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EQUINE FRACTURES - EMERGENCY FIRST AID AND STABILIZATION TECHNIQUES
Overview
Lacerations (tears in the skin and underlying muscle), punctures and fractures comprise the vast majority of injuries in horses. A successful outcome for an injury often requires prompt recognition of the injury and appropriate treatment before a veterinarian arrives. To accomplish this, horse owners should be prepared for a variety of emergency situations.
Initial Management of Horses with Fractures
With many fractures, damage continues to occur after the original injury due to lack of stabilization of the broken bone(s). Moreover, horses will constantly attempt to bear weight on an unstable limb. Consequently, the most important action an owner can take is to immediately immobilize the fracture site and protect the injury from contamination. Attempt to keep the horse quiet and do not move it until the limb is adequately stabilized. If the horse is extremely distressed, it may be necessary to sedate it. If sedation is needed, use the lowest possible dose that provides the desired effect. Too much sedation could compromise coordination and reduce pain sensation, resulting in greater damage as the horse moves around. Pain relief may be provided with nonsteroidal anti-inflammatory drugs, but if the veterinarian is already on the way, it is better to wait.
If there is an open wound associated with the fracture injury, the wound should be quickly cleaned with water and bandaged to protect it from further contamination. Do not use disinfectants since some can cause tissue damage and slow healing. Do not apply ointments or other medications before a veterinarian can assess the injury, because they can impair evaluation and treatment.
If bleeding is excessive, control it by direct pressure over the wound. Pressure bandages for controlling bleeding should be applied before splinting is attempted.
Stabilizing Fractures
Fractures that do not have a wound or opening can become open and contaminated if the horse flails about or moves excessively. Thus, stabilization using an appropriate splinting technique for the fracture location should be attempted as soon as possible. Inappropriate first aid or stabilization measures can have devastating results, however, exacerbating skin, muscular and neurovascular trauma and destroying all potential for fracture healing.
Preparation is the key to being successful in any emergency situation. Having the necessary emergency supplies organized and easily obtainable will greatly increase the success of treatment for all orthopedic emergencies. Typical supplies needed for orthopedic injuries include bandage material, clean wound dressings, and splints made from common building materials such as boards, PVC pipe, electrical conduit and duct tape.
Splinting Chart
Transportation
If a veterinarian cannot come to your horse, transportation of the animal will be necessary before medical treatment can be administered. Transportation is extremely stressful for horses with an unstable limb; even with an appropriate splinting device, they still must balance most of their weight on three legs. Anything that can be done to improve transportation of the fracture patient will increase the chances for a successful outcome.
If available, horses should be transported in a specialized trailer containing a sling (Figure 1). The sling will allow the patient to rest intermittently and will prevent the horse from falling down.
Figure 1. This sling can be attached to the ceiling of the horse trailer or stall to support the horse during transportation or treatment. It has also been used for rescuing horses.
Another good choice is a large slant-loading trailer with a low step, moveable partitions, and a ramp. Horses require a lot of room to load and unload but need a firm wall to lean on during transportation. Having a step trailer that is low to the ground or a trailer with a ramp will greatly facilitate loading and unloading the fracture patient. Horses with either forelimb or hindlimb fractures should be loaded forward. However, when unloading, horses with forelimb fractures should be unloaded backward, and horses with hindlimb fractures should be unloaded forward. With all of the position changes required for loading, transportation and unloading, it is easy to see that a large trailer with movable partitions is necessary.
Once loaded, horses with forelimb fractures should be positioned facing backward in the trailer. It is much easier for them to support their weight if there is a sudden stop. Similarly, horses with hindlimb fractures should be transported facing forward.
Decision-Making Before Definitive Treatment
Once the fracture patient has been temporarily stabilized, the next step is to consider the options for treatment and to determine whether the horse is a candidate. The main factors that should be considered are:
o Patient condition and temperament
o Location of fracture
o Patient size
o Open fracture grade
o Severity of the fracture
o Cost of treatment
In general, a small horse (500-700 lb) that has an excellent temperament and is in good condition with a closed, simple fracture of the distal (lower) limb has the best overall chance for survival. Large horses with highly fragmented open fractures of the proximal (upper) limb have poor prognoses for survival. Horses that have lost blood supply to the limb should be humanely destroyed.
Although there are many variables to consider for each patient, one of the main factors is cost. The cost for treatment can sometimes exceed $20,000 in more complicated cases, so it is important to request an estimate for surgery and to discuss with your ACVS Veterinary Surgeon the risks, potential complications, and success rate of the procedure before making your decision.
Long bone fracture repair in horses is extremely challenging and should only be attempted by an experienced veterinary surgeon in an appropriately equipped facility. ACVS Veterinary Surgeons have the advanced training and experience to help your horse. Find an ACVS Surgeon
Conclusion
Each step of treatment, beginning immediately after injury (first aid and stabilization), is critical for improving the chances for a successful outcome. Without appropriate first aid and emergency splinting, the overall prognosis for survival can be poor. However, if emergency first aid is performed properly, the chance for a successful outcome can be increased, sometimes significantly so.
If your horse sustains a limb fracture:
o Keep the horse quiet and do not move it from the location it is in until the limb is adequately stabilized with an appropriate temporary splint.
o Provide pain relief with nonsteroidal anti-inflammatory drugs only.
o If there is an open wound, clean it with water only and bandage it to protect it from further contamination.
o Control blood loss by applying direct pressure over the wound with bandages. Pressure bandages should be applied before splinting is attempted.
o For all fractures, stabilize as soon as possible using an appropriate splint based on the location of the fracture.
o Ask your veterinarian for a referral to an ACVS Veterinary Surgeon
—Larry D. Galuppo, DVM
Diplomate ACVS
Posted 8/21/2006
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