Emergency Care and Stabilization of Equine Fractures in the Field

True or False: Fortunately, fractures are uncommon but fractures can be catastrophic.

True!

True or False: A fracture is always a death sentence.

False! A fracture is NOT always a death sentence.

What gives a horse a fighting chance with a fracture?

Prompt recognition and appropriate first aid care (proper splinting and transportation)

Give an example of a situation where human action does NOT give a horse a fighting chance with a fracture.

Not appropriately applied splint (like bandaging) and causing destability and further displacement

Why should you only use light sedation when dealing with a horse with a fracture?

Could allow more weight than should to be on limb due to sedation -> further displace

What are the THREE major factors that influence the prognosis associated with a fracture?

1. Owner willingness/financial ability

2. Likely outcome

3. Expertise/appropriate facility to manage repair

Which would have a better prognosis, a horse with a fourth metatarsal bone fracture or mid-bone fracture of the third metatarsal bone?

Fourth metatarsal: excellent prognosis and may not require significant financial outlay

Mid-bone third metacarpal: more uncertain prognosis and a much higher cost

In general, the more (proximal/distal) you go on a limb, the worse the prognosis.

Proximal

How can temperament impact fracture repair candidacy?

A fractious/untrained horse might not be good candidate

In what TWO major ways can a horse's health condition impact fracture repair candidacy?

1. An unthrifty horse may have impaired healing (catabolic state)

2. Owner with unthrifty horse may not be committed to care for the injured horse

How can the size of the horse impact fracture repair candidacy?

Larger horses place more stress on repaired fracture sites and opposite supporting limb

What location of a fracture may result in permanent unsoundness?

Articular fractures

What TWO questions can you ask to indicate a more severe fracture, supporting a poorer prognoses?

1. Is the fracture open?

2. Is the fracture comminuted?

Better prognoses are associated with (smaller/larger) horse size, (good/poor) temperament, (closed/open) fracture planes, and fractures of the (lower/upper) limb.

This means vice versa for poorer prognoses.

Smaller

Good

Closed

Lower

In what TWO scenarios might indicate that humane euthanasia is the best likely outcome?

1. Loss significant blood supply to the limb

2. Accompanying soft tissue injury

True or False: The cost of fracture repair can easily run tens of thousands of dollars, even in uncomplicated cases primarily due to post-op patient care.

True!

How should you handle cost of a fracture repair in a horse that is insured?

Have owner contact company immediately and work accordingly to their policy

What are the TWO major immediate considerations for a fractured limb?

1. Protecting fracture from additional contamination

2. Immediate immobilization

Many equine fractures are complicated when broken bones pierce the skin, leading to an increased risk of infection. This is called a —— fracture.

Compound

True or False: Some fracture may be relatively stable, like hoof fractures. With others, fractured bones must be stabilized to prevent further damage to the injured tissues. Horses can further damage an injured limb if they continue to try to bear weight on it.

True!

In initial management, wound bandaging should occur (before/after) efforts are made to stabilize the limb.

Before

What kind of fractures need the most protecting from additional contamination?

Concomitant open wounds associated with compound fractures

How should you clean a wound associated with fracture and control bleeding?

Gentle cleansing/lavage with tap water (no aggressive cleaning, even with compound fractures)

Direct pressure

True or False: In initial management, pain management should involve no more than NSAIDs.

True!

A horse with a fracture should not be moved until when?

Fracture is stabilized

What is necessary to stabilize a fracture site and is mandatory before horses are shipped for attempts at fracture repair?

Proper splinting

Name THREE side effects to improprer splinting.

1. Closed fractures become compound with excess movement

2. Movement of fractures can cause complete deterioration of fracture site

3. Make fracture repair impossible

What TWO things are required for proper management of orthopedic injuries in the field?

1. Clean bandages

2. Appropriate wound dressings

Commercially available splints can work very well for (lower/upper) limb fractures.

Lower

True or False: Boards, split pieces of PVC pipes, and duct tape can be used to manufacture your own splints.

True!

Fractures of the horse can be grouped into —- levels of the fore and hindlimbs with recommendations for external support specific to each level.

4

What fractures are involved in a level 1 on the thoracic limb? (3)

Phalanges, proximal sesamoids, and distal metacarpus

What portion of the limb is splinted in a Level 1 on a thoracic limb?

Distal carpus to toe

What commercial splint helps to align the bones of the metacarpus and digit to stabilize Level 1 fractures in the horse?

What is it particular useful for treating horses with?

Kimzey Leg Saver Splint

Disruption of suspensory apparatus

What aspect of the limb is a splint placed in a Level 1 THORACIC limb?

Dorsal

Why is it important to apply a splint over minimal padding when stabilizing Level 1 fractures?

How can an assistant help keep the limb straight during the process?

Proper alignment of bones in the digit

Hold above carpus to stabilize

What kind of fractures are Level 2 thoracic limb?

Mid forelimb (distal radius to mid metacarpus)

Where are splints placed in a Level 2 thoracic limb and how far does it extend on the leg?

Caudal and lateral

Elbow to ground

How is the Robert Jones bandage created for a Level 2 thoracic limb?

Multiple layers of cotton padding compressed with gauze and Elasticon

In a Level 2 thoracic limb, the diameter of the finished bandage should be approximately --- times the diameter of the limb at the fracture site.

3

What kind of fractures are Level 3 thoracic limb?

Middle and proximal radius

True or False: Fractures of the middle and proximal radius are often open fractures, are more difficult to mobilize, and have a grave prognosis.

True!

Where are the splints placed in a Level 3 thoracic limb?

How does it extend the leg?

Caudal and an extended lateral split

To elbow (extended lateral lays against the shoulder)

What is the primary goal of splinting Level 3 fractures?

Why>

Prevent abduction of injured limb

Flexing/extending muscles on lateral surface of forelimb -> contraction disrupts skeletal frame and abducts DISTAL to fracture site -> penetration of distal bone through medial side of limb

True or False: Foals should be stabilized with a Robert Jones bandage that extends from the axilla to the toe with a lateral splint that extends up the lateral aspect of the chest and lies against the ribcage.

True!

Euthanasia is often recommended for adults with what type of fracture in the thoracic AND pelvic limbs due to poor prognosis?

Level 3

What kind of fractures are Level 4 thoracic limb?

Humerus, ulna, and distal scapula

Where does the splint orient and extend on a Level 4 thoracic limb?

Caudal splint from elbow to ground

True or False: The main purpose of a Level 4 thoracic limb splint is to splint the fracture.

False! It does NOT splint the fracture site. The main purpose is to fix the carpus for transportation to force support and improve balance. They will need help loading.

What fractures are Level 1 pelvic limb?

Phalanges and distal metatarsus

How is the splint oriented in Level 1 pelvic limb?

Plantar

True or False: As in the thoracic limb, it is helpful to have an assistant suspend the injured limb from the hock in a flexed manner in a Level 1 fracture.

True!

What makes application of a plantar splint or cast more convenient to align the solar surface of the foot with the bones of the digit and metatarsus?

Natural flexion of pelvic limb due to reciprocal apparatus

What fractures are a Level 2 pelvic limb?

Middle and proximal metatarsus

How are the splints oriented and extend the leg in a Level 2 pelvic limb?

Plantar and lateral splints from point of hock to ground

What acts as a functional extension of the metatarsus and provides additional support when incorporated into a Level 2 pelvic limb splint?

Tuber calcis

Why should padding be less in a Level 2 pelvic limb than thoracic limb?

More difficult to include tarsus in bandage and too much padding makes difficult to stabilize

What kind of fractures are Level 3 pelvic limb?

Tibia and tarsus

How is the splint oriented and extend the leg in a Level 3 pelvic limb?

Extended lateral splint wrapped stifle to ground and extended hip to ground

What pelvic limb fractures are more difficult to mobilize and have a grave prognosis in adults?

Level 3

What is the major goal of a Level 3 pelvic limb splint?

Prevent abduction and rotation of limb

What happens if an unstable tibia fracture is present in a Level 3 pelvic limb?

What does this result in?

Flexion of stifle occurs without hock flexion

Overriding ends of fracture fragments -> trauma to bones and soft tissue

True or False: As in the case of radius fractures of the thoracic limb, level 3 fractures of the pelvic limb create abnormal abduction of the distal portion of the limb, which must be prevented.

True!

What kind of fractures are Level 4 pelvic limb?

Femur or pelvis

What kind of splint does a Level 4 pelvic limb get? Why?

None- protected by large muscle groups

True or False: Horses with Level 4 pelvic limb fractures should be kept quiet and assisted as much as possible when loading or transporting to another facility.

True!

Transported horses should be (loosely/closely) confined to help them maintain their balance on a trailer using bales of hay or shavings.

Closely

Forelimb fractures should always face the ---- of the trailer, while hindlimb fractures always face the ---.

Back

Front

(Fracture is always at the back of the trailer)

When driving a trailer, (acceleration/braking) is always controllable, but (acceleration/braking) is not always controllable.

Acceleration

Braking