EQUINE VETERINARY EDUCATION / AE / SEPTEMBER 2017


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Carpal alignment can be maintained and/or supported


by splinted Robert Jones bandages. Wooden struts as previously described (Part 2: Wright 2017) are most frequently employed and for maximal benefit should be applied over a modified Robert Jones bandage that doubles the diameter of the limb. If wooden struts are employed then a minimum of two splints placed at 90° to each other are necessary. A lateral splint extending from the level of the elbow to the ground is necessary in all cases. This may be supplemented by a cranial splint from the level of the elbow to the distal metacarpus (Fig 11) and/or a caudal splint from the level of the elbow to the ground. In the author’s hands, horses ambulate better with the former. An alternative is application of half or third diameter PVC piping caudally from the level of the elbow to the ground with layered cotton wool (Robert Jones-like) applied to the limb with sufficient quantity and distribution to create a parallel-sided tube, which fits with minimal movement into the curved pipe splint. All splinting materials must align well with the long axis of the limb and be secured tightly with overlying tape, which may be nonelastic or elasticated and pulled to its limit.


Fractures of the carpus which do not jeopardise axial stability Fractures of the carpus are common training and racing injuries but the vast majority do not compromise axial stability of the limb. Temporary immobilisation does not generally contribute to tissue preservation, influence prognosis or provide significant analgesia. Indeed, in most circumstances, confining bandages, splints etc. are an encumbrance to the horse. Thus noncollapsing slab fractures or chip fractures of dorsodistal radius or cuboidal bones generally obtain no


benefit from attempts at splinting. Sometimes, when haemorrhage and thus joint distension are marked, application of counter pressure in the form of an elasticated bandage appears to reduce discomfort. Suitable, tailored, zip up bandages (Pressage3) are available. Fractures of the accessory carpal bone do not jeopardise


axial stability of the limb. Complete fractures in a frontal plane are seen as training and racing injuries both in flat racing and, following falls, in jump racing. Such fractures commonly comminute and usually are markedly unstable with displacement occurring with flexion of the carpus. Whatever management route is taken minimising secondary


damage, including trauma to the carpal sheath of the digital flexor tendons and its contents is likely to be contributory to case outcome. The carpus may be fixed in extension by use of a tube/sleeve cast as described above or alternatively application of a cranial/dorsal wooden splint over a modified Robert Jones bandage from proximal antebrachium to distal metacarpus will suffice (Fig 12). On course immobilisation is not generally considered necessary, but fixing the carpus in


a) c)


a)


b) d)


b)


Fig 12: Complete frontal plane fracture of an accessory carpal bone; (a) lateromedial radiograph of the carpus extended; (b)


Fig 11: a) and b) Carpus immobilised with cranial and lateral splints incorporated into a modified Robert Jones bandage.


lateromedial radiograph of the carpus flexed; (c and d) carpus fixed in extension by a cranial/dorsal splint from proximal antebrachium to distal metacarpus incorporated in a modified Robert Jones bandage.


© 2016 EVJ Ltd


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