514


EQUINE VETERINARY EDUCATION / AE / SEPTEMBER 2017


wing, commonly lacerate iliacofemoral arteries and may lacerate the parent internal iliac artery or, less commonly, the external iliac artery (Fig 19). This frequently is catastrophic resulting in distressing haemorrhagic shock and exsanguination. Swelling may first be visible in the pubic or perineal areas as haemorrhage dissects through fascial planes before the whole hindquarter increases in size. Pain commonly is only minimally or temporarily controlled. At this stage, in the author’s experience, survival is rare and euthanasia on humane grounds is justified. Afflicted horses can become uncontrollable so intervention should not be delayed unduly. Supportive or palliative care is futile. In one series, 6 of 11 racetrack pelvic fractures died from exsanguination within 1 h of injury (Hill 2003b). Of equal concern is the fact that fracture of the ilial wing and shaft may not displace immediately but can do so in a ‘creeping’ manner over following days or weeks with equally catastrophic scenarios. Fractures of the pubis and ischium are less common


racing and training injuries. Displaced fractures are rare and so vascular trauma and clinical presentation consequently less dramatic. Crepitus may be appreciated, particularly with fractures involving the acetabulum. If not evident on external palpation or manipulation, it is unlikely to be detected on rectal examination (Rutkowski and Richardson 1989). On the racetrack, all animals with a potential differential


diagnosis of pelvic fracture must be managed with caution; in the peracute phase, confident differentiation of fracture location frequently is not possible. Additionally, a number are complex fractures, some of which may not displace until hours, days or even weeks later (Pilsworth 2003). Horses should be moved carefully on low-loading trailers or boxes to the racecourse clinical facility. Unloading should also be performed cautiously with appropriate sedation and analgesia to maintain control throughout. Animals should be supervised at all times and prevented from lying down. Ultrasonography can offer quick, on site, confident


confirmation of a number of displaced fractures, particularly of the ilial wing. However, in the acute phase, nondisplaced fractures may not be evident, additionally, confusing acoustic shadows can be created by intramuscular vessels (Shepherd and Pilsworth 1994). Images of the ilial shaft should be interpreted with caution but any evidence of osseous discontinuity is of concern. On course ultrasonographic location of fractures usually is the most objective guide to acute case management available. The principal question to be answered is the relative safety of moving or transporting the horse. For emergency evaluation, it is not necessary to clip the horse; adequate contact will be obtained from liberal application of alcohol (Shepherd and Pilsworth 1994). In the absence of osseous discontinuity, hypo- to anechoic zones in the muscle pattern consistent with haemorrhage adjacent to the bone must also be viewed as suspicious (Pilsworth 2003). Sometimes independent movement of the fracture can be seen on limb manipulation during real time ultrasonography (Shepherd and Pilsworth 1994; Pilsworth 2003). In some cases of ilial wing fracture, callus indicative of prodromal pathology may be present before complete fracture and can be identified ultrasonographically (Shepherd and Pilsworth 1994). The decision to move horses with fractures or potential


fractures of the pelvic girdle from the racecourse is one of the most difficult decisions that face the racetrack veterinarian.


© 2016 EVJ Ltd


Often, there is considerable pressure for horses to be moved and, in Europe at least, many racecourses do not have facilities or staffing arrangements suitable for protracted periods of on site stabling. In these situations, the veterinarian has to act as an advocate for the horse’s welfare. Horses with complete fractures of the ilial shaft cannot safely be transported. However, in the acute phase, confident diagnosis of such frequently cannot be made. Complete fractures of the ilial wing are less likely to be life threatening. All horses with suspected fractures of the pelvic girdle should be prevented from lying down by use of cross ties or overhead wires and, at least for the first few days, should be maintained under constant supervision. In addition to clinical monitoring, supportive care and nursing will be necessary in order to minimise the risks of pleuropneumonia, overload laminitis etc. Horses should stand on deep conforming bedding. Dry shavings laid over a 7–10 cm layer of damp shavings or sand is preferred. Water must be present at head height but feed should be offered at ground level with the horse released from its restraining ties and held at not greater than 4 h intervals to promote mucociliary drainage of the respiratory tract.


Author’s declaration of interests No conflicts of interest have been declared.


Ethical animal research Ethical review not applicable for this review article.


Source of funding None.


Acknowledgement The author gratefully acknowledges the skilled artwork of John Fuller.


Manufacturers' addresses


1Kimzey Metal Products, Woodland, California, USA. 2BSN Medical Ltd., Hull, Yorkshire, UK. 3Bandages Ltd., Canterbury, Kent, UK.


References


Adams, S.B. (1996) Fractures of the scapula. In: Equine Fracture Repair, Ed: A.J. Nixon, W.B. Saunders, Philadelphia. pp 254-258.


Beinlich, C.P. and Bramlage, L.R. (2002) Results of fixation of third metacarpal and metatarsal diaphyseal fractures. Proc. Am. Ass. Equine Practnrs. 48, 247-248.


Bischofberger, A.S., Furst, A., Auer, J. and Lischer, C. (2009) Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: clinical outcome in 10 mature horses and 11 foals. Equine Vet. J. 41, 465-473.


Bramlage, L.R. (1983) Current concepts of emergency first aid treatment and transportation of equine fracture patients. Compend. Cont. Educ. Prac. Vet. 5, 564-573.


Bramlage, L.R. (1996) First aid and transportation of fracture patients. In: Equine Fracture Repair, Ed: A.J. Nixon, W.B. Saunders, Philadelphia. pp 36-42.


Dyson, S.J. (2011) The elbow, brachium and shoulder. In: Diagnosis and Management of Lameness in the Horse, 2nd edn., Eds: M.W. Ross and S.J. Dyson, Elsevier/Saunders, St Louis. pp 456-474.


Estberg, L., Stover, S.M., Gardner, I.A., Johnson, B.J., Jack, R.A., Case, J.T., Ardans, A., Read, D.H., Anderson, M.L., Barr, B.C., Daft, B.M., Kinde, H., Moore, J., Stoltz, J. and Woods, L. (1998) Relationship between race start characteristics and risk of catastrophic


Continued on page 520


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88