Оглавление
Группа авторов. Fractures in the Horse
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
Fractures in the Horse
Preface
List of Contributors
1 Introduction
Historical Review
The Ancient World
Middle Ages/Mediaeval Period
The Renaissance/Reformation
The Enlightenment and Industrial Revolution
The Twentieth and Twenty‐first Centuries
The Future
References
2 Bone Structure and Function
Introduction
Bone Architecture
Cellular Components
Bone Formation
Vascular Supply
Innervation
Microstructure
Ultrastructure
Organic Component
Inorganic Component
Mineralization
Function
Tissue (Material) Properties
Structural (Whole Bone) Properties
Adaptation
Stress Protection
Conclusions
References
3 Pathophysiology of Fractures
Material Features of Bone Failure
Loading Modes
Locally Acting Loading Modes
Globally Acting Loading Modes and Resulting Fracture Configurations
Tension
Compression
Torsion
Bending
Shear
Combined Loading
Relationships Between Location and Morphology
The Mechanical Behaviour of Bone
Structural Properties and the Load–Deformation Curve
Material Properties and the Stress–Strain Curve
The Role of Geometry
Viscoelasticity
Monotonic and Repetitive Stress Fractures
Classifications of Fractures
Fracture Topography
Completeness
Complexity
Displacement
Contamination
Articular Involvement
Other Factors
References
4 Fracture Epidemiology
State of Knowledge
Geographic, Discipline and Horse Level Incidence
Incidence of Fractures Sustained During Competition. Thoroughbred Racing
Thoroughbred Racing in North America
Thoroughbred Racing in the UK
Thoroughbred Racing in Other Countries
Quarter Horse Racing
Endurance Riding
Eventing
Incidence of Fractures Sustained During Training. Thoroughbred Training
Showjumping Training
Measures of Fracture Incidence in Other Horses
Risk Factors, Predisposing Factors and Evidence
Risk Factors Associated with Training Regimens
The Importance of Detailed Information About Horses Under Investigation
Predictability and Potential for Effective Screening
References
5 Imaging Fractures
Introduction
Image Quality
Image Interpretation
Negative Studies
Radiography. General Principles
Technical Considerations. Projections
Artefacts and Other Misleading Features
Limitations
Principles of Interpretation
Fracture Types. Monotonic Fractures
Stress Fractures
Articular Fractures
Fissure Fractures
Avulsion Fractures
Compression Fractures
Accompanying Features. Soft Tissue Swelling
Presence of Gas Lucency
Monitoring Fracture Healing
Ultrasonography. General Principles
Technical Considerations. Transducers
Artefacts and Other Misleading Features
Limitations
Principles of Interpretation
Entheses
Secondary Features
Monitoring Fracture Healing
Nuclear Scintigraphy. General Principles
Technical Considerations. Time of Evaluation
Patient Preparation
Image Acquisition
Image Quality
Descriptors
Quantitative Assessment
Qualitative Assessment
Clinical Indications
Limitations
Principles of Interpretation
Dorsal Cortex of the Third Metacarpal Bone
Enostosis‐like Lesions
Monitoring Fracture Healing
Computed Tomography. General Principles
Technical Considerations
Artefacts
Clinical Indications
Limitations
Principles of Interpretation
Magnetic Resonance Imaging. General Principles
Technical Considerations
Clinical Indications
Limitations
Principles of Interpretation
Monitoring Fracture Healing
Positron Emission Tomography
References
6 Bone Healing
Introduction and Principles
Phases of Bone Healing
Cellular and Humeral Influences on Bone Healing
Mechanical Influences on Bone Healing
Monitoring Bone Healing
Healing of Stress Fractures
Healing of Incomplete Fractures
Healing of Complete Non‐displaced Fractures
Healing of Displaced Fractures
Healing of Reduced and Repaired Fractures
Healing of Repaired But Non‐reduced and/or Unstable Fractures
Effects of Internal Fixation on Bone Healing
Effects of External Fixation on Bone Healing
Intrinsic Factors That Affect Healing
Exogenous Factors That Influence Fracture Healing. Pharmacologic Influences
Non‐steroidal Anti‐inflammatory Drugs
Bisphosphonates
Antimicrobials
Biological Techniques
Bone Grafts
Synthetic Bone Substitutes
Exogenous Devices
Conclusions
References
7 Triage and Emergency Care
Introduction
Racecourse Fractures
Insurance
Clinical Assessment
Clinical Features of Specific Fractures
Distal Phalanx
Navicular Bone
Middle Phalanx
Proximal Phalanx
Distal Condyles of the Third Metacarpal and Metatarsal Bones
Forelimb Proximal Sesamoid Bones
Transverse and Oblique Fractures of the Diaphysis of the Third Metacarpal and Metatarsal Bones
Cuboidal Bones of the Carpus
Carpal Subluxation and Collapsing Carpal Fractures
Radius
Ulna
Humerus
Scapula
Tarsus
Tarsal Luxation and Subluxation
Tibia
Stifle Joints
Femur
Pelvis
Sedation
Analgesia
Radiography
Ultrasonography
Wounds
Principles of Temporary Immobilization
Techniques for Temporary Immobilization. Robert Jones Bandages
Splinted Robert Jones Bandages
Bandage Cast
Casts
Compression Boots
Dorsal Splint
Flexion Splints
Palmar/Plantar Splint
Recommended Emergency Support
Distal Phalanx and Navicular Bone
Middle Phalanx
Proximal Phalanx
Distal Condyles of the Third Metacarpal/Metatarsal Bones
Proximal Sesamoid Bones
Diaphyseal Fractures of the Third Metacarpal/Metatarsal Bones
Fractures of the Carpus
Fractures of the Radial Diaphysis
Ulnar Fractures
Fractures of the Humerus and Scapula
Fractures of the Tarsus
Tibial Fractures
Fractures Involving the Stifle Joints, Femur and Pelvic Girdle
Transport
Ambulances
Nursing and Supportive Care
References
8 Surgical Equipment, Implants and Techniques for Fracture Repair
Principles
Anatomic Fracture Reduction
Stable Internal Fixation
Preservation of Blood Supply
Early, Active Mobilization
Pre‐operative Planning and Approach to Bone
Instruments and Implants
Equipment for Internal Fixation. Depuy Synthes Instruments
Power Drill
Large Fragment Set
Drill Bits
Double Drill Guide
Universal Drill Guide
Special Drill Guides for Plate Application
Drill Guides for Locking Head Screws
Countersink
Depth Gauge
T‐Handle
Tap
Screwdrivers
Torque‐Limiting Devices
Tension Device
Push–Pull Device
Plate Bending Press
Bone Clamps
Additional Instruments
Screw Types, Sizes and Techniques
Cortex Screws
Self‐tapping Cortex Screws
Screws Inserted in Lag Technique
Position Screws
Plate Screws
Cancellous Screws
Cannulated Screws
Locking Head Screws
Headless Screws
Screw Removal. Intact Screws
Stripped Hexagonal Screw Head
Broken Screws
Plates
Dynamic Compression Plates
Locking Compression Plates
Principles of Plate Fixation
Plate Functions and Applications. Neutralization Plates
Compression Plate
Buttress Plates
Application of a Dynamic Compression Plate
Application of a Locking Compression Plate
Human Femoral Locking Compression Plates
Veterinary T‐LCP
Human Distal Femoral Locking Compression Plates
Compact 2.4 UniLOCK System
Variable‐angle Locking Compression Plates
Limited Contact Dynamic Compression Plates
Dynamic Condylar Screw and Dynamic Hip Screw Implant Systems
One‐third Tubular Plates
Leg Lengthening Plates
Intramedullary Implants
Steinmann Pins
Stacked Pin Fixation
Rush Pins
Interlocking Intramedullary Nails
Wire and Cable. Orthopaedic (Cerclage) Wire
Cables
Reduction Devices
Fragment Distractor
Aiming Devices
Equine Aiming Device
References
Notes
9 Pre‐operative Planning and Preparation
Introduction
Detailed Plan of the Surgical Procedure. Assessment and Understanding of the Fracture Configuration and Plan for Fixation
Access to the Surgical Site
Positioning the Horse and Limbs
Anticipated Methods for Reduction
Fixation
Imaging
Wound Closure
Bandaging and External Coaptation
Laminitis Prophylaxis
Recovery from Anaesthesia
Instruments, Implants and Disposable Items
Personnel
Imaging Modalities
Radiography
Fluoroscopy
Computed Tomography
Arthroscopy
Endoscopy
Preparation of the Operating Room
Floor Plan
Preparation of the Patient
Peri‐operative Antimicrobials
Pain Management
Strategies for Complications
Equipment
Failure to Effect Reduction
Technical Errors During Implant Insertion
Anaesthetic Crisis
Complication During Recovery
Sign Out
Recovery
Open Fractures
Emergency Management
Use of Antimicrobials
Debridement and Lavage
Soft Tissue Closure
Fracture Stabilization
Prognosis
References
10 Anaesthesia and Analgesia
Abbreviations
Pre‐operative Evaluation and Consideration
Pre‐operative Analgesia
Induction of Anaesthesia
Maintenance of Anaesthesia and Intra‐operative Analgesia
Peripheral Nerve Blocks
Monitoring and Cardiovascular Support
Recovery from Anaesthesia
Head and Tail Rope Techniques
Deflating Air Pillow
Large Animal Vertical Lift
Sling Recovery
Pool Recovery System
Tilt Table
Other Potential Complications
Anaesthesia of Foals
References
11 Intra‐operative Complications
Technical Errors
Fracture Reduction
Splitting Bone Fragments
Implant Location. Inadvertent Screw Contact
Screws in Joints
Screws in the Fracture Plane
Screw‐induced Malalignment
Growth Plates
Screw Length
Locking Implants
Screw Breakage and Damage
Instrument Breakage
Inability to Tighten or Stripping of Screws
Asepsis and Prevention of Surgical Site Infection
Preparation of the Surgical Field and Draping
Prevention of Airborne Contamination
Handling of Implants and Instruments
Intra‐operative Wound Irrigation
Operating Room
Intra‐operative Imaging
Glove Perforation
Communication
References
12 Standing Fracture Repair
Development and Philosophy
Indications and Contra‐indications
Case Selection
Facilities and Equipment
Pre‐operative Preparation, Sedation and Local Anaesthesia
Operative Technique
Post‐operative Care. Post‐operative Bandaging and Immobilization
Medical Management
General Nursing Care
Rest, Review and Return to Training
Summary
References
13 External Coaptation
Introduction
Casts
Materials and Construction
Application
Monitoring and Maintenance
Removal
Transfixation Casts
Equipment and Construction
Results
External Skeletal Fixation Devices
Distal Limb ESFD
Application
Results
Other External Fixation Devices
References
14 Post‐operative Complications
Construct Instability
Screw Loosening
Infection
Risk Factors
Implant Associated Biofilm
Prevention
Diagnosis
Clinical Evaluation
Cytological Analysis and Microbiological Culture
Laboratory Parameters
Diagnostic Imaging. Ultrasound
Radiography
Computed Tomography
Magnetic Resonance Imaging
Scintigraphy
Treatment
Drainage and Debridement
Implant Removal or Replacement
Antimicrobial Treatment
Intravenous Regional Limb Perfusion
Intra‐osseus Perfusion
Antimicrobial‐impregnated Implants and Local Delivery Systems
Supporting Limb Laminitis
Risk Factors
Pathophysiology
Clinical Signs
Radiography
Prevention and Treatment
Pain Management
Podiatry
Trimming
Load Re‐distribution
Reducing Effective Body Weight
Changes in Bedding
Medication
Cryotherapy
Limb Deformities
Post‐operative Colic
References
15 Convalescence and Rehabilitation
Introduction
Rehabilitation Goals. General Considerations
Inflammatory Phase
Reparative Phase
Remodelling Phase
Musculoskeletal Comorbidities
Pain Modulation. Cryotherapy
Heat Therapy
Transcutaneous Electrical Nerve Stimulation
Physiotherapeutic Modalities. Neuromuscular Electrical Stimulation
Pulsed Electromagnetic Field Therapy
Whole Body Vibration Therapy
Therapeutic Ultrasound
Laser Therapy
Physiotherapeutic Exercise
Proprioceptive Facilitation Techniques
Aquatic Therapy
Targeted Physical Therapy. Injury‐specific Exercises
Core‐specific Exercises
Outcome Measures
Goniometry
Pressure Algometry
Summary
References
Notes
16 Fractures of the Distal Phalanx
Anatomy
Fracture Types
Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Specific Management Techniques
Type 1 (Non‐articular Wing) Fractures
Type 2 (Articular Wing) Fractures
CT‐Guided Lag Screw Fixation
Post‐operative Care and Convalescence
Type 3 (Mid‐sagittal) Fractures
Screw Size
Screw Position
Screw Number
Lag Screw Fixation Technique
Type 4 (Extensor Process) Fractures
Fragment Removal
Repair
Type 5 (Complex and Transverse) Fractures
Type 6 (Solar Margin) Fractures
Type 7 Fractures
Results
References
17 Fractures of the Navicular Bone
Anatomy
Fracture Incidence and Aetiology. Parasagittal Fractures
Transverse Fractures
Frontal Plane Fractures
Fractures of the Sloping Border
Distal Border Fragments
Bipartite and Tripartite Bones
Parasagittal Fractures. Presentation and Diagnosis
Conservative Management
Surgical Repair
Pre‐operative Planning
Surgical Preparation
Computed Tomographic Imaging
Surgical Technique
Post‐operative Care
Outcome
Complications
Fragment Removal
Palmar/Plantar Digital Neurectomy
References
18 Fractures of the Middle Phalanx
Anatomy
Fracture Types
Osteochondral Chip Fractures of the Proximal Articular Surface. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Treatment Options and Recommendations
Techniques for Treatment
Results
Axial Fractures. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Techniques for Treatment
Results
Fractures of the Palmar/Plantar Eminences. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Techniques for Treatment
Proximal Interphalangeal Arthrodesis
Surgical Technique
Results
Comminuted Fractures. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Techniques for Treatment
Results
Fractures of the Distal Articular Surface
References
19 Fractures of the Proximal Phalanx
Anatomy
Fracture Types
Fragmentation of the Dorsoproximal Articular Margin
Short Incomplete Parasagittal Fractures
Long Incomplete Parasagittal Fractures
Complete Parasagittal Fractures
Comminuted Fractures
Dorsal (Frontal) Fractures
Fractures of the Palmar/Plantar Processes
Fragmentation of the Distal Articular Margin
Distal Articular Fractures
Salter–Harris Fractures
Incidence and Causation. Epidemiology
Aetiopathogenesis
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations. Short Incomplete Parasagittal Fractures
Long Incomplete Parasagittal Fractures
Surgical Repair – Dorsal Screw Configuration
Surgical Repair – Triangular Screw Configuration
Standing Fracture Repair
Complete Parasagittal Fractures
Moderately Comminuted Fractures
Minimally Invasive Repair
Open Reduction and Internal Fixation
Highly Comminuted Fractures
Long Frontal Plane Fractures
Short Dorsoproximal Dorsal (Frontal) Plane Fractures
Fractures of the Palmar/Plantar Processes
Distal Joint Fractures
Salter–Harris Fractures
Results
Short Incomplete Parasagittal Fractures
Long Incomplete Parasagittal Fractures
Complete Parasagittal Fractures
Comminuted Fractures
Long Frontal Plane Fractures
Short Dorsoproximal Dorsal (Frontal) Plane Fractures
Fractures of the Palmar/Plantar Processes
Salter–Harris Fractures
References
20 Fractures of the Proximal Sesamoid Bones
Anatomy
Aetiology
Incidence
Classification
Apical Fractures. Incidence and Location
Diagnosis
Treatment
Results
Abaxial Fractures
Diagnosis
Treatment
Results
Uniaxial Mid‐body Fractures. Incidence and Location
Diagnosis
Treatment
Lag Screw Fixation
Transfixation/Hemi‐circumferential Wire
Autologous Cancellous Bone Grafts
Post‐operative Care
Results
Basilar Fractures. Incidence and Location
Diagnosis
Repair
Results of Repair
Removal of Articular Fragments
Results with Removal
Non‐articular Basilar Fragments
Results
Sagittal/Axial Fractures
Fractures Caused by External Trauma
Destabilizing Fractures of the Proximal Sesamoid Bones
Diagnosis
First Aid
Treatment
Arthrodesis of the Metacarpo/Metatarsophalangeal Joint
Post‐operative Care
Complications
Results
References
21 Fractures of the Distal Condyles of the Third Metacarpal and Third Metatarsal Bones
Anatomy
Fracture Types
Incidence and Causation
Clinical Features and Presentation. Fractures of the Palmar/Plantar Subchondral Bone
Bicortical Incomplete Fractures
Complete Non‐displaced Fractures
Displaced Fractures of the Lateral Condyles
Propagating Fractures
Complex Fractures
Imaging and Diagnosis. Fractures of the Palmar/Plantar Subchondral Bone
Bicortical Incomplete Fractures
Complete Non‐displaced Fractures
Displaced Fractures of the Lateral Condyle
Propagating Fractures
Concurrent Lesions
Acute Fracture Management
Treatment Options and Recommendations
Fractures of the Palmar/Plantar Subchondral Bone
Incomplete Fractures
Complete Non‐displaced Fractures
Displaced Fractures
Propagating Fractures
Techniques for Treatment. Anaesthesia for Repair
Fractures of the Palmar/Plantar Subchondral Bone
Bicortical Incomplete Fractures. Pre‐operative Planning and Preparation
Surgical Technique
Variations in Technique
Post‐operative Care
Fracture Healing
Complications
Implant Removal
Complete Non‐displaced Fractures
Fracture Healing
Displaced Fractures of the Lateral Condyle
Surgical Technique
Post‐operative Care
Fracture Healing
Propagating Fractures
CT‐directed Minimally Invasive Repair
Percutaneous Repair
Open Lateral Approach
Plate Fixation
Standing Repair
Post‐operative Care
Complications
Implant Removal
Complex and Complicated Fractures
Results
Fractures of the Palmar/Plantar Subchondral Bone
Incomplete Fractures
Complete Non‐displaced Fractures
Displaced Fractures
Propagating Fractures
Concurrent Lesions and Complications
References
22 Diaphyseal Fractures of the Third Metacarpal and Third Metatarsal Bones
Anatomy and Biomechanical Considerations
Fracture Types
Incidence and Aetiology
Dorsal Cortical Stress Fractures
Diagnosis
Treatment
Incomplete Longitudinal Fractures
Diagnosis
Treatment
Avulsion Fractures Associated with the Origin of the Suspensory Ligament
Diagnosis
Treatment
Transverse Stress Fracture of the Distal Diaphysis
Diagnosis
Treatment
Complete Diaphyseal Fractures
Diagnosis
Treatment
References
23 Fractures of the Second and Fourth Metacarpal and Metatarsal Bones
Anatomy
Fracture Types
Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Treatment. Proximal Fractures
Medical Management
Surgical Debridement
Internal Fixation
Ostectomy of Mt4
Mid‐Diaphyseal Fractures. Medical Management
Surgical Management
Distal Fractures
References
24 Fractures of the Carpus
Anatomy
Osteochondral Chip Fractures (Fragments) of the Dorsal Articular Margins. Incidence and Location
Clinical Signs
Pathogenesis
Treatment
Surgery
Post‐operative Care
Results
Arthroscopic Surgery for the Repair of Carpal Chip Fractures
Avulsion Fragments Associated with the Palmar Intercarpal Ligaments
Osteochondral Fragments in the Palmar Compartments of the Carpal Joints
Incidence and Diagnosis
Treatment
Results
Carpal Slab Fractures
Incidence
Diagnosis
Treatment
Surgery. Frontal Plane Slab Fracture of the Radial Facet of the Third Carpal Bone
Frontal Plane Slab Fractures of the Intermediate Facet of the Third Carpal Bone
Frontal Plane Slab Fractures of Radial and Intermediate Facets of the Third Carpal Bone
Comminuted Collapsing Fractures
Sagittal Fractures of the Third Carpal Bone
Sagittal Slab Fractures of Other Carpal Bones
Frontal Plane Slab Fractures of Other Carpal Bones
Post‐operative Care and Results
Accessory Carpal Bone Fractures
Diagnosis
Treatment
References
25 Fractures of the Radius
Anatomy
Fracture Types and Causation
Clinical Features and Presentation
Imaging and Diagnostics
Acute Fracture Management
Treatment Options and Recommendations
Fissure Fractures
Repair of Simple Diaphyseal Fractures
Implant Selection
Surgical Techniques
Physeal Fractures
Proximal Radius
Distal Radius
Post‐operative Management
Results
References
26 Fractures of the Ulna
Anatomy
Incidence
Aetiology
Fracture Types and Classification
Clinical Signs
Radiography and Radiology
Emergency Care
Treatment Options and Recommendations
Conservative Treatment
Fracture Repair. Principles and Surgical Approach
Locking Compression Plate Repair
Fixation of the Ulna to the Radius in Foals
Repair of Apophyseal Avulsion (Type 1a) Fractures
Repair of Salter–Harris Type II (Type 1b) Fractures
Simple Humero‐ulnar Articular (Type 2) Fractures
Fractures Commencing at or Distal to the Radio‐ulnar Articulation (Type 5 Fractures)
Comminuted (Type 4) Fractures
Open Fractures
Repair with Wire
Fractures with Cubital Luxation
Fragment Removal
Recovery from Anaesthesia
Post‐operative Care and Convalescence
Results
Apophyseal Avulsions
Salter–Harris Type II Fractures
Proximal Non‐articular (Type 3) Fractures
Simple Humero‐ulnar Articular Fractures
Comminuted Articular Fractures
Fractures Commencing at or Distal to the Radio‐ulnar Articulation
Open Fractures
References
27 Fractures of the Humerus
Anatomy
Fractures of the Greater Tubercle. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Non‐surgical Treatment
Surgical Treatment
Post‐operative Care
Results
Fractures of the Deltoid Tuberosity
Treatment and Results
Stress Fractures. Incidence and Causation
Clinical Features and Diagnosis
Treatment and Results
Physeal Fractures
Diaphyseal Fractures. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Conservative Management
Surgical Management
Results
References
28 Fractures of the Scapula
Anatomy
Fracture Types
Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis. Radiography
Ultrasonography
Nuclear Scintigraphy
Treatment. Supraglenoid Tubercle Fractures
Complete Fractures of the Scapular Neck or Body
Fractures of the Scapular Spine
References
29 Fractures of the Tarsus
Anatomy
Fractures of the Tarsal Bones
Fractures of the Medial Malleolus of the Tibia
Fractures of the Lateral Malleolus of the Tibia
Fractures of the Distal Intermediate Ridge of the Tibia
Sagittal Fractures of the Talus
Fractures of the Trochlear Ridges of the Talus
Fractures of the Medial Tubercles of the Talus
Other Fractures of the Talus
Fractures of the Calcaneus
Fractures of the Central Tarsal Bone
Fractures of the Third Tarsal Bone
Fractures of the Proximal Third Metatarsal Bone
Other Tarsal Fractures
References
30 Fractures of the Tibia
Anatomy
Fracture Types
Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis. Radiography
Nuclear Scintigraphy
Computed Tomography
Treatment. Proximal Physeal Fractures
Distal Physeal Fractures
Fractures of the Tibial Tuberosity
Diaphyseal Fractures
Incomplete Fractures
Stress Fractures
Fractures of the Medial Eminence
Caudal Cruciate Avulsion Fractures
References
31 Fractures of the Patella
Anatomy
Fracture Types
Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis. Radiography
Ultrasonography
Treatment
Subtotal Patellectomy and Removal of Intra‐Articular Fragments
Repair of Parasagittal Fractures
Transverse Fractures
Extra‐articular Fragmentation
References
32 Fractures of the Femur
Anatomy
Proximal (Capital) Physeal Fracture. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Surgical Techniques
Results
Diaphyseal Fractures. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Surgical Techniques
Results
Distal Physeal Fractures. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Surgical Techniques
Results
Fractures of the Third Trochanter. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Results
Fractures of the Supracondylar Tuberosity/Gastrocnemius Muscle Avulsion. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Results
Fractures of the Trochlear Ridges
Fractures of the Femoral Condyles
Avulsion Fractures of the Cranial Cruciate Ligament
References
33 Fractures of the Pelvis
Anatomy and Biomechanics
Fracture Types, Incidenceand Causation
Clinical Features and Presentation
Fractures of the Tuber Coxae
Fractures of the Iliac Wing
Fractures of the Iliac Shaft
Fractures of the Ischium
Pubic Fractures
Risk Factors Associated with Pelvic Fractures. Age
Sex
Track Surface
Other Risk Factors
Imaging and Diagnosis
Ultrasonography
Scintigraphy
Radiography
Computed Tomography
Treatment Options and Recommendations
Displaced Open Fractures
Delayed Emergence of the Parent Fracture Bed
Iliac Wing Fractures
Case Selection and Management
Pain Control
Prevention of Displacement
Prevention of Pleuropneumonia
Prevention of Laminitis
Prevention of Colic
Potential of Problems with Parturition
Prevention of Injury on Return to Training
Results
Iliac Wing
Iliac Shaft
Tuber Coxae
Tuber Ischium
Ventral Pelvis and Acetabulum
References
34 Fractures of the Vertebrae and Sacrum
Introduction
Fractures of the Axial Dens with Atlantoaxial Subluxation. Anatomy (Figure 34.1)
Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Ventral Atlantoaxial Fusion Using an LCP
Other Techniques
Results
Atlantoaxial Subluxation. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Treatment Options and Recommendations
Dorsal Laminectomy
Results
Complete Ventral Luxation of the Axis. Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Treatment Options and Recommendations
Fractures of the Atlas
Fractures of the Axis
Fractures of Cervical Vertebrae 3 to 7. Anatomy (Figure 34.7)
Fracture Types, Incidences and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Plate Fixation
Dorsal Laminectomy
Results
Fractures of Thoracolumbar Vertebrae. Anatomy
Fractures Types, Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Acute Fracture Management
Treatment Options and Recommendations
Surgical Stabilization in Foals
Fractures of the Spinous Processes
Fractures of the Sacrum. Anatomy (Figure 34.22)
Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Treatment Options and Recommendations
Technique and Results
Fractures of the Coccygeal Vertebrae
References
35 Fractures of the Ribs
Anatomy
Fracture Types
Incidence and Causation
Clinical Features and Presentation
Imaging and Diagnosis
Treatment Options and Recommendations. Conservative Treatment. Foals
Adults
Fracture Fixation
Approach
Plating
Nylon Cable (Zip Tie)
Securos Cranial Cruciate Ligament Repair System™ and Similar Suturing Techniques
Pins and Wires
Results
References
36 Fractures of the Head
Introduction
Anatomy
Cerebral Cranium
Visceral Cranium
Mandible
Clinical Signs
Clinical Examination
Treatment Principles
Pre‐operative Management
Surgical Considerations
Post‐operative Management
Complications
Fractures of the Cerebral Skull
Examination
Clinical Signs
Acute Treatment and Medical Management
Surgical Treatment
Prognosis
Fractures of the Facial Skull
Surgical Approach
Reduction
Fixation. Fragment Interdigitation
Polydioxanone Sutures
Orthopaedic (Cerclage) Wire Sutures
Rosettes (FlapFix)
Plates
Skin Closure
Post‐operative Care
Fractures of Incisive, Frontal, Nasal and Maxillary Bones
Orbital Fractures
Outer Parts of the Orbit
Inner Part of the Orbit
Fractures of the Mandible
Surgical Planning and Preparation
Wound Management
Post‐operative Care
Surgical Techniques
Intraoral Wire
Wire Placement
Engagement of the Incisors
Anchoring the Wire
Cable Fixation
Screws and/or Plates
U‐shaped Splint
Polymethylmethacrylic Compounds
External Fixators
Pinless Fixator
Individual Fracture Locations and Configurations. Pars Incisiva
Symphysis of the Mandible in Young Horses
Premaxilla
Interdental Space
Unstable Bilateral Fractures of the Pars Incisiva
Fractures of the Interdental Space and Pars Molaris
Vertical Ramus
Fractures of the Hyoid Apparatus
References
37 Fractures in Foals
Introduction
Physeal Fractures
Anatomy
Salter–Harris Fracture Definitions
Pathophysiology of Physeal Fractures
Common Physeal Fracture Locations in the Horse
Considerations in the Management of Orthopaedic Injury in the Foal
Instability
Biomechanical Considerations
Fracture Reduction and Load Sharing
Implant Selection
Prevention of Angular Deformities
Analgesia and Medical Management
External Coaptation
Nursing Care
Fractures of the Distal Phalanx
Fractures of the Proximal and Middle Phalanges
Fractures of the Proximal Sesamoid Bones
Fractures of the Mid and Distal Third Metacarpal and Metatarsal Bones
Casts and Transfixation Casts
Internal Fixation
Prognosis
Fractures of the Proximal Metacarpus and Metatarsus
Fractures of the Cuboidal Bones of the Carpus and Tarsus
Radial Fractures
Fractures of the Ulna
Humeral Fractures
Fractures of the Scapula
Calcaneal Fractures
Tibial Fractures
Femoral Fractures
Pelvic Fractures
Guidelines for Implant Removal. Indications
Risks
Timing
Techniques
Post‐operative Management and Complications
References
Index
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