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EQUINE VETERINARY EDUCATION / AE / SEPTEMBER 2017
Review Article
Racecourse fracture management. Part 3: Emergency care of specific fractures
I. M. Wright Newmarket Equine Hospital, Suffolk, UK. Corresponding author email:
referrals@neh.uk.com
Keywords: horse; fracture; racecourse; assessment; immobilisation
Summary In consideration of first aid of appendicular fractures in the horse, the literature is inconsistent and in some cases wrong or misleading. This in large part is due to misunderstanding of fracture mechanics and this paper aims to give a contemporary review of the subject. It is particularly relevant for fractures that occur on the racecourse or in horses in training which, due to their aetiopathogenesis, have substantial site and configuration commonality. However, the techniques discussed are frequently also applicable to non- racing injuries. Clinical features are important in assessing horses on the racecourse when imaging techniques are limited. This paper highlights these in order to guide decision making.
Forelimb fractures
Fractures of the distal phalanx Fractures of the distal phalanx are an uncommon racing or training injury in the UK but may present in the hours that follow with lameness of increasing severity. They appear to be more common in the USA (Rabuffo and Ross 2002). Clinical signs (increased arterial pulse amplitude etc.) commonly raise the foot as a focus of suspicion. Distension of the distal interphalangeal joint usually accompanies articular fractures. The hoof capsule prevents marked displacement and there is little to be achieved by application of additional temporary support. Frequently, these do not have the common impact type configurations of other distal phalangeal fractures. Most configurations are thought to be reduced by limb loading; this is not readily achieved but is enhanced by provision of adequate analgesia.
Fractures of the navicular bone Although the incidence of fractures appears low, in the author’s experience fractures of the hindlimb navicular bones in horses in training and racing appear to exceed their forelimb counterparts. Lameness usually is acute in onset and severe in intensity. Localising signs commonly and rapidly are referable to the foot. Palpable distension of the distal interphalangeal joint, sometimes accompanied by ill-defined soft tissue swelling in the angle between the palmar/plantar surface of the middle phalanx and collateral cartilage may be detected. Additionally, swelling may develop over the deep digital flexor tendon as it emerges between the heel bulbs with resentment of digital pressure on the tendon. Transverse/horizontal fractures can result in markedly reduced palmar/plantar support to the distal interphalangeal joint and consequential subluxation. Such fractures usually will displace
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markedly. With fractures of the sloping margins (wings), localising signs may be sided. In the acute phase, most horses make toe only foot
ground contact and should be supported in this position for transport and further evaluation. However, if the animal loads the limb with flat foot ground contact then it should be supported in this position as such horses may resent enforced
distal joint flexion and will be encumbered in movement by fixing the limb in this position.
Fractures of the middle phalanx Fractures of the middle phalanx occasionally occur in horses in training and racing but have been considered as rare racetrack injuries (Hill 2003a). Parasagittal, distal condylar, comminuted and fractures of the palmar/plantar processes have been recognised. The latter appear commonest and may be uniaxial or biaxial. Both usually displace and biaxial fractures generally are accompanied by palmar/plantar subluxation of the proximal interphalangeal joint. Emergency support of such is critical to avoid trauma to the palmar/ plantar digital neurovascular bundles and catastrophic sequelae.
Affected animals are commonly non- or minimally
weightbearing and instability in the region of the proximal interphalangeal joint may be clinically apparent. Soft tissue swelling generally is rapid in appearance. Limbs with, or suspected to be with, fractures of the palmar/plantar processes of the middle phalanx should receive acute temporary immobilisation of the metacarpophalangeal/ metatarsophalangeal and interphalangeal joints in a flexed position. A palmar/plantar board splint is ideal but good reduction also can be obtained with a Leg Saver
Splint1.In the absence of these and/or in situations of reduced diagnostic confidence a dorsal splint would also be appropriate. It is likely that parasagittal and comminuted fractures of
the middle phalanx are best immobilised with techniques similar to those used for the proximal phalanx.
Fractures of the proximal phalanx Sagittal and parasagittal fractures of the proximal phalanx historically were the most common racing and training longbone fracture in Europe. However, in the last 10 years, their incidence has been superseded by fractures of the metacarpal condyles (Jacklin and Wright 2012). Horses with complete and comminuted fractures usually
are unable to continue to gallop. Jockeys riding horses that suffer comminuted fractures of the proximal phalanx are aware immediately of a severe injury. Some are audible as a
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