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Compendium January 1999 20TH ANNIVERSARY Equine

CONSULTANT’S CORNER

How should I handle a 200-kg foal with


an open transverse midshaft metacarpal
fracture prior to surgical referral?

ideal splint should counteract the gle to help prevent shifting during
Gary M. Baxter, VMD, MS damaging biomechanic forces in the transport, and they should be tightly
Diplomate, ACVS affected area without being so cum- secured to the bandage using nonelas-
Department of Clinical Sciences bersome as to hinder the animal’s tic white tape. If PVC material is not
College of Veterinary Medicine and movement. The splint should also be available, any lightweight, rigid mate-
Biomedical Sciences economic and capable of being ap- rial (e.g., wood, aluminum, flat steel)
Colorado State University plied in any field situation without is effective.
the need for general anesthesia. Portions of the forelimb above and
below the site of a midshaft metacar-

B
efore tending to the fractured Fracture Stabilization pal fracture can facilitate splint appli-
limb, a good physical examina- Open transverse midshaft metacar- cation. In this case, the small size of
tion should be performed and pal fractures are located in the mid- the foal should also aid in obtaining
the wound cleaned and lavaged if forelimb division and are thus best good stabilization of fracture frag-
possible. However, local treatment of stabilized with Robert–Jones ban- ments. Because of the sparse soft tis-
wounds may be difficult in young, dages combined with full-limb sue coverage in the metacarpal region,
fractious foals. Sedating the foal with polyvinyl chloride (PVC) splints ap- however, closed fractures in this loca-
xylazine may enable examination of plied caudally and laterally. The ban- tion can easily become open if not ad-
the limb and help control skeletal dage should be applied in several lay- equately splinted (or, in this case, the
pain. ers; each layer of padding (cotton) wound may enlarge and cause further
To minimize bacterial colonization should be no more than 1-inch thick contamination of the fracture site).
of the fracture site, broad-spectrum and compressed with elastic or brown This is especially true for foals because
antimicrobials (e.g., penicillin com- gauze to increase its stiffness. The to- their thin skin provides little resis-
bined with gentamicin, amikacin, or tal diameter of the finished bandage tance to bone penetration. However,
ceftiofur) should be administered be- should be approximately three times foals tend to protect their fractured
fore transporting the foal; this may the diameter of the limb at the frac- limbs better than do adults, which
also help prevent osteomyelitis devel- ture site. Splints should extend from aids in the transport of young horses.
opment if internal fixation is per- the elbow to the ground at a 90° an- The mare and foal should be trans-
formed. In addition, it may be bene-
ficial to apply an antibiotic dressing
over the wound and administer non- Consultant’s Corner is a regular feature in the Equine section of Compendium.
steroidal antiinflammatory drugs (e.g., The purpose of the column is to provide expert answers to questions that are fre-
phenylbutazone, flunixin meglumine, quently asked by practitioners. Readers are encouraged to ask questions that they
or ketoprofen). would like to have answered, and experts are welcomed to submit questions they
For the purposes of fracture splint- would like to address. For suggestions involving topics in equine medicine, please
ing, the forelimbs and hindlimbs can contact James N. Moore, DVM, PhD, Department of Large Animal Medicine,
be divided into four functional units College of Veterinary Medicine, University of Georgia, Athens, GA 30602; 706-
depending on the biomechanic forces 542-3325; fax 706-542-8833; email jmoore@cvm.vet.uga.edu.
acting in each area (Figure 1). The
Equine 20TH ANNIVERSARY Compendium January 1999

ported together in a van or large trail-


er, if possible. The mare should be
confined within the trailer to make it
easy for the foal to stay close; there is
usually no need to confine the foal
further. No immobilization
necessary
Caudal splint to lock No immobilization
Additional First Aid carpus in extension necessary
Horses with fractures often require
emergency first aid treatment (see Robert–Jones bandage Robert–Jones bandage
with extended lateral splint with extended lateral splint
Equine Fracture First Aid Kit Con-
tents). Horses are not readily ambu- Robert–Jones Robert–Jones
bandage with caudal bandage with plantar
latory on three limbs and become and lateral splint and lateral splint
very anxious if unable to bear weight
Dorsal splint Plantar splint
on a fractured limb; in many cases
their responses lead to additional in-
jury. First aid measures should there- Figure 1—Dividing the horse’s limbs into four functional areas provides a guide for
fore minimize further damage to the applying external support to stabilize fractures for transport. (From Bramlage LR:
fractured limb and maintain it in a First aid and transportation of fracture patients, in Nixon AJ [ed]: Equine Fracture
condition that allows repair (see Repair. Philadelphia, WB Saunders Co, 1996, p 38. Modified with permission.)
Goals of First Aid Fracture Manage-
ment). Although most of these ob-
jectives can be achieved by properly Equine Fracture First Aid Kit Contents
stabilizing or splinting the fracture, Material Purpose
fractures of the equine upper fore- Gauze (sterile and nonsterile) Apply over wound (if present) for
limb and hindlimb are nearly impos- protection
sible to stabilize with external splints. Rolled and/or sheet cotton Padding under splint–cast or
The bones in these locations are, Robert–Jones bandage
Razor or portable clippers Hair removal around wound
however, surrounded by large muscle
Antibiotic ointment Topical dressing for open wounds
groups that inherently stabilize frac- Elastic support wrap Place over cotton to compress and
ture ends, making external coapta- tighten Robert–Jones bandage or
tion less important. bandage under a splint–cast
In horses, immobilization is more White tape To secure splints or boards to bandage
important in preserving limb vascu- Polyvinyl chloride splints Splint–cast application
larity than in preventing hemorrhage (varying lengths)
at the fracture site. Severe hemor- Fiberglass cast material Splint–cast application
rhage rarely accompanies fractures in Board splints (varying lengths) or Splinting of radial and tibial fractures
horses, but vascular thrombosis re- aluminum rod
sulting from continued stretching Drugs (antibiotics, sedatives, Sedation, pain relief, treatment of
nonsteroidal antiinflammatory open fractures
and direct trauma often leads to di-
drugs)
minished vascularity of the distal
limb. Limb immobilization also Optional Contents
tends to reduce the animal’s anxiety, “Leg-saver” Kimzey splint Immobilization of distal limb fractures
enabling the horse to regain control Farley compression boot Immobilization of distal limb fractures
of the limb even though the limb
cannot bear weight. Once the limb is
stabilized, most horses will rest it in- Loss of intact skin coverage over a and femur) aspects of a horse’s limb
stead of continually trying to place it fracture is thought to predispose to rarely become open, suggesting that
in a normal stance, which may cause infection, especially if internal fixation proper immobilization of fractures in-
further soft tissue and bone damage. is performed. Equine skin is thin and volving the metacarpus/metatarsus,
One of the most important purpos- readily penetrated by sharp bone frag- radius, and tibia is the most critical
es of immobilization is to prevent the ments. Fractures of the distal (pha- factor in preventing the development
development of an open fracture. langes) and upper (humerus, ulna, of an open fracture during transport.
Compendium January 1999 20TH ANNIVERSARY Equine

Bibliography
Goals of First Aid Fracture Management Bramlage LR: Current concepts of emergency first aid treatment and
transportation of equine fracture patients. Compend Contin Educ Pract
■ Prevent damage to neural and vascular elements of Vet 5(10):S564–S574, 1983.
the limb. Bramlage LR: First aid and transportation of fracture patients, in Nixon
■ Prevent skin penetration by the fracture fragments. AJ (ed): Equine Fracture Repair. Philadelphia, WB Saunders Co, 1996,
■ Minimize further contamination of an existing pp 36–42.
wound. Brodell JD, Axon DL, Evarts CM: The Robert Jones bandage. J Bone
■ Relieve the animal’s anxiety by stabilizing the Joint Surg 68:776–779, 1986.
fractured limb. Herthel DJ: A systematic approach to long bone fracture management. J
■ Minimize further damage to the fractured bone Equine Vet Sci 13:258–260, 1993.
Turner AS: Long bone fractures in horses. Part I. Initial management.
ends and surrounding soft tissue.
Compend Contin Educ Pract Vet 3(9):S347–S354, 1981.

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