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?
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
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.