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Injury management

Updated: Nov 3, 2021

Horses are highly athletic animals who face intensive exercises and horse races regularly. Many medical emergencies may occur during these sessions. The horse caretakers should clearly understand these conditions to know when to seek veterinary care. Though there is a lot of medical emergencies, the most common ones that are related to the musculoskeletal system can be listed as follows:

  • Fractures

  • Luxations

  • Lacerations

  • Puncture wounds

  • Synovial infections

  • Exertional rhabdomyolysis

Each of these conditions will be discussed further.

When an emergency injury takes place, an evaluation should be done to understand the degree of the injury and the structures that have been damaged from the injury. Radiographs and synoviocentesis can offer help for this evaluation. Emergency care done in the field is not necessarily enough to cure any kind of injury, but this can vastly improve the success rate of further treatment when proper emergency care is given at the right time along with the correct diagnosis.


Fractures

“A fracture is a break, usually in a bone.” There are various types of fractures identified by the nature of the fracture and its severity. Some of the common types of fractures are:

  • Simple cracks – only one crack in the bone

  • Comminuted splinters – the bone is separated into several pieces

  • Incomplete fractures – a fracture that is only on one side of the bone

  • Complete fractures – a full break giving separate bone pieces as a result

  • Displaced fracture – when the bone fragments caused by a fracture is moved away from the original place

  • Stress – comparatively small, less severe fractures

  • Star – multiple cracks occurred radiated from a central area

  • Articular fractures- A fracture involved in a join

  • Closed fracture – fracture without a wound on the skin

  • Open fracture- the bone parts are visible from outside along with a wound

The main clinical signs are

  • Increased heat in a localized area.

  • Showing signs of pain, swelling, and lameness.

A special fact that should be remembered is that the only reason for lameness is not bone fractures. Some have that idea. This is wrong. Lameness can be caused by multiple causes, such as laminitis and abscesses in the hooves.

Situation management

Out of all the previously mentioned types of injury, the prognosis of fracture treatment is greatly affected by the proper immediate care. The horse should not be moved out of the place where the injury occurred until veterinary care is given unless it is necessary. If replacing is essential, it should be moved to the minimum distance as possible because trying to walk on the fractured limb causes to worsen the situation by resulting in a lot of damage to the tissue as moving with an injured limb makes a horse undergo anxiety. Immediate veterinary care is needed. In horse races, this kind of injury has a higher probability of occurring. Veterinarians should be there to provide medical care. The veterinarian will administer a non-steroidal anti-inflammatory drug (NSAID) as phenylbutazone, flunixin, meglumine to relieve extreme pain and limit inflammation. Usually, intensive pain-relieving medicine is not recommended here as it will relieve a lot of main and the horse will try to walk. Then a splint is applied. The splint does not necessarily have to be put covering the whole injured limb. It is enough to apply only covering the affected joint. The main purpose of a splint is to immobilize the area preventing further damage. The animal shows immediate signs of relief after applying a splint because it can bear weight from that limb and distribute the weight of the body among all four limbs. Then the horse should be carefully transported to a hospital for further care while providing proper support to stabilize the limb.

If the injury is in the forelimbs, the horse should be transported facing backward, so in case you have to make a sudden break, the increased force will be directed to hind limbs. If the injury is in hindlimbs, the animal should be transported facing forward. The animals are instructed to transport in tight partitious ships, which allows the animal to lean on sides for extra support, which keeps only head and neck not restricted. After proper treatment with the modifying veterinary techniques, there is a higher recovery rate, and some of these horses even may attain the ability to race. So quick decisions should not be made, such as euthanasia.


Luxations

Luxation can be defined as the complete dislocation of a joint. A partial dislocation is a subluxation. The types of luxations seen among racehorses and show horses are patella luxation, fetlock, pastern, coffin joint luxations.

Luxations can be diagnosed by joint instability, crepitus, or the abnormal sound that comes from joints and the abnormal angular of the limb. Joint instability refers to the abnormal lateral to the medial motion of the joint.

In these situations, sedation or a twitch can be helpful to restrain the animal for further examination. As in fractures, luxation also needs immediate help in limb immobilization. To confirm a luxation and to design a treatment plan, it’s necessary to take a radiograph. But any external coaptations should be performed beforehand. If there is no radiographic facility available in the field, the animal should be transported safely to a nearby facility. How the animals with orthopedic injuries in limbs should be traveled was discussed earlier under fractures.

Management of these situations has the primary objects such as releasing anxiety and immobilize the fractured or luxated limb until transported to a hospital facility. This helps a great deal to increase the prognosis. For fetlock, pastern, coffin joint luxation in the forelimb, the best immediate care is to align cannon bone with phalanges to form a straight weight-bearing column and apply a splint properly.

When applying splints, they should never end in the middle of a long bone or the margin of the injury.


Laceration

A laceration is a wound produced by the tearing of soft tissues. These wounds are often irregular and unevenly cut. The laceration wounds are often contaminated with bacteria and debris of the object that caused the injury.

The wounds should be immediately cleaned with an antiseptic drug to prevent any microbial infection.

As for the performance horses, it’s often the extensor tendon that undergoes laceration. Splints are used to immobilize the areas with the wound. The splints using for extensor tendon lacerations that are for flexor tendons are different.


Puncture wounds

A puncture wound is caused by a sharp and pointy object such as a nail or animal teeth. These wounds don’t bleed as hard as lacerations and appear to close up. Puncture wounds can cause infection too. These wounds should be treated accordingly.

Due to the foreign body particles that may remain in the wound, the treatment includes surgical interventions.

A puncture wound in the chest can cause pneumothorax. Pneumothorax is a collapse of lungs. This condition develops breathing difficulties. Pneumothorax is considered fatal unless prompt medical attention. Easy ways to diagnose is the abnormal breathing pattern caused by respiratory distress. The thorax should undergo surgery for proper treatments, but as a temporary treatment, the chest wound can be sealed by an airtight plastic wrap. The plastic wrap is being sealed with elastic adhesive tape. This way, further infections are controlled.

Hemothorax is a condition where the thoracic cavity or pericardial cavity is filled with blood due to a puncture wound in the chest. This condition also causes respiratory distress.

Penetration of the abdominal cavity can sometimes be fatal based on the damaged structures. Even with minimal organ damage, conditions such as peritonitis and abdominal hemorrhages can be developed. The wound should be properly cleaned and disinfected, and then bandaged. Since the blood reports are done to confirm peritonitis takes some time, broad-spectrum antibiotics and pain managing drugs are administered until then.


Synovial infections or Septic synovitis

Septic synovitis can be defined as infection within synovial structures such as synovial joints, bursa, or tendon sheath. Synovial infections are caused by bacterial intervention into the synovial structures, which are usually sterile. There are three main routes from which microbes can reach the synovial structures.

  • A wound happens to the joints penetrating synovial membranes, and bacterial contamination could occur, causing infection. This is the main cause of synovitis in adult horses.

  • Hematogenous spread or microbial spread through blood. This happens as a secondary effect of another infection in the body, such as diarrhea, pneumonia, and umbilical infection. Microbes in these infections could travel through the blood and come to the synovial cavity. This is the common cause of synovitis in foals.

  • Latrogenic spread or the introduction of bacteria to the synovial cavity through surgical procedures performed on the joints. EX - Arthroscopy

Synovitis is considered an emergency when it comes to horses. Synovitis can be very dangerous because sometimes it can put an end to the carrier of a racehorse. So the horse should be directed to veterinary attention as soon as the sign is shown suspecting synovitis. This can be diagnosed by running a few tests to synovial fluid taken from the suspected joint.

The effects of synovitis are severe lameness (Lameness is an abnormal gait in the animal due to the pain of some part of the limb), damage in articular cartilage, bone, and soft tissues associated with the infected synovial joint. An intense inflammatory response can be developed if not treated quickly enough, putting the horse at risk of developing osteoarthritis and degenerative joint disease.

The intentions of treatment are to eliminate the infection and help the horse deal with the pain that offers comfort. If there is a wound, it should be cleaned well and disinfected. Later antibiotic treatment is performed both locally in the infected area and systemically.

In order to offer comfort, anti-inflammatory drugs are offered. Due to the pain from the infected limb, the animal is reluctant to keep that limb on the floor, resulting in additional pressure on the parallel limb. This may result in laminitis, which is the inflammation of the laminae that binds the hoof wall to pedal bone in the hoof in the parallel limb. It is called supporting limb laminitis.


Exertional rhabdomyolysis (ER)

Exertional rhabdomyolysis is a syndrome of muscle pain and cramping associated with exercise due to muscle dissolution. This is also known as “tying up.”

Some ER symptoms are firm, painful muscles over the lumbar and sacral regions following exercises, and excessive sweating. In severe cases, discolored urine can be seen due to discharge of myoglobin alone with urine.

A diagnostic plan is designed by considering how the horse faces exercise challenges, genetic testing, or muscle biopsy.

Abruptly accelerated exercises, intensive exercises on hot, humid days, and high tolerance races done on hot and humid days can cause having an episode of ER. By identifying the cause of the disease, a veterinarian can design specific management strategies to control this condition. A nutritionally balanced diet with adequate vitamin E and selenium and electrolyte balance after performing exercises and races in the hot weather is essential to prevent future episodes of ER.

If the horse has fever, cough, and nasal discharge, should not do exercises with that horse to manage this disease. 12-48 hours of rest should be offered to a horse who had an episode of ER until he moves around again. Request a veterinarian to examine the horse 2 -3 weeks after the first ER episode to decide when the horse can restart the regular exercise sessions.


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