Page 100 - Manual of Equine Field Surgery

96 LIMB SURGERIES

POSTOPERATIVE CARE the amputated portion of the splint bone is

unlikely but may require additional rest, antiin-

l flammatory therapy, and possibly further surgical

• l PostoRerative Care removal.
I l ::,; '. tw. . .

Bandaging: A sterile dressing is placed over the

incision and a half limb bandage is placed and

changed the day following surgery. An inner pres- ALTERNATIVE PROCEDURES

sure bandage can be placed over the incision site

to control postoperative hemorrhage and swelling. Segmental ostectomy of the affected portion of

If placed, this should be removed the day follow- the splint bone leaving the proximal and distal

ing surgery. The bandage is changed every 2 to 4 segments intact has been described as an alterna-

days for 3 weeks. If a drain has been placed, it tive to resection of the entire splint bone distal to

should be removed within 3 days or sooner if the fracture. Results were good in the 17 cases

drainage is minimal. described. 1

Exercise Restridions: Strict stall rest is advised

for the first 1 O days followed by stall rest with

handwalking for the following 2 weeks. Return to

activity is then dependent on healing of the site COMMENTS

and the degree of any concurrent suspensory lig-

ament damage. In general, exercise is limited to Minimally displaced fractures will often heal ade-

small-area turnout for at least 2 months postop- quately with conservative rnanagement.i" Frac-

eratively. tures in the proximal third of the splint bone may

Medications: Phenylbutazone is administered at require internal fixation or complete removal of

4.4 mg/kg BID for the initial 24 hours and 2.2 metatarsal bone IV.5•6 Amputation of the splint

mg/kg BID for an additional 3 days. Further anti-

inflammatory use is dependent on concurrent bone i11 the proximal one fourth of the splint bone

problems such as suspensory desmitis. Antibiotic potentially destabilizes the remaining portion of

use and duration are dependent on the presence the splint bone and is not recommended without

of infection and ideally guided by culture results. consideration of internal fixation of the remain-

If a drain is placed, antibiotic therapy should be ing proximal fragment. If the proximal fragment

continued 24 hours past removal of the drain. is stable, some open proximal fractures may be

Generally, if debridement is thorough, the need managed by debridement without disturbing the

for antibiotic therapy is minimal. proximal or distal segment attachments.i+"

Suture Removal: Skin sutures are removed 12 Distal splint bone fractures are often associated

days postoperatively. with hyperextension injuries or suspensory liga-

ment desmitis.Y These conditions should be as-

sessed preoperatively and may dictate postopera-

tive therapy. Fractures in the middle third of the

EXPECTED OUTCOME splint bone are generally a result of trauma and

are more likely to be associated with infection or

The prognosis for middle and distal splint bone sequestrum formation.

fractures is excellent. The prognosis for proximal

splint bone fractures is variable.

REFERENCES

COMPLICATIONS

1. Jenson PW, Gaughan EM, Lillich JD, et al: Segmen-

Seroma formation may occur especially if a large tal ostectomy of the second and fourth metacarpal

amount of dead space was present during closure. and metatarsal bones in horses: 17 cases (1993-

2002), J An1. Vet Med Assoc 224(2):271, 2004.
This is generally treated by continued bandaging 2. Adams SB, Fessler JF: Excision of distal splint bone

or, if persistent, by opening the distal end of the fractures. 111 Adams SB, Fessler JF, editors: Atlas of

incision. Dehiscence of the incision is possible, equine surgery, Philadelphia, 2000, WB Saunders.

especially if a seroma develops. Generally, this is 3. Dyson SJ: The metacarpal region. In Ross MW,

only partial dehiscence and can be allowed to heal Dyson SJ, editors: Diagnosis and management of

by second intention. Excessive bone reaction near lameness in the horse, St Louis, 2003, WB Saunders.