Assessment of the fracture patient

How do you assess the equine fracture patient?

• Acutely lame/None weight bearing

  • May have history of intermittent lameness (stress fracture)

• Evidence of external trauma (not always)

• Determine specific injury

• Systemic evaluation

What considerations should be made for an objective examination of an equine fracture patient?

• Safety

• Pain (consider NSAIDs/a2 agonists)

• Shock (hypovolaemic in pelvic/femoral)

• Temperament of animal

• Police involvement/ legal/insurance aspects

• Ability to move horse/referral centre location

• Ability to place support bandage

• If deep pain -ve, may not be able to use leg again = no point repairing —> amp?

What does the decision of conservative or surgical treatment vs euthanasia for a fracture depend on?

• Type of fracture

• Presence of complicating factors

  • Contamination/damaged blood/nerve supply

• Economics

• Expertise and equipment available

• Welfare and ethics

Which fractures require immediate humane destruction?

• Proximal limb (>250kg)

  • Complete f# of femur

  • Complete f# of humerus

  • Complete f# of tibia

• Comminuted (broken in more than 2 pieces), open, highly unstable

What are the general principles of external coaptation?

• Stabilise joint above and joint below

• Always extend to top of long bone —> never end in middle of long bone —> (creates fulcrum and predisposes to fracture)

• Splints

What is the aim of a splint?

• Stabilise fracture/subluxation, prevent displacement and protect soft tissues

• Do not end splint at fracture site

• Good splint will immediately improve comfort of horse

How do fractures differ in small animals from horses?

• Rarely life threatening in SA

• 60% have evidence of thoracic trauma but only 20% have associated clinical signs

How do you assess a small animal fracture?

• Full systemic examination

  • Screen for pnemothorax, pulmonary contusions, diaphgramatic hernia

  • Neurological status- can change prognosis

  • Urinary status- need to be dealt with before fracture

  • Cardiac status- ABC

What initial medication can you provide to stabilise a SA patient with a fracture ?

• IVFT —> crystalloids at 60-90ml/kg/hour, 10-15ml/kg over 10 mins and reassess

• Analgesia —> Opioids mainly

  • can use NSAIDs if well hydrated & not actively bleeding

• Antibiotics (open fracture)

• Oxygen

What will you look for on a radiograph in a SA fracture patient?

• Thoracic (Can use ultrasound if not stable enough to xray)

  • Pneumothorax

  • Haemothorax

  • Diaphragmatic rupture

  • Pleural effusion

• Bladder

• 2° assessment

  • Open wound

  • Fractures

What are the considerations that need to be made in stabilising fracture in SA?

• Can stabilise nearly all in SA

• But consider:

  • Financial

  • Expertise

  • Equipment

  • Timing of fracture

What are the open fracture grades?

• Grade I: Bone punctured through skin and retracted back beneath the skin

• Grade II: Exposure of the bone with soft tissue damage, and a wound of >1cm

• Grade III: High energy trauma, extensive soft tissue damage, loss of soft tissues and high contamination

at risk of becoming contaminated → worsens prognosis

How do you deal with an open fracture if animal stable enough?

• Flush

• Debridement

  • Gross —> tap water shower down

  • Lavage —> 18G needle + 20ml syringe with saline / tap water

  • Sharp dissection

  • Wet to dry dressings (debris sticks to, it helps remove —> sedate / well analgesed)

  • Silver dressings

  • Initial fracture stabilisation

• Swab

• Prophylactic ABs

• Dress

What are the alternative treatment options to fracture fixation?

• Cast

• Cage rest

• Amputation (cheaper)

• Euthanasia

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