Equine Orthopedic Field Emergency
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Description of stabilization considerations and techniques for orthopedic injuries in the horse.
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Equine Orthopedic Field Emergency
- 1. Emergency Management of Equine Orthopedic Injuries Dane M. Tatarniuk, DVM December 10th, 2013
- 3. On the phone… • • • • What type of injury is sustained? Is it known how the injury occurred? Is it known when the injury occurred? How lame is the horse? Weight bearing? Recumbent? • Is there any ongoing bleeding? • Keep owner calm, keep horse confined – Let owner know how long it will take for you to get to them • Give owner something they can do – ie, hook up horse trailer, bandage, etc. • Can have owner text picture/video to you – Understand better what is going on
- 4. What to take in your truck… • Sedatives • IV anesthetics (ketamine) • Antibiotics • Pain medication • X-Ray machine • Ultrasound machine • Clippers • Surgical instruments & suture • Bandaging material • Splinting material • Cast material • Euthanasia solution
- 5. Goals of First Aid Management • Assessment of the horse – Look for systemic signs, colic – Evaluate injury • Communicate – Concerns regarding injury – Diagnostics required to fully understand injury – Potential complications • Create a plan: – on-farm management of injury • ie, laceration repair – on-farm stabilization for referral • ie, fracture stabilization • Determine prognosis for owner – If unsure, contact referral hospital for consultation – If prognosis or cost is unfavorable, may necessitate euthanasia on-farm
- 6. On-farm Evaluation • Physical exam – HR elevated? – Signs of shock • Hemorrhage • Hypertonic, then Isotonic – Colic? • Musculoskeletal Exam – Instability, swelling, lacerations, lameness, etc. – What anatomical structures in the area? – Contaminated?
- 7. Non-weight bearing lameness • Differentials – – – – Fracture(s) Foot abscess Cellulitis Septic synovial structure(s) • Joint, tendon sheath, bursa – Solar puncture – Lacerated tendon(s)
- 8. Challenges of Fracture Repair in Horses • • • • Soft tissue damage Requires strong implants / constructs Anesthetic recovery Post-operative complications – Laminitis, cast complications, myopathy, sores • Prolonged hospitalization – Increased cost
- 9. Prognosis • With surgical repair, some fractures have poor prognosis, while others have excellent prognosis • Depends on many variables: – – – – – – – What bone is fractured Configuration of fracture Open vs. Closed Duration of fracture Soft tissue or vascular damage Articular vs. non-articular Purpose of horse • Athlete vs. Pasture sound pet – Age, breed, weight of horse • If unsure, best option is to phone referral center to speak to an equine surgeon
- 10. Adult Fracture Classification 1. Complete vs. Incomplete 2. Displaced vs. Non-displaced 3. Open vs. Closed – 3 subtypes 4. Configuration – Transverse, oblique, spiral, comminuted, avulsion 5. Location – Bone(s) & Limb – Diaphysis, epiphysis, metaphysis, physis
- 11. Neonatal Fracture Classification • Salter Harris – Type 1 • Physis – Type 2 • Physis to metaphysis – Type 3 • Physis to epiphysis – Type 4 • Metaphysis to epiphysis – Type 5 • Compression fracture of physis
- 12. Goals of Fracture Stabilization 1. Prevention of damage to neurovascular structures 2. Keeping fractured bone from penetrating skin and becoming an open fracture 3. Protect an open fracture from contamination through skin opening 4. Stabilize the limb to relieve patient anxiety and minimize further fracture displacement 5. Minimize further damage to the ends of bone (& soft tissue).
- 13. Sedation & Analgesia • Enough to decrease anxiety of horse • Options – Alpha-2 agonists (xylazine, romifidine, detomidine) • Good choice – Acepromazine • Careful with hypotensive patients – Opioids • Butorphanol for further sedation/analgesia, but only if combined with alpha-2 agonist • Analgesia – If require more than NSAIDs and sedation… • Intramuscular morphine – Don’t want to make them feel ‘too’ good on limb
- 14. Splint • Requirements – Economical, accessible for first aid application in the field – Neutralizes forces on the fracture – Does not impede the horse from moving – Applied in the standing patient, in a field setting
- 15. Splint Material • Clean & protect any wounds • Place bandage overlying fractured limb – Sheet or roll cotton, combine – Vetwrap, elasticon – Robert Jones • Provide stability – Splint • PVC, Wood, Bars – Cast • Bandage cast – Pre-made • “Kimzey Leg Saver” splint
- 16. Biomechanical Forces • Extensor muscles can act to abduct the limb • Suspensory apparatus – Instead of fetlock flexion • Bending force at the fracture site • Reciprocal apparatus – During stifle flexion • Distraction of tibial & tarsus fractures
- 18. Forelimb Phalanges • Align dorsal cortices of the phalanx bones – Counter bending force at fetlock • Splint applied on dorsal surface
- 19. Metacarpus • Start with Robert Jones bandage – 2 to 3x the diameter of limb, layered cotton/combine – Then, place a lateral and palmer splint • Rigid material • Up to the level of the elbow • Fixed in place with duct tape / white tape
- 20. Radius • Prevent abduction of the limb – No muscular covering the medial side • Robert Jones bandage • Caudal splint from elbow to heels • Lateral splint from withers to hoof
- 21. Calcaneus • Fracture of the ulna/calcaneus creates disruption of the triceps apparatus – ‘Dropped elbow’ appearance • Place Robert Jones bandage • Place palmar splint from elbow to heel – Keeps carpus in extension
- 22. Humerus, Scapula • No splinting possible to protect fracture • Rely on overlying heavy musculature • Often times, difficult to know whether it is radius or humerus fracture with radiographs – Splint like a radius fracture as pre-caution
- 24. Hindlimb Phalanges • Aligned along the plantar surface of the limb – Reciprocal apparatus – Better dorsal cortical alignment
- 25. Metatarsus • Same principles as metacarpus • Robert Jones bandage • Plantar and lateral splints – Lateral splint up to level of tuber coxae
- 26. Tarsus, Tibia • Susceptible to displacement from flexion of the stifle, due to reciprocal apparatus • Lateral splint from tuber coxae to foot
- 27. Stifle, Femur • No option from immobilization proximal to stifle joint • Rely on heavy surrounding musculature
- 28. Recumbent Horse • Utilize sedation • If horse is unsafe to be around, consider IV anesthetics (ketamine) • Stabilize the limb as you would for a standing horse • Transport the horse via sliding the horse onto a tarp • Move tarp into trailer
- 29. Transportation Considerations • Think about the brakes & momentum – If forelimb fracture • Want to face horse backwards – Hind-end towards the front – If hindlimb fracture • Want to face horse forwards
- 30. Questions?
Editor's Notes
- Clinical features of fractures:Visualization of displaced, open fractureInstability on flexion/extension/palpationCrepitus + swellingPainIf not non-weight bearing lame, significant (grade 3+) lameness
- When talking to surgeon, the best way is to email or text pictures of the radiographs.If you can’t do that, then you need to describe the fracture over the phone….classification.