Page 122 - Manual of Equine Field Surgery

118 LIMB SURGERIES

ward. Special care should be taken over bony the transition between cast support and normal

prominences, joints, and the coronary band, as weight bearing. Foals often require temporary

these are the areas most likely to be injured with heel extension after cast application because of

the cast cutter. flexor tendon laxity (Figure 19-16).

Bandaging or splint application is indicated

after cast removal to prevent edema and to ease

Cast Monitorng
i

Casts must be monitored daily for the presence of

heat, discharge, pressure sores, and cracking.

Horses wearing casts should be monitored closely

for changes in the level of lameness present. Early

cast removal and replacement or reassessment are

indicated immediately if the cast has broken or

the horse has had a significant change in lameness

level.

COMPLICATIONS

Cast sores, disuse osteopenia, articular cartilage

Figure 19-13 Bandaging and elevation of the con- softening, joint stiffness, tendon or ligament

tralateral limb.

laxity, or breakage of the cast may occur.2•4•10•11

Pressure or friction sores generally occur at the

proximodorsal aspect of the third metacarpal

bone, the proximoplantar aspect of the superficial

digital flexor tendon, and the palmar/plantar

aspect of the sesamoid bones in half limb casts

(Figures 19-17 and 19-18). In distal limb casts,

pressure or friction sores are most common at the

proximopalmar aspect of the pastern. Foals and

thin-skinned horses are particularly susceptible to

cast sores. The degree of articular cartilage

atrophy and disuse osteopenia and laxity is likely

related to the length of cast immobilization and

to the use or lack of use of the limb during the

Figure 19-14 Cast removal using a11 oscillating saw. casting period. In foals, marked flexor tendon

Figure 19-15 After the entire cast has been split with Figure 19-16 Application of a heel extension to

an oscillating saw. Cast spreaders are inserted to sepa- provide flexor tendon support in a foal with tendon

rate the two halves of the cast. laxity secondary to cast application.