Equine orthopedic emergencies (Bauck) Flashcards Preview

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Flashcards in Equine orthopedic emergencies (Bauck) Deck (32):
1

What is an orthopedic emergency?

  • Any acute-onset, severe lameness
    • Fracture
    • Joint lux
    • Synovial infection
    • Tendon rupture/laceration
    • Laceration and puncture wound
    • Sole abscess or laminitis

2

Primary goal for fractures and catastrophic traumas

stabilize limb for transport

3

Fracture Patient First Aid

  • Physical restraint
  • Relevant history and rapid examination
  • Sedation and analgesics
  • Examination & Immobilization of affected limb
  • Trasport to hospital

4

Physical Exam

  • Assess cardiovascular status
  • Affected limb or limbs
    • Is the horse bearing weight
    • Is the skin intact?
    • Presence of heat, pain, swelling, instability, crepitus
  • Evidence of trauma at other locations

5

Sedation

Dos

  • Alpha-2 agonists primary drugs (xylazine or detomidine)
    • +/- butorphanol
  • May need higher/more frequent doses
    • avoid ataxia
  • Example initial dose for 500kg horse
    • 200mg xylazine + 5mg butorphanol
    • 5mg detomidine + 5mg butorphanol

6

Sedation

don'ts

  • Avoid excessive ataxia
  • Avoid acepromazine: hypotension

7

Goals of fracture stabilization

  • Reduction of pain & anxiety
  • Immobilize adjacent joints if possible
  • Essential before transport, radiographs

8

Fracture stabilization chart

TQ

Q image thumb

A image thumb
9

Section 1: Distal Fractures

  • Distal MC/MT3, P1, P2
    • breakdown injuries & fetlock luxations
  • Align dorsal cortices into straight line
    • Neutralizes bending forces at fetlock joing and fracture site
    • Apply dorsal splint
  • Apply light compression bandage (1/2" thick)
    • NOT Robert Jones

10

Q image thumb

  • Kimzey 'leg saver' splint
    • suspensory breakdown
    • catastrophic fracture P1

11

Section 1: Distal hindlimb

  • Same as front
  • Light bandage and plantar splint

*something about a little bit of extension in the toe

12

Section 2: mid-forelimb

  • Proximal 2/3 metacarpus, carpus, distal radius
  • Maintain bony alignment and immobilize distal to fracture site
  • Robert Jones, ground to elbow
  • Caudal & Lateral splints

13

Robert Jones Bandage

  • Multiple layers of rolled cotton
  • Layers compressed by brown gauze
  • 1 inch/layer
  • Final diameter = 3x limb
  • Apply splints with duct tape or white tape (NO STRETCH)
    • NOT ELASTICON

14

Section 2: Mid & Proximal Metatarsus

  • Stabilize by using the calcaneal tuberosity (point of hock) as extension of MT3
  • Apply lateral and plantar splints over padded bandage
  • Caudal splints should extend from calcaneus to ground

15

Barring catastrophic rupture, which two joints flex/extend together

Hock and stifle

16

Section 3: Mid & Proximal radius

  • Goal
    • prevent abduction
  • Lateral pull of antebrachial muscles distal to fracture site
  • Can lead to open fracture
  • Robert Jones bandage
  • Caudal splint-elbow to the ground
  • Lateral splint-whithers to the ground
  • Extended lateral splint prevents abduction

17

Very little soft tissue on which aspect of forelimb?

medial aspect

18

Section 3: Tarsus and Tibia

  • Problem: Reciprocal apparatus and minimal soft tissue coverage
  • Goal: prevent abduction of limb
  • RBJ from stifle to ground
  • Lateral splint-tuber coxae to ground
  • Wide Wooden board or contoured metal rod
  • Width = resistance to rotational forces
  • Length prevents abduction

19

Section 4

Proximal to Elbow

  • Includes humerus and scapula
  • Well protected by muscle
  • No coaptation
  • Splinting actually contraindicated

20

Olecranon fractures

about

  • Special case
  • Complete olecranon fractures and some humoral fractures
  • Disrupt triceps apparatus
  • Apply splint to align bone column and fix carpus
  • This allows weight bearing on limb

21

Olecranon fractures

Bandage

  • Goal:
    • align bones
    • fix carpus in extension
    • allow weight bearing
  • Padded bandage (NOT RJB)
  • Caudal splint
    • Olecranon to fetlock/or ground

22

Section 4: Proximal to Stifle

  • Coaptation NOT performed (contraindicated)
    • Could inc traum from pendulum effect
  • Protected by musculature

23

Open Fracture

  • any break in skin
  • Clean wound before bandaging
  • Keep moist
  • Initiate broad spectrum antibiotics
  • Tetanus toxoid
    • any laceration ask about tetanus vaccination status

24

After limb is stabilized

  • Analgesia 
    • Some is ALWAYS provided
      • bute or banamine
    • Does NOT create more damage
    • Avoid corticosteroids
  • Flunixin meglumine: 1.1 mg/kg
  • Phenylbutazone IV: 4.4 mg/kg

25

Fx complications/

post stabilization care

  • Hypotensive shock (rare)
    • lacerated artery and blood loss
    • dehydration/loss of circulating volume
  • IV fluids
    • Isotonic bolus
      • NormR
      • Plyte
  • Nephrotoxic drugs
    • be conscientious of dehydration + NSAIDS + aminoglycosides

26

Radiographs

  • Not always possible/necessary
  • Better at referral hospital
  • Perform when affects decision to transport
  • Can perform with splint in place

27

Transport

  • Large vans and gooseneck trailers
  • Keep dividers in place
    • use chest/rump bars for support
  • Untied head, neck free for balance
  • NO STOCK TRAILORS
  • NO LOOSE BOX STALLS
  • Minimize distance the horse must walk

28

Position on trailor

  • Easier for the driver to control acceleration, not breaking
    • HINDLIMB fractures: FACE FRONT
    • FRONT LIMB fractures: FACE BACK

29

Fracture prognosis

Categories

  1. Type, number & location of fractures
  2. Open vs Closed
  3. Degree of soft tissue damage/vascular injury
  4. Age, breed and weight of horse
  5. Nature of patient
  6. Time between injury and repair
  7. Effectiveness of first aid before referral

30

Reparability of fractures

More distal and less weight bearing fractures easier to repair, better prognosis

31

Amenable bones for repair

  1. Phalanges
  2. Sesamoids
  3. MC/MT
  4. Carpal
  5. Tarsal
  6. Patella
  7. Ulna

32

Bones adverse to fracture repair

  1. Radius
  2. Humerus
  3. Scapula
  4. Calcaneus
  5. Tibia
  6. Femur
  7. Pelvis