3 Equine Limb Splinting and Fracture Stabilization

Equine Limb Splinting and Emergency Fracture Stabilization

• Limb splinting is indicated in situations involving the stabilization of equine limbs and emergency fracture management.

Objectives

• Recall situations where limb splinting is indicated.
• Application of each type of splint should be described.
• Splinting technique appropriateness, is defined by fracture location.

Indications for Splint Application

• Post-traumatic limb stabilization is achieved through splinting.
• Distal limb fractures requires a splint.
• Splinting useful due to radial nerve paralysis.
• Wound healing is promoted through splinting.
• Splinting is used as surgical site or laceration repair of a high motion joint.
• Second intention wound healing utilizes splints.
• Flexural limb deformities in neonatal foals are treated with splints.
• Congenital carpal and metacarpal phalangeal flexural deformity can be addressed with splints.

Bandage/Splint Combination

• Considered the best method for emergency stabilization.
• Application is fast and inexpensive.
• Materials are readily available.
• Blankets, towels, bed sheets, and jackets can be used in emergency situations.
• Pillows are too bulky and compress too easily for splinting.
• Acceptable splint materials include PVC pipe sections, boards, broom handles, and metal bars.
• Kimzey Leg Saver and other commercial splints.

Application of the Splint/Bandage

• Stability of bandages is important.
• Use just enough padding to make the limb cylindrical to protect soft tissues and allow uniform splint pressure distribution.
• More bandage material can be added on top of the splint.
• Bandage should be applied as tightly and uniformly as possible.
• Excessive padding and inadequate tension, allow the fracture to move.
• Splint becomes the load bearing structure.
• Splint should be placed after the first bandage layer.
• It's important to immobilize the joint above, and all joints below the fracture.
• Splint from the ground to the proximal aspect of the adjacent long bone.
• Apply two splints at 90° to each other.
• Secure the splint with non-elastic tape like duct tape or 2" white athletic tape.

Fracture Regions in the Horse

• Fractures can occur in either the front or hind limbs.

Front Limb Fractures

• P1, P2, +/- P3, and sesamoid bone fractures often involve suspensory apparatus breakdown.
• MC III and carpal bone fractures.
• Radius fractures may include the ulna.
• Humerus and scapula fractures can occur.

Hind Limb Fractures

• Same as front limb.
• MT III and tarsal bones can be fractured.
• Tibia can be fractured..
• Femur can be fractured.

Region 1: Phalanges & Sesamoids

• Dorsal cortices must be aligned when splinting.
• Splinting removes the lever arm from the fetlock joint.
• Use one dorsal and one lateral splint, but a lateral splint is not always necessary.
• Heel wedge may be applied to the foot.
• Application could give the horse a toe touching appearance.

Region 1: Front Limb

• Apply a tight bandage to the area, more so than routine, almost to the point of ripping.
• Protect all soft tissues before splinting.
• Place the dorsal splint with aligned dorsal cortices.
• Secure proximally & at the fetlock.

Region 1: Rear Limb

• Addition of a lateral splint is necessary, if there is medial/lateral instability present.
• The construct should be fully covered with inelastic tape.
• Multiple techniques have been described.
• Place a dorsal splint & align dorsal cortices.
• Splint is safe using inelastic tape.
• Note that the horse may not tolerate it & kick.
• The lateral splint can be added if it is necessary (not shown).

Region 2: MC/MT III, Carpal/Tarsal Bones

• Splintage depends on if the fracture is in the front or hind limb.

Front Limb Splintage

• One lateral splint.
• One caudal splint.
• Extends from the ground to the point of the elbow.
• Locks carpus in extension.

Hind Limb Splintage

• Lateral splint to the level of the stifle joint.
• May only need up to the tarsus if the fracture is in the distal metatarsus at a clinician’s discretion.
• Plantar splint to the point of the calcaneus.

Region 2: Front Limb Application

• Horse should be in a weight bearing stance, or attempt to be.
• SplintValue should be assessed for length to the olecranon.
• Pad should be to the proximal aspect, to protect the soft tissues.
• Assess for gaps in pastern, metacarpus, and radius, and add padding as needed to fill the gaps.
• Secure the splints to the limb with proximal, middle, and distal wraps.
• Begin with the caudal splint, as it is the easiest to start with.
• Compression of the leg to the splint is important
• Then add the lateral splint.

Region 2: Rear Limb Application

• Cover the construct with inelastic tape if you are sure the splints are appropriately positioned
• Splintage is similar to the front limb.
• Maintain a weight bearing position.
• Secure plantar splint first, only to the level of the calcaneus.
• To the stifle : mid-metatarsus fractures & proximal, the best fit line to allow both the tibia and the metatarsus to be engaged by the splint.
• To the tarsus : distal metatarsal fractures only, align the splint with the metatarsus.
• Then, secure with duct tape.

Region 3: Radius and Tibia

• Both regions have different splintage requirements.

Region 3: Radius Splintage

• Lateral splint to the level of the withers prevents abduction of the distal limb and subsequent open fracture development medially.
• Caudal splint extends to the point of the elbow.

Region 3: Tibia Splintage

• Difficult to splint.
• Single lateral splint to the level of the coxofemoral joint.
• Need to have an ideally contoured splint to the limb.
• Caudal splinting is not possible or is not helpful.

Radius Splint Application

• Splintage should be assessed for fit.
• Length should be considered, where the caudal is to the olecranon, and lateral to the scapula.
• Add padding as necessary.
• Secure splints to the limb, with caudal splint first, then the lateral splint.
• Then fully cover the construct with tape.

Tibia Splint Application

• Apply a full limb bandage.
• The splint should be assessed for length & gaps to the level of the hip.
• Add padding as necessary.
• Secure the splint - lateral only.
• The best fit line: engage both tibia & metatarsus
• Extra support on the tibia.
• When reciprocal apparatus cycles the fracture, more duct tape should be used.

Region 3b: Ulna

• Ulnar fracture causes loss of triceps function.
• Classical dropped elbow stance with carpal flexion.
• Single caudal splint, from the ground to the point of the elbow.
• Locks the elbow into extension & allows weight bearing.

ULna/ Radial Nerve Application

• Apply a full limb bandage as as tightly as possible.
• Place and size a caudal splint from the ground to the level of the elbow with the horse in weight bearing position.
• Fill in gaps between the bandage/limb & splint with cotton as needed.
• Apply caudal pressure on the dorsal aspect of the carpus to lock it into extension while tightly holding the splint to the leg
• Tightly wrap inelastic tape proximally, at the carpus, and at the fetlock to secure the splint in place.
• Tightly wrap tape with 50% overlap until the entire bandage is covered.

Region 4: Humerus & Femur

• Cannot be adequately stabilized externally.
• Very distal humerus fractures may benefit from a caudal splint to the elbow, and locks carpus in extension & allows some use of the leg.

Case Example

• Cases of fractures, luxations and other issues are listed, with explanation how to splint, the materials to use, and things to look out for.

Case Example 1

• 10 Y/O QH mare, who presents gotten loose while at a rodeo.
• Involves semi truck on a nearby highway.
• Multiple dorsal carpal and fetlock abrasions
• There is intermittent inability to bear weight on the left front limb.
• There is type 2 olecranon fracture diagnosed on radiographs, and knew buckles when standing.
• To splint, apply a full limb bandage as tightly as possible then place and size a caudal splint from the ground to the level of the elbow, with the horse in a weight bearing position. You would fill any gaps between bandage/limb, and apply caudal pressure, and wrap tightly with in-elastic tape proximally at the carpus and at the fetlock until the entire bandage is covered*.

Case Example 2

• 4 Y/O QH filly found acutely.
• She is in non weight bearing angled distal right hind limb.
• Tarsometatarsal luxation with MTI fracture.
• To Splint Apply full limb bandage as tightly as possible*.
• Then Place a plantar splint from the ground to the point of the Calcaneus with the horse in weight bearing position and Place a lateral splint to the level of the stifle in a “best fit line to align as much of the tibia and metatarsus.
• Fill gaps between bandage and splint ,and after taping place Extra tape in high motion areas .
• Materials include cotton, brown gauze,cohesive bandage,duct tape and an appropriate size lateral splint.

Case Example 3

• 15yr old morgan stallion, presents roadside on the emergency, unable to rise, after being hit by a car.
• Closed mildly comminuted right hind end metatarsal fracture..
• The pictured stabilization is lacking DP stabilization; The splints Do Not extend to ground also electrical tape strength questionable also Don Not extend proximally enough .
• A potential solution is a lateral splintage to the level of the stifle and a plantar splint to the level of Calcaneus, and depending on materials used to ensure adding a dorsal splint to the tarsus, in toe touching.