Page 28 - Manual of Equine Field Surgery

CHAPTER 4

Emergency Management of the Fracture Patient

Gal Kelmer

INDICATIONS INITIAL EVALUATION AND TREATMENT

Unstable appendicular skeleton fractures. Prompt and proper fracture stabilization in the

horse can make the difference between death and

an athletic future. A horse with a fractured, unsta-

EQUIPMENT ble limb can rapidly induce further trauma that

will markedly decrease the chance for successful

Bandaging material includes uniform layered repair and survival. The goal of the initial treat-

cotton padding, elastic gauze, elastic adhesive, ment and stabilization is to prevent further

inelastic tape, and wound dressing materials. trauma. Such trauma may result in eburnation of

Splints can be made from any lightweight rigid fracture ends, further fragmentation and fracture

material. PVC (polyvinyl chloride) pipe, 8 to displacement, damage to neurovascular struc-

10cm in diameter and of 4- to 8-mm wall thick- tures, skin penetration leading to an open frac-

ness, sectioned longitudinally into thirds makes ture, and additional soft tissue damage.!"

an excellent, inexpensive, readily available splint- Initial assessment of the injured .horse inclu-

ing material. The sharp edges of the splint may be des evaluating the systemic condition, specifically

rounded and should be wrapped with tightly hydration status and cardiovascular function, the

taped padding. Other acceptable splinting mate- bone involved, and the stability of the bony

rials include wooden splints, 5 to 20 cm wide and column, and determining whether the fracture is

10 to 20 min thick, and aluminum or concrete open or closed. Typically, the horse will be sys-

reinforcement rods, 12 to 16 mm in diameter, cut temically stable and will benefit from immediate

to length (Figure 4-1). stabilization of the injured limb. Analgesia and

sedation of the fractured horse are important in

order to relieve anxiety and alleviate pain, thereby

POSITIONING AND PREPARATION minimizing further self-inflicted damage to the

injured limb. Phenylbutazone ( 4.4 mg/kg IV) is

All emergency fracture stabilization should be beneficial for both its analgesic and anti-inflam-

done with the horse in a standing position while matory properties. Additional analgesia and seda-

providing analgesia and mild to moderate seda- tion can be achieved using detomidine (0.01 to

tion. Recovery from general anesthesia can chal- 0.02 mg/kg IV/IM) with or without butorphanol

lenge even an ideal fracture repair by the ap- (0.01 to 0.04 mg/kg IM). Use caution when

plication of extreme forces to the horse's limb. administering these sedatives and analgesic agents,

Thus, general anesthesia should be avoided unless so as not to render the horse ataxic. Horses with

these fractures may be dehydrated and hypo-
absolutely necessary.1

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