First Aid and Transportation of Equine Fracture Patients

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First Aid and Transportation of Equine Fracture
Patients

• Jeff Brakenhoff, DVM
• Equine Surgery Resident
• Michigan State University

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Emergency Management

• Tremendous advancement in fracture fixation
• Successful outcome

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Emergency Management

• Expensive endeavor
• Proper temporary stabilization influences the
  prognosis significantly

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Prognosis

• Location The above the carpus-tarsus rule
• in adult horses
• Severity
• Age/Weight

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Prognosis

• Open/Closed
• Configuration
• Soft tissue damage

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Prognosis

• Intended use
• Temperament

Performance
Breeding
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• Most of these injuries cannot be managed easily
  in the field
• Necessitates transport to a surgical facility

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Emergency Steps

• Calm the patient
• Perform a cursory exam
• Apply protective splint, bandage or cast
• Perform other diagnostics
• Begin therapy
• Transport the patient to a hospital

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Calm the patient

• Do not move horse
• Lip twitch
• Tranquilization, Sedation, and Pain Relief
• Detomidine/Butorphanol
• Xylazine/Butorphanol
• Goal Relaxation without ataxia

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Cursory Exam

• Physical exam
• Most are painful and anxious
• Sweating and shocky
• Hemorrhage rarely a problem
• Assess the extent of damage
• Some limbs are too severely damaged for an
  attempt at repair

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Decision

• Discuss findings and prognosis with owner
• Use teaching hospitals as a resource
• Repair vs. Euthanasia

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Apply Protective Bandage, Splints, and/or Cast

• Objectives
• General guidelines
• Specific fractures and proper application of
  splints, etc

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Objectives

• Preserve the neural and vascular element of the
  limb
• Prevent an open fracture

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Objectives

• Protecting the limb from contamination
• existing skin opening
• Stabilization of the limb
• to relieve the anxiety
• Minimize further damage
• bone ends and soft tissue

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Guidelines

• Bandage
• Apply counter pressure to the injury site
• Swelling
• Protects the soft tissues
• Splints

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Guidelines

• Splints
• Lightweight
• Durable
• Easy to apply
• Fits snugly
• Prevents damage to soft tissues

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Splints

• Examples
• Wood
• PVC
• Rebar

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Splinting

• Techniques vary with fracture location
• Four Zones

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Zone 1

• Phalanges and distal 1/3 cannon bone
• Dominated biomechanically by the angle of the
  fetlock
• Fracture site becomes principle bending focus
• Goal Counteract this bending force

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Phalanges and Distal Cannon Bone

• Align phalanges in same plane as cannon bone

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Zone 1
Dorsal Splint -with non-elastic tape
Light Bandage
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Cortical alignment

• Leg Saver
• Kimzey Splint

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Zone 2

• Distal radius, carpus to midcannon
• Robert-Jones bandage is essential

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Robert-Jones Bandage

• Applied in multiple layers
• Roll cotton
• Elastic gauze
• Each layer no greater than 1 inch
• Prevents shifting and compacting
• Evenly distributed over limb
• Goal 3x the diameter of the limb

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Zone 2 -forelimb

• Apply splint over bandage
• Non-elastic adhesive tape
• Caudally and laterally at 90
• Extend from elbow to ground

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Zone 2 hindlimb

• Similar principles as forelimb
• Less extensive Robert-Jones bandage applied
• Splints
• Caudally and laterally at 90

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Zone 3 -Radius

• Difficult to stabilize
• Principle musculature lies on lateral side
• Thin skin medially
• Muscles act as abductors
• Preventing abduction is essential

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Radius

• Robert-Jones Bandage
• Lateral splint
• Extending proximally toward withers
• Fit snug to triceps
• Taped securely at level of axilla

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Zone 3 -Tibia and Tarsus

• Again difficult to stabilize
• Similar musculature location as forelimb
• Soft tissue damage a concern medially

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Tibia and Tarsus

• Goal prevent abduction and over-riding
• Robert-Jones bandage up to stifle
• Thick and tight
• Lateral splint
• Bent to follow the contour of limb
• Extend from ground to rump
• Cranial/Caudal splints
• Difficult to apply and of little support

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Zone 4 -Elbow

• Unable to extend limb effectively
• Loss of triceps apparatus
• Exception to carpus-tarsus rule

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Elbow

• Goal
• Keep carpus in extension
• Use limb for support and balance
• Full limb bandage
• Caudally applied splint
• Ground to point of elbow

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Zone 4 Humerus/Scapula

• Well protected by muscle
• Swelling gives some support
• Additional bandaging difficult and not needed
• concerned about radial nerve damage

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Zone 4 Femur/Pelvis

• Well protected
• Difficult to stabilize
• Support the opposite limb

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Zone 4 Femur Foals / Minis
Carpus-tarsus rule does not apply to foals
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Other Diagnostics/Treatment

• Radiographs
• Antibiotics
• Analgesia
• IV fluids

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Transportation

• Support is essential
• Direction of horse
• Forelimb fracture face back
• Hindlimb fracture face forward

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Summary

• Location
• Configuration

Comminuted
Soft tissue damage
Open Tibial Fracture
Adult Radial and Femur Fracture
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Summary

• Age/Weight
• Proper bandaging
• Apply splints at 90
• Support while shipping

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Thank You

• Fort Dodge
• MSU Surgeons
• Michigan Veterinary Conference