Introduction

Aims

• Reduce anxiety in horse:
  • Physical restraint.
  • Pain relief Anesthesia: analgesia - overview.
  • Sedation Anesthesia: standing chemical restraint.
  • Stabilize injured limb - splint bandage, cast.
• 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

• If skin penetration - apply water soluble antibiotic ointment and sterile dressing before splinting.
• Drugs of choice, detomidine Detomidine hydrochloride or xylazine Xylazine or romifidine (UK) Romifidine +/- butorphanol Butorphanol.
• Sedation Anesthesia: standing chemical restraint - should not be excessive as induced ataxia may → further damage.

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 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'ts, Emergencies - when to call the vet and Fractures to give to your clients.

Splinting fractures of the forelimb

Splinting fractures of the hindlimb

Specific fractures

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.