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Musculoskeletal: external fixation - casts

pequis

Introduction

  • To provide stabilization and immobilization of a limb following injury.

Uses

Types
  • Foot cast: for hoof wall avulsion injury External fixation: cast 02 - foot .
  • Fetlock and foot cast: heel bulb laceration External fixation: cast 01 - half limb  foot .
  • Distal or short limb cast: to cover foot up to proximal metacarpus or metatarsus.
  • Full limb cast: extends above the carpus or tarsus to proximal radius or tibia; for trauma proximal to fetlock, distal to mid-radius or mid-tibia; reduces strain deformation of the superficial and deep digital flexor tendons of the hindlimb.
  • Sleeve or tube cast: for carpus or tarsus, eg angular limb deformities; permits weightbearing on limb; from proximal radius/tibia to distal metacarpus/metatarsus.

Advantages

  • Modern materials are fast drying and lightweight.
  • Cheap alternative to surgery.
  • Enables horse to bear weight on affected limb, reducing stress and secondary complications to contralateral leg during recovery period.
  • Can be applied to the foot, lower leg or whole limb.
  • Foot casts can be applied to a compliant horse under sedation.

Disadvantages

  • Some abrasions from prolonged cast wearing are inevitable.
  • Require careful monitoring.
  • Horse may weight bear before cast has 'cured'.
  • If long-term cast - may need to replace during treatment period.
  • General anesthesia necessary for casts beyond the foot.
  • Plaster of Paris casts do not achieve full strength for 24 h.
  • Some horses will not tolerate full-limb cast.

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • Duration of cast application depends on injury.
  • Phalangeal or metacarpal or metatarsal III fractures MC / MT 3: fracture - recovery only if cast.
  • Heel bulb lacerations , joint wounds, tendon lacerations Flexor tendon: trauma - 2-3 weeks immobilization. See picture series of laceration Coronary band: trauma 01, two weeks after cast removal Coronary band: trauma 02 - 2 weeks post-cast and four weeks after cast removal Coronary band: trauma 03 - 4 weeks post-cast.
  • Primary means of fracture immobilization - leave on until fracture has healed, replacing at monthly intervals or sooner if required.
  • Foals - replace cast at 10-14 day intervals.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Stewart H L, Werpy N M, McIlwraith C W & Kawcak C E (2020) Physiologic effects of long-term immobilization of the equine distal limb. Vet Surg 49 (5), 840-851 WileyOnline.
  • Eggleston R B (2018). Equine Wound Management: Bandages, Casts, and External Support. Vet Clin North Am Equine Pract 34 (3), 557-574 PubMed.
  • Pérez-Nogués M, Dechant J E, Garcia-Nolen T & Stover S M (2018) Evaluation of the effects of initial water temperature and curing time on fiberglass cast strengthVet Surg 47 (6), 809-816 PubMed.
  • Janicek J C, McClure S R, Lescun T B et al (2013) Risk factors associated with cast complications in horses: 398 cases (1997-2006)J Am Vet Med Assoc 242 (1), 93-98 PubMed.
  • David F, Cadby J, Bosch G et al (2012) Short-term cast immobilisation is effective in reducing lesion propagation in a surgical model of equine superficial digital flexor tendon injury. Equine Vet J 44 (5), 570-575 WileyOnline.
  • Virgin J E, Goodrich L R, Baxter G M & Rao S (2011) Incidence of support limb laminitis in horses treated with half limb, full limb or transfixation pin casts: a retrospective study of 113 horses (2000-2009). Equine Vet J Suppl (40), 7-11 PubMed.
  • Milner P (2009) Application of a distal limb (foot) cast. UK Vet 14 (1), 15-18 VetMedResource.
  • S A Hopper, R K Schneider, M H Ratzlaff et al (1998) Effect of different full-limb casts on in vitro bone strain in the distal portion of the equine forelimb. Am J Vet Res 59 (2), 197-200 VetMedResource.
  • Riggs C M (1997) Indications for an application of limb casts in the mature horse. Equine Vet Educ 9 (4), 190-197 WileyOnline.
  • Wilson D G & Vanderby R (1995) An evaluation of fiberglass cast application techniques. Vet Surg 24, 118-121 PubMed.
  • McClure S R, Watkins J P, Bronson D G & Ashman R B (1994) In vitro comparison of the standard short limb cast and three configurations of short limb transfixation casts in equine forelimbs. Am J Vet Res 55 (9), 1331-1334 PubMed.

Other sources of information

  • Nixon A J (2020) Ed. Equine Fracture Repair. 2nd edn. Wiley-Blackwell, USA. ISBN: 978-0-813-81586-2.
  • Auer J A & Stick J (2019) Equine Surgery. 5th edn. W B Saunders, USA.

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