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Download Long Bone Fractures in Horses Christine Smith DVM DipACVS
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Long Bone Fractures in Horses Christine Smith DVM DipACVS Agnes Banks Equine Clinic 5 Price Lane, Agnes Banks NSW Principles Protect soft tissues/neurovascular structures Calm horse and client Avoid closed open Avoid simple comminuted/ displaced Neutralise forces Easy to apply with accessible materials Calm the horse and provide analgesia Be applied standing Protect the bone and soft tissues from further trauma An effective splint Restraint Sedation Analgesia Control bleeding Bandage & Splint Material Systemic Status Often difficult Racehorses > 2 people Use physical barrier Twitch Long Bone Fractures Christine Smith Avoid over sedation α-2 agonist + opioid Xylazine (0.3 mg/kg IV) Butorphanol (0.01-0.02 mg/kg IV) Phenylbutazone (4.4 mg/kg IV) or Flunixin (1.1 mg/kg IV) Critical Multiple layers Apply firmly Cotton roll Tensofix, Vetrap Repeat above in multiple layers Finish with Elastoplast Non elastic tape to position splint Board Broom Handle Twitch Handle Long Bone Fractures Christine Smith Polyvinyl Chloride (PVC) 6” diameter, schedule 40 Cast Material Stabilization Control Bleeding Remember Rest of Horse Shock Blood loss Dehydration Heat stress Antibiotics mid-MC3 carpus & distal radius Align dorsal cortices Counteract bending Robert Jones Caudal & lateral splint elbow to ground ulna humerus distal scapula mid-proximal radius Medial Skin Neutralize abduction Lateral splint Caudal splint Bramlage Muscle Protection Triceps Apparatus Light Bandage Caudal Splint fix carpuswt. bearing Long Bone Fractures Christine Smith ulna humerus distal scapula Muscle Protection Triceps Apparatus Light Bandage Caudal Splint Fix carpus in extension wt bearing mid-proximal MTIII Muscle protection No immobilization Bending forces Calcaneus Robert Jones Caudal & lateral Bramlage at least we don’t have to splint his front leg Bramlage Reciprocal apparatus Stifle flex→ Fx collapse Medial protection Prevent abduction Lateral splint Wide board Long Bone Fractures Christine Smith Muscle coverage Control limb Not weight bearing No effective splint Kimzey Life-Saver 3-Sizes P2 Fractures no immobilization caudal splint fix carpus no immobilization extended lateral extended lateral caudal and lateral plantar and lateral dorsal plantar Bramlage 1996 Any fracture involving the pastern joint require a pastern arthrodesis Bi-articular fractures have worse prognosis for return to athletic function Most require plates and screws and casts Long Bone Fractures Christine Smith Comminuted fractures Open reduction Need intact strut from joint to joint Cast post operative for > 4 weeks Usually open Huge Concerns Infection Blood supply Double plate Transfixation cast Sagittal fractures Can be missed If longer than 3 mm consider Closed lag screw fixation Good prognosis Cast for recovery Common in racehorses If exit through cortex Lag screws Ones that spiral proximally Double plate, Cast Medial Mt3 Long Bone Fractures Christine Smith 9 weeks Very difficult in adults Beware of kicked horse Too lame Initial rads often NAF Conservative vs ORIF Most carry good prognosis Exceptions Adults Open Articular Very short thick bone ORIF Double plate Interlocking medullary nail Conservative management Very difficult in adults Spiral, often comminuted Usually open Double plate Prognosis adults – poor Prognosis foals - guarded Long Bone Fractures Christine Smith Foals Treatment Proximal physeal fractures Salter-Harris II Medial fragment Tension band Implants medially Prognosis fair Scapular Fracture Femur Fracture Approach is a nightmare Not attempted in adults Foals poor prognosis Size of horse The higher in the leg the fracture, the worse the prognosis Blood supply Joint involvement Open = Infection Fracture Configuration Comminuted Implant options above and below fx Size of horse Post op laminitis Implant failure Weight Age of horse Foals FLD, ALD, growth plate disruption Intended Use Hard to diagnose Ultrasound useful No fixation possible Post op laminitis Implant failure Weight Age of horse Foals FLD, ALD, growth plate disruption Intended Use
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