Equine Orthopedic Field Emergency
-
Upload
dane-tatarniuk -
Category
Health & Medicine
-
view
912 -
download
0
description
Transcript of Equine Orthopedic Field Emergency
Emergency Management of Equine Orthopedic Injuries
Dane M. Tatarniuk, DVMDecember 10th, 2013
Hickstead, 2011
Barbaro, 2007Trailer Accidents
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
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
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
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?
Non-weight bearing lameness
• Differentials– Fracture(s)– Foot abscess– Cellulitis– Septic synovial
structure(s)• Joint, tendon
sheath, bursa
– Solar puncture– Lacerated
tendon(s)
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
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
Adult Fracture Classification
1. Complete vs. Incomplete2. Displaced vs. Non-displaced3. Open vs. Closed– 3 subtypes
4. Configuration– Transverse, oblique, spiral, comminuted, avulsion
5. Location– Bone(s) & Limb– Diaphysis, epiphysis, metaphysis, physis
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
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).
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
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
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
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
Forelimb
1) Phalanges2) Metacarpus3) Radius4) Calcaneus5) Humerus/Scapula
Forelimb Phalanges• Align dorsal
cortices of the phalanx bones– Counter
bending force at fetlock
• Splint applied on dorsal surface
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
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
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
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
Hindlimb
1. Phalanges2. Metatarsus3. Tibia & Tarsus4. Stifle, Femur
Hindlimb Phalanges
• Aligned along the plantar surface of the limb– Reciprocal
apparatus– Better dorsal
cortical alignment
Metatarsus
• Same principles as metacarpus
• Robert Jones bandage
• Plantar and lateral splints– Lateral splint up to
level of tuber coxae
Tarsus, Tibia• Susceptible to
displacement from flexion of the stifle, due to reciprocal apparatus
• Lateral splint from tuber coxae to foot
Stifle, Femur
• No option from immobilization proximal to stifle joint
• Rely on heavy surrounding musculature
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
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
Questions?