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Equine musculoskeletal trauma: assessment and stabilization (Proceedings)

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Nov 01, 2009

Types of musculoskeletal trauma

• Wounds and lacerations
• Skin
• Deep structures (tendon, ligament, joint, bone)
• Vascular injury
• Nerve injury
• Fracture

Patient assessment

• Horses may be frantic and distressed following trauma
• Use appropriate restraint to keep you and your patient safe during assessment
• Use sedation
     o Most equine sedatives also provide analgesia as well as provide chemical restraint
     o Will decrease horse's anxiety for thorough assessment
• Anatomy
     o Knowledge of anatomy is critical to appropriate assessment
     o Appropriate identification of affected structures
     o Determines necessity of immediate treatment
     o Will dictate method of stabilization for transport
     o Anatomic relationships very important
          • Integument
          • Muscle
          • Vascular and nerve
          • Tendon/ligament
          • Synovial structures: joints, tendon sheaths, bursa
          • Bone
     o Location, Location, Location
          • Small wounds in the wrong location can be life-threatening
          • Based on location some fractures cannot be repaired

Integument

• Lacerations and wounds
     o When involving only the skin, subcutaneous tissue and fascia they usually will heal well
     o Some may require extensive wound care management long term
• Burns
     o As in human burn patients these require extensive management locally and systemically

Muscle

• Muscle damage is confined to the areas above the carpus and tarsus
• Not necessarily life or performance threatening unless extensive
• Myositis can be a bigger concern than direct trauma
     o Clostridial Myositis

Vascular injury

• Laceration of large vessels can result in exsanguination
• Damage to major blood supply to the limb can result in loss of the limb – either by transection or blunt trauma

Nerve injury

• Loss of sensation
     o Can return over time
• Loss of function
     o Can lose function of a limb which is life-threatening
• Examples: suprascapular, radial, or femoral nerve paralysis