Orthopaedic Referrals

Equine long bone fractures constitute an important part of our referral case load and require special care prior to referral. Generally speaking, long bone fractures proximal to the carpus and hock in adult horses carry a very poor or hopeless outlook. The notable exception to this are fractures of the ulna which in many cases are amenable to the application of a dynamic compression plate with return to full soundness. Fractures distal to the carpus and hock may be amenable to lag screw repair or to the application of a dynamic compression plate.

It is essential that such cases are referred with the injured limb supported by a Robert Jones bandage with splints or even a proprietary splinting device.

The Hospital is equipped with a low loading fracture ramp which should be used where possible to facilitate unloading and to prevent further unnecessary limb damage. It is also sensible to support the other limbs before travelling the horse. Judicious use of non-steroidal anti-inflammatory medication is valuable to keep the horse comfortable and to make loading and unloading easier.

Veterinary surgeons who would like to refer a patient with a long bone fracture, should call the Hospital or the Practice out of hours emergency telephone number. You will then be put in touch with the duty surgeon to discuss the feasibility of the treatment. Advice will then be given regarding appropriate management prior to referral.

The Hospital also deals with an increasing number of referred cases of synovial sepsis. Any wound near a joint is best presumed to have a potential articular component until proven otherwise. Septic synovitis is always considered an emergency and referral without delay is liable to result in a significantly higher success rate. The use of arthroscopic lavage/ debridement and the insertion of antibiotic impregnated beads or foam have contributed to this.

Elective orthopaedic cases, such as for arthroscopy are always welcome. There are now very few joints or other synovial cavities which are not amenable to arthroscopic inspection. The advent of digital radiography, combined with diagnostic ultrasound, gamma scintigraphy or arthroscopy has enabled more accurate diagnosis, prognosis and in some cases therapy in many orthopaedic cases.