we need to stabilize the patient?
- what are our priorities in serious cases?

A

Stabilization:
- Pale mucous membranes
- Increased CRT
- Tachycardia (>60bpm), tachypnea (>32brpm)
<><><><>
In cases of:
- Unstable limb fracture
- Ongoing blood loss
Priority:
- Stabilization of the fracture
- Stop the blood loss

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7
Q

Fracture management in the field
A. Physical exam
- how is the accuracy of our injury assessment? what are problem areas for this?

A
  • Often the assessment of injuries underestimates the extent of the injury
  • Especially after trauma in horses that have been kicked in areas such as:
  • Scapular spine
  • Major tubercle of the humerus, deltoid tuberosity
  • Cutaneous plane of the radius
  • Metacarpus, tuber coxae
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8
Q

Fracture management in the field
- Treatment or euthanasia?

A
  • Despite great advances in veterinary orthopedic surgery – some injuries and fractures in horses cannot be treated successfully
  • If prognosis is hopeless – euthanasia should be recommended
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9
Q

Fracture management in the field
B. Emergency treatment, protocol overview

A

B1. Sedation
B2. Initial wound management
B3. Fracture stabilization
B4. Administration of proper analgesia and anti-inflammatory medication
B5. Antimicrobial prophylaxis
B6. Intravenous fluid therapy
B7. Safe transportation of the horse
<><><><>
order can be different

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10
Q

Fracture management in the field
- Emergency treatment sedation

A
  • Dictated by circumstances
  • Alpha-2 agonist drug of choice:
    > Few side effects
    > Provide reliable sedation and some analgesia
  • Combination with opioids – butorphanol
  • Acepromazine – avoid in compromised patient – vasodilatory effects
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11
Q

Fracture management in the field
- Emergency treatment
B2. Wound management

A
  • Skin wounds must be treated with care
  • Cover the wound with water soluble gel
  • Clip the hair around the wound
  • Clean the skin around the wound
  • Clean and disinfect the wound
  • Cover the wound with a sterile dressing and bandage the limb
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12
Q

Fracture management in the field
- Emergency treatment
B3. Fracture Stabilization
- how to? goals?

A
  • Stabilization in an anatomically normal position - most important
  • It should be applied to allow the patient to bear some weight without
    excessive damage
  • Distal limb support that does not contribute to stabilization should be
    avoided
    <><><><><>
    Goals
    1. Reduction of pain and anxiety and facilitation of partial weight bearing
    2. Prevention of further compromise of the patient
    3. Immobilization of the adjacent joints
    <><>
  • The joints above and below the fractured bone should be immobilized
  • Stabilization should extend well beyond the fracture line
  • Never end of the coaptation near the fracture line – it act as a lever
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13
Q

B3. Fracture Stabilization
Types of stabilization

A
  1. Robert Jones Bandage–3 times the diameter of the limb
  2. Splints
  3. Bandagecast
  4. Cast
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14
Q

B3. Fracture Stabilization
Principles of stabilization

A
  1. Prevention of soft tissue damage
  2. Regional immobilization
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15
Q

fracture stabilization - considerations for prevention of soft tissue damage

A
  • Stabilization may result in pressure and friction
  • Padding should be layered. Each layer tightened
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16
Q

Regional stabilization front limb
1. Fractures of the distal phalanx

A
  • The hoof capsule prevents marked displacement
  • cast on the foot ideally
17
Q

Regional stabilization front limb
2. Fractures of the navicular bone

A
  • Support with an elevated heel position
  • prevent DDF pulling navicular bone
18
Q

Regional stabilization front limb
3. Fractures of the middle phalanx

A
  • Immobilization in flexed position
19
Q

Regional stabilization front limb
4. Fractures of the proximal phalanx

A
  • Straight immobilization
  • Robert Jones + splints, Cast
  • avoid lateral and medial forces
20
Q

Regional stabilization front limb
5. Fractures of the 3rd Metacarpus

A
  • Distracting forces lateromedial
  • Straight immobilization
21
Q

Regional stabilization front limb
6. Fractures Proximal sesamoid bones

A
  • Flexed
  • avoid proximal and distal forces
22
Q

Regional stabilization front limb
7. Stable fracture of the carpus

A
  • The majority do not compromise axial limb stability
  • Care of the soft tissues with a light conforming bandage
  • Fractures of the accessory carpal bone can distract.
  • Adding a splint to prevent carpal flexion
23
Q

Regional stabilization front limb
8. Fracture of the radius

A
  • Prevent abduction
  • usually mid-diaphysis
  • medial radius less covered by muscle, can open
24
Q

Regional stabilization front limb
9. Fracture of the olecranon
- what do we observe? what do we do?

A
  • The triceps apparatus is disarmed
  • The horse cannot fix the limb in extension
  • Result:
  • Drop elbow
  • Flexed carpus
  • Toe drag
    <><><>
  • splint in the back, put leg in extension to help triceps?
25
Q

Regional stabilization front limb
10. Fracture of the humerus

A
  • No benefits from temporary external support
  • Limb mechanics preclude effective immobilization and the
    surrounding muscle masses protect the fractured bone.
26
Q

Regional stabilization hind limb
11. Fracture of the 3rd Metatarsus

A
  • Immobilization with splints to the talocentral-calcaneoquartal joint
  • Coaptation placed further proximal can be resented
27
Q

Regional stabilization hind limb
12. Fracture of the tarsus and tibia

A
  • Long lateral splint
  • Reach the coxofemoral joint
  • tibia has less muscle cover on iside, prevent abduction to stop fracture from becoming open
28
Q

Regional stabilization hind limb
14. Stable fracture of the tarsus
(small bone fractures)

A
  • Attempts at immobilization can be counterproductive
  • Care of the soft tissues with a light conforming bandage
29
Q

Regional stabilization hind limb
15. Fracture of the femur

A
  • Marked hemorrhage frequently associated
  • The femur is surrounded by muscles and cannot be stabilized
30
Q

Regional stabilization hind limb
16. Pelvic fracture

A
  • Manage with caution
  • The decision to move horses with pelvic fracture is difficult
  • Fractures of the ilial shaft are life threatening.
  • Displaced fracture can lacerate iliac/femoral arteries
31
Q

B4. Analgesia and Anti-inflammatories
- when should we administer?
- Overriding principle of analgesia in fracture management:

A
  • Most effective when administered early in the pain cycle
  • Should be given as soon as the fracture is stabilized
    <><><><>
    Overriding principle of analgesia in fracture management:
  • No medication can provide the same level of analgesia and reduction
    anxiety as that delivered by proper support and immobilization
  • Analgesics are never an adequate substitute for immobilization
32
Q

B4. Analgesia and Anti-inflammatories
- what drugs are useful?

A

Non-steroidal anti-inflammatories,
examples:
- Phenylbutazone 4.4 mg/kg IV
- Flunixin meglumine 1.1 mg/kg IV
<><><><>
Opiod analgesia,
examples:
- Morphine 0.1 mg/kg IM
- Hydromorphone 0.03-0.06 mg/kg

33
Q

B5. Antimicrobials for fractures
- when do we give them? what do we give?

A
  • Immediate administration is indicated in open fractures
  • Otherwise, antibiotic therapy can be delayed until the time of surgery.
    <><><><>
    Broad spectrum antibiotics
  • Penicillin 22,000 IU/kg IV
  • Gentamicin 6.6 mg/kg IV
34
Q

B6. Intravenous fluid therapy for fractures
- when do we give and why? what do we give?

A
  • Hypovolemic shock – result of a volume deficit because of blood loss
  • Distributive shock – occurs when vasomotor tone is lost
    <><><><>
    Fluid therapy is indicated to help restore perfusion:
    1. Hypertonic saline solution 7.2%, 2 to 4mL/kg
  • Expand the intravascular space
    <><>
    2. Isotonic crystalloids – balanced electrolyte solution lactated Ringer
  • Designed to be replacement of fluids
  • Fluid deficit replaced initially with 20mL/kg bolus
  • Followed by maintenance requirement 2-4 mL/kg/h
35
Q

B7. Transportation for fracture cases
- how do we orient the standing horse?

A

Standing horse
- Front limb fracture – face backwards
- Hind limb fracture – face forward
- Placed in a partition
- Aid of a harness

3. Equine 3 (9 decks)

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