and an estimated value of the animal concerned. (This latter value may be left to the owner to fill in.) This information is important to patient care and client relations and also touches upon the medicolegal aspects of patient care, described at length in a recent text [3].
Perform a complete physical examination including a hemogram.
Assess lameness and associated lesions. (See Movie: Evaluation of the Equine Musculoskeletal System).
Start gathering data by using the AO Equine Fracture Documentation System.
Make the owner aware of the alternatives to surgery and have your description countersigned.
A complete physical examination and hemogram are performed. While focused on the musculoskeletal system, including potentially predisposing conformational defects, care is taken to evaluate the animal as a whole. Assessment of lameness and any associated lesions should follow a systematic approach [4] with which the clinician has become comfortable. In the so-called exercise induced fractures [5], particular attention is paid to the possibility of the lesions being bilateral. The pain on one side is usually greater than on the other, and masks the existence of the second fracture. The findings of the examination are carefully documented, and communicated to the owner and any interested colleagues in practice. The initial (referral) set of radiographs is reviewed and augmented when necessary with additional views. From these films, a preoperative plan is diagrammed indicating the location and size of the implants to be used in the surgical repair (Fig. S3A). This plan is initially used to serve as a check on the availability of implants in the size(s) indicated, and the appropriate instrumentation for their insertion, and later to guide the surgeon during the actual operation. Recently a Large Animal Preoperative Planner has been introduced.
Fig. S3A
The area surrounding the surgical site is clipped with a fine blade (#40). For fractures of the limbs distal to the carpus or the hock, this is carried out circumferentially to facilitate draping in a subsequent step. The entire animal is bathed to remove dirt, sweat, and detritus from its body and limbs (Fig. S3B), and the operative site is scrubbed with a soap containing tamed iodine. A sterile dressing is used to cover the site, and this is held in place with a light bandage (Fig. S3C).
Fig. S3B
Fig. S3C
Perioperative antibiosis is warranted even in elective surgeries [6]. When truly prophylactic, it is brief in duration, extending roughly from the day before surgery to the day after [7]. The nature of this therapy will be dictated by the condition of the surgical site [8], concerns about anesthetic interactions [9], the presence of infection at a distant locus [10], the identification of nosocomial organisms, or certain details of the procedure itself [11]. As a rule, the treatment is timed so that an effective level of drug is present at the time of surgery. Broad-spectrum antibiosis consisting, for instance, of a penicillin and an aminoglycoside is applied.
Withhold food for 12 hours prior to anesthesia.
Use antibiotics from the day before through the day after surgery.
In consultation with other members of the staff, the time of surgery is decided upon, assuring the presence of all necessary equipment and personnel throughout induction, surgery, and recovery phases. Food is withheld for 12 hours prior to the induction of anesthesia.
Position the horse for 360° access to the surgical site.
3.2 The day of surgery
A final check is carried out on the readiness of the surgical suite, the instrumentation, the personnel, and the anesthesia/recovery equipment. The patient is examined, and its vital signs are measured and recorded. Any significant changes since the initial evaluation are documented and communicated to the owners and/or their representative(s). The horse is positioned to allow easy access of the surgical team to the fracture site and to facilitate intraoperative radiographs (Fig. S3D). Final preparation of the patient, the surgical site (Fig. S3E), and the surgeon are described in detail elsewhere [12], and the salient points are covered below. Any points on preparation related to specific procedures are detailed in the chapters devoted to them.
Fig. S3D
Fig. S3E
Fig. S3F
Fig. S3G
Ideally the correctly positioned, adjusted, and carefully draped x-ray machine (Fig. S3F) will need only to be wheeled up to the table to make the exposures required (Fig. S3G). The films in their holders are also covered with sterile drapes prior to their being extended into the field. If facilities permit, image intensification offers the advantage of being much quicker, but similar precautions must be taken against contamination. Many ready-made sterile plastic covers are obtainable in sizes that fit most of the common pieces of equipment. Any staff that remain in the room during the radiographic examination (e.g., surgeon, anesthetist) are suitably attired in lead aprons (Fig. S3H) worn throughout the procedure underneath their gowns (Fig. S3I).
Fig. S3H
Fig. S3I
At the conclusion of surgery, a suction drain is usually inserted in those cases having a significant amount of soft tissue trauma and “dead space” that could potentially develop into a seroma. Bandaging, splinting, and casting will vary depending on the surgeon's preferences and the lesion(s) in question (Fig. S3J). This topic will be treated in detail in the chapters dealing with specific fractures.
