Equis ISSN 2398-2977

Musculoskeletal: fracture - first aid

Contributor(s): Steve Adair, Chris Whitton, Jarred Williams

Introduction

Aims

  • Reduce anxiety in horse:
  • Obtain preliminary diagnosis.
  • Prevent further injury to soft tissues, eg neural and vascular structures, associated with fracture site.
  • Prevent laceration of skin associated with closed fracture → open fracture.
  • Prevent secondary traumatic injury to other three weightbearing limbs.

Immediate first aid

  • Assess systemic health of patient through triage examination/physical examination. Horses may be in shock, had varying levels of hemorrhage, altered mentation, or other conditions necessary to identify before chemical restraint, if needed.
  • Apply physical restraint, eg twitch Restraint methods and attempt a brief assessment of the injury before considering systemic medication.

Inappropriate analgesia or sedation could result in further injury due to horse's loss of awareness of the injury; sedation may also prevent safe transport.

Medication

Acepromazine should be used with careful consideration as it can lead to hypotension.

  • Intravenous fluid therapy Fluid therapy: overview: if animal is in shock, sweating profusely or threat of compromised circulation.
  • Anti-inflammatories Therapeutics: anti-inflammatory drugs/analgesics, eg phenylbutazone Phenylbutazone, flunixin meglumine Flunixin meglumine, ketoprofen or vedaprofen (UK) Ketoprofen.
  • In the case of open fractures, initiation of systemic antibiotics may be warranted. Protocols of choice should include broad-spectrum antibiotics with good bioavailability, eg penicillin Penicillin G and gentamicin Gentamicin (aminoglycoside) or enrofloxacin (if azotemic or concerns of hydration status and renal perfusion).

Assessment of injury

  • Conduct a thorough general physical assessment Musculoskeletal: physical examination - adult.
  • Observe the horse's stance, gait Musculoskeletal: gait evaluation (where appropriate), ability to weight bear on each limb.
  • Check history: any previous injuries?
  • Although some injuries can be diagnosed immediately, check for other concurrent injuries.
  • If necessary, wash limb to ensure complete evaluation. Oftentimes, clipping the hair over small wounds or abrasions is helpful to identify the extent of superficial trauma.
  • Some injuries are not amenable to treatment and in general warrant immediate euthanasia Euthanasia:
    • Comminuted fractures + severe soft tissue damage.
    • Femoral fractures: complete.
    • Humeral fractures: complete in horses >300 kg.
    • Tibial fractures: complete.

If there is uncertainty about the severity of the injury DO NOT euthanize until a full assessment has been made.

Splinting

  • Splinting is important to prevent further damage to neural/vascular elements, bone ends, soft tissues, and to prevent a closed fracture becoming an open fracture.
  • Must be easy to apply with minimal assistance from lay bystanders.
  • Splinting also stabilizes the limb which relieves stress/anxiety, permitting the horse to ambulate.
  • General anesthesia not recommended in the field on stressed horse.
  • Must neutralize damaging forces, eg contracture of muscles no longer on a skeletal frame, at the fracture site.
  • Choice of splint will depend on biomechanical forces at work at the site of injury and the location of the injury.
  • Combinations of light bandaging, splints, Robert Jones bandage Musculoskeletal: Robert Jones bandage and casts Musculoskeletal: external fixation - casts may be used.

Transport

  • Forelimb fractures have facing backwards - should be as confined as possible to allow support on all sides.
  • For hindlimb fractures have facing forwards.
  • An injured horse can travel in either its accustomed vehicle or by ambulance Transport.
  • Ideally a low-loading vehicle should be used or one with a ramp.

Print off the Owner Factsheets on Bandaging - the dos and don'tsEmergencies - when to call the vet and Fractures to give to your clients.

Splinting fractures of the forelimb

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Splinting fractures of the hindlimb

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Specific fractures

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Lutter J D, Cary J A, Stephens R R & Potts L B (2015) Relative stiffness of 3 bandage/splint constructs for stabilization of equine midmetacarpal fractures. Vet Emerg Crit Care 25 (3), 379-87 PubMed.
  • Mudge M C & Bramlage L R (2007) Field fracture management. Vet Clin North Am Equine Pract 1, 117-33 PubMed.

Other sources of information

  • Furst A E (2012) Emergency Treatment and Transportation of Equine Fracture Patients. In: Equine Surgery. Eds: Auer J A & Stick J A. Elsevier Saunders, USA. pp 1015-1025.
  • Bramlage L (2004) Development of Fracture Management in the Horse. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 27-28.
  • Smith R K W (2004) Handling and Moving the Suspected Equine Fracture Patient. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 77-78.
  • Walmsley J P (2004) First Aid and Transportation of Equine Fracture Patients. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 213.


ADDED