Page 659 - Adams and Stashak's Lameness in Horses, 7th Edition

Lameness of the Proximal Limb 625

prevent catastrophic breakdown of the fracture. Horses
should be closely watched for tolerance of being tied.
VetBooks.ir off over time. Short hand walks can be initiated after 90
NSAIDs are initially administered; these can be weaned
days. A total of at least 6 months before a return to
intended use should be considered.

Displaced Fractures
Internal fixation of complete displaced fractures of
the radius is the preferred method of treatment. The use
of transfixation casts is generally considered for open
contaminated fractures in which the chances of success-
ful plate fixation are poor because of the risk of infection
or when there are economic constraints. The application
of a full‐limb cast alone for displaced fractures of the
radius is not acceptable in most cases because the humer-
oradial joint cannot be adequately immobilized. If a cast
is applied, it frequently results in increased rotational
forces on and movement at the fracture site. In addition,
the more proximal the fracture, the greater the chances
that the cast will cause a pendulum effect to the distal
limb. This causes more tissue damage and results in a
27
failure of the fracture to heal. However, cast applica-
tion alone has been used to successfully treat some distal
Figure 5.28. A nuclear scintigraphic examination of increased radial fractures when there are economic constraints.
uptake of radioactive isotope in the distal radius, indicating a stress A combination of a full‐limb cast and Thomas splint
fracture of the metaphysis. Source: Courtesy of Dr. Dan Burba. has also been recommended for some uncomplicated mid-
shaft radius fractures in young horses. 27,67 Bandage splints
Treatment have been used to treat a few horses with complete frac-
tures of the distal radius. In one report, two horses with
First Aid complete fractures (one nondisplaced, one displaced)
Immediate immobilization of a displaced radial frac- involving the distal half of the radius were treated success-
ture is very important (see musculoskeletal emergencies fully with a modified Robert‐Jones bandage with the addi-
in Chapter 12). Appropriate attention to any open tion of light strong splints. Healing occurred in 14–16
68
wound to address contamination and to reduce further weeks and both horses were able to return to usefulness.
soft tissue damage is necessary. With closed displaced A transfixation pin cast using positive profile, cen-
fractures, application of appropriate external coapta- trally threaded, one‐fourth‐inch stainless steel pins
tion can prevent the fracture from becoming open. placed transcortically in a sagittal plane at 30° to each
A heavy layered cotton bandage is firmly applied from other is best suited for fractures in the distal third of the
the hoof to as far proximal on the antebrachium as pos- radius (Figure 5.29).
sible. Two splints, one placed lateral and one placed cau- A single‐plate application on the cranial or craniolat-
dal to the limb, with the lateral splint extending from eral surface is only recommended in foals less than
the ground to the withers and the caudal splint extend- 250 kg that have a transverse mid‐diaphyseal fracture
ing from the ground to the olecranon process, is recom- with an intact caudal cortex (Figure 5.30). In foals, it
90
mended. 10,93 Nonelastic adhesive tape or 1–2 rolls of is preferential not to bridge the physes and to not engage
fiberglass cast material are used to affix the splints to the ulna because it could result in elbow dysplasia and
the bandage. The portion of the lateral splint that arthritis due to the differential growth rate of the ulna
79
extends proximal to the bandage should contact the and radius. Internal fixation in adult horses for dis-
brachium when the limb is in a weight‐bearing posi- placed fractures generally has an unfavorable prognosis.
tion. This proximal application of the lateral splint In larger foals and adults, two plates are used: one is
90
provides counterpressure to prevent the limb from placed as a tension band on the cranial surface, and the
abducting with weight‐bearing. This approach generally other is placed as a neutralization plate on the lateral or
5
stabilizes the limb enough to allow the patient to be medial surface 90° to the other plate (Figure 5.31). The
transported for treatment without running the risk of use of a 5‐mm locking compression plate (LCP) or a
further injury to the fracture site. dynamic condylar plate (DCP) as one of the plates is
recommended. 47,90 In a report of 54 radial fractures,
double plating was used in all adult horses. A variety of
Nondisplaced Fractures
plates were used including DCP, limited contact dynamic
Fractures that are nondisplaced or incomplete with compression plate (LC‐DCP), dynamic condylar screw
minimal displacement are often candidates for conserva- (DCS), or the LCP. Although there was no correlation as
tive treatment. This involves stall confinement for up to to what would be the best plate, these authors believed
3–4 months. 7,20 It may be necessary to attach the horse that the use of LCP would ultimately provide a better
to a wire to keep the horse from laying down to initially outcome based on the improved stability shown in