approach to eq fractures

Presenting signs

·    If acute/severe fractures – see conformational abnormalities, severe lameness, pain, crepitus

·    If non-displaced – see minimal lameness, localising signs

·    If articular involvement – see joint effusion

History

·    History of trauma? E.g. kick, fall

·    Was it sudden onset?

·    Noticed any swelling? Did that occur suddenly?

Investigation

·    Palpation feeling for heat, pain, selling, crepitus

·    Administer sedation/analgesia if needed to allow examination

·    Radiography – minimum 2 views, but if non-displaced may not see radiographic changes

·    U/S for pelvic fractures

·    Gamma scintigraphy – useful for non-displaced stress fractures

Causes

·    Trauma – most common

o  Acute (kick, fall), chronic (stress fractures in racehorses)

·    Developmental – fragments due to OCD

·    Secondary to other diseases, e.g. neoplasia

Management

·    Immediate stabilisation

·    Surgical repair

o  Use of CT/MRI to determine site, arthroscopy to assess articular surface

o  Lag screws, position screws, plate screws

·    Appropriate stabilisation, analgesia and rest post=op

·    Consider euthanasia if:

o  Irreparable fracture, e.g. open comminuted long bone

o  Horse cannot be stabilised/transported for appropriate treatment

o  QoL long term will be poor

o  O cant afford treatment

o  Horse will not tolerate box rest/rehabilitation

Complications

·    Articular involvement ® degenerative joint disease

·    Contamination ® osteomyelitis, synovial sepsis, soft tissue involvement

·    Soft tissue involvement ® tendon, ligament, muscle or neurovascular damage

·    Unstable fractures ® non-healing, malunion

·    Damage to periosteal vascular supply ® sequestrum formation

·    Mechanical overload of contralateral limb ® laminitis