LA Orthopedic Emergencies

Limb Fractures

Limb fractures: a cause of non-weight bearing lameness. Limb fractures are considered an emergency and should be evaluated as soon as possible.

Some things that the owner can do while you are on your way include:

  • Keeping the horse calm (offering hay, treats, a buddy, etc.)
  • Try to reduce movement of the horse
  • Hook up the trailer to prepare for a potential referral
  • Try to apply compression if there is hemorrhage

Supplies that you will potentially need in your truck:

  • Sedatives, analgesics, and tranquilizers
  • Bandage and splinting supplies → we will get into that later
  • NSAIDs
  • Laceration repair supplies
  • X-ray machine
  • IV catheter supplies
  • Euthanasia solution

When you arrive at the farm

If the horse is in stable condition and calm, complete a full physical exam (heart rate, respiratory rate, temperature, mucous membranes) to ensure that the horse is systemically well. Be mindful for signs of shock or colic.

If the horse is down / thrashing, sedate then reassess the situation. Additionally, you will likely need to sedate before starting manipulation or assessment of the traumatized limb. The sedation will also assist with analgesia, depending on the drugs used.

**The goal of sedation is that you should be able to complete an exam, manipulation, and stabilization of the affected limb without causing ataxia and increased risk of further injury. Physical restraint, such as a twitch or stocks, can also be useful, depending on the case.

Continued assessment

Determine where the fracture is likely located and if there is any instability or laxity within the limb.  If there is a wound over the fracture location, it is considered an open fracture until proven otherwise, and should be treated as such.

Fracture stabilization

Stabilization as quickly as possible is very important so the horse does not cause further injury to itself. Stabilization can help protect neuromuscular structures, prevent a closed fracture from becoming open, protect an open fracture from continued contamination, prevent further luxation, and prevent additional damage to the bones, cartilage, and surrounding tissues that will be needed for healing.

The goal of splinting is to prevent movement of the fracture in the medial-lateral direction and in the dorso-palmar or dorso-plantar direction. Splints should be placed perpendicularly. Additionally, the proximal limb will act like a pile driver and distract lower limb fractures. This is minimized by supporting the limb with the dorsal cortices aligned.

Splints: get creative! Broom or pitchfork handles, PVC pipes, metal pipes, pieces of wood, etc. are all reasonable options as long as they are safe and sturdy. There are also manufactured splints, such as the Kimzey splint, that is easy to use.

Robert-Jones Bandage

  • Many layers of cotton with brown gauze over each layer → leg should be at least 3 times the original diameter when you are done
  • Each layer is tighter than the previous one
  • Vet wrap as the final layer
  • +/- splint (can attach with duct tape)

You can apply a cast, but that is more tedious, the horse must be completely still, and it will likely be removed immediately by the referral center. However, cast material is easy to carry in the truck and a bandage cast may be easier than splinting.

For fracture stabilization, the location of the fracture matters.

  • Fracture anywhere distal to the fetlock, including the fetlock and distal metacarpus (forelimb)
    • Bandage and splint must extend from the ground to the carpus
    • You want the bony column in the leg to be in alignment with the toe pointed
    • Apply the splint dorsally
      • Or apply a Kimzey splint in the same fashion (with the toe pointed)
    • **If you suspect lateral/medial instability, you can apply splints on the lateral and/or medial aspects of the bandage as well
  • Fracture from distal metacarpus to proximal carpus
    • Don’t point the toe in this case, just let them stand normally
    • Robert-Jones bandage with lateral and palmar splints extending from the ground, past the elbow

 

  • Fracture of the radius
    • Robert-Jones bandage from the ground to the elbow with a palmar splint to the elbow and a lateral splint to the withers
  • Fracture of olecranon or humorous (dropped elbow with a flexed carpus → looks like radial nerve paralysis)
    • A light bandage from the ground, up to as high as possible past the elbow, with a palmar/caudal splint
      • This gives the limb stability so the horse can balance better
      • Lock the carpus in extension
  • Fracture anywhere distal to the fetlock, including the fetlock and distal metatarsus (hindlimb)
    • Bandage and splint must extend from the ground to the tarsus
    • You want the bony column in the leg to be in alignment with the toe pointed
    • Apply the splint on plantar aspect
      • Or apply a Kimzey splint in the same fashion (with the toe pointed)
  • Fracture of the metatarsus
    • Allow the horse to stand normally and do not point the toe
    • Robert-Jones bandage with lateral splint extending past the tarsus and plantar splint to the calcaneus

 

  • Fracture of tarsus or tibia
    • Rare fractures and hard to stabilize
    • Robert-Jones bandage from the ground to the stifle with a lateral splint extended at least to the hip
  • Fracture proximal to the stifle
    • Cannot be stabilized
    • The good news is there is a lot of musculature in that region to stabilize itself

Once the fracture is stabilized, radiographs can be taken and/or the horse can get trailered to a referral hospital. If the horse has a fractured forelimb, face them backwards in the trailer. If the horse has a fractured hindlimb, face them forwards in the trailer. Allow the horse to have the use of its head to balance in the trailer, but do not allow them to turn around.

Resources

Orsini, J. A., & Divers, T. J. (2014). Equine Emergencies: Treatment and Procedures. St. Louis, MO: Elsevier/Saunders.

Smith, J. J. (2006). Emergency Fracture Stabilization. Clinical Techniques in Equine Practice, 5(2), 154–160. doi: 10.1053/j.ctep.2006.03.009

Palmer S.E. (2012). How to Stabilize Equine Fractures in the Field. AAEP Proceedings

License

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Large Animal Surgery - Supplemental Notes by Erin Malone, DVM, PhD; Elaine Norton, DVM PhD; Erica Dobbs, DVM; and Ashley Ezzo, DVM is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, except where otherwise noted.