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Articles & Information
FROM THE HOOFCARE & LAMENESS ARCHIVES Shoeing Support for Fracture
Surgery Note: this article was originally published in Hoofcare & Lameness in 1994. Pre- or post-operative farriery is frequently found to be of use during equine fracture surgery. Farrier can protect a cast and prevent movement inside it. Shoeing may also be used to reduce stress at the site of the fracture or cast, and to support structures once the cast has been removed. Horseshoes can be made and applied to immobilize a fracture. In many cases involving fracture surgery, the opposing limb is subjected to extra stress, which may be relieved by farriery. In cases of removal of pathological fractures and sequestra, shoeing can provide protection, ease management, and apply pressure where needed. Cast Protection and Movement Prevention The limb inside a cast will often move, causing irritation and abrasions with the consequent possibility of infection. A cast shoe can be applied to protect the distal end of the cast from wear and reduce movement inside the cast. A tabbed glue-on shoe such as Mustad's "Glu II" may be screwed through its tabs and the cast, connecting the hoof wall to the cast. Care must be taken not to screw into any sensitive tissue within the foot. An alternative is the Dalric cuff, which allows an appropriate shoe to be rivetted to a plastic collar. This can be both glued and screwed. Stress Relief for the Fracture Site and Limb Relevant compound fractures may involve one or more of the following bones of the leg: distal third metacarpal, proximal sesamoids, proximal and middle phalanges (P-1 and P-2). When such fractures involve damage to support structures (ligaments and tendons), the hoof-pastern axis may collapse when the cast is removed. Shoeing for these cases should give caudal support, and hold the toe on the ground while pulling the hoof capsule back as close as possible to its correct hoof-pastern axis. A fishtail shoe (a radical fetlock support device with palmar-plantar extension resembling a fish tail) may be needed to support the fetlock at the proper position and extension. Protection for the Contralateral Limb Farrier problems in the contralateral limb are usually caused by excessive wear of the exterior capsule when that foot is dragged or slides. Laminitis is also common in the opposite foot, caused by a number of factors associated with continual weightbearing. In the case of excessive wear, normal shoeing will usually give sufficient protection to the bottom of the foot, with frequent checking on the condition of the shoe and nails. In all cases, correct hoof-pastern axis should be achieved and carefully maintained and monitored while the opposite foot is healing. When and if laminitis occurs or is suspected in the contralateral limb to the fracture or injury, a potentially life-threatening condition exists that may be more dangerous than the original injury. The heartbar shoe with dorsal wall resection has proven successful in many cases. Prognosis is poor in severe cases involving prolapse of the distal phalanx (P-3). I have had insufficient experience with heel elevation (wedging) and deep digital flexor tendon desmotomy techniques to comment here on their potentials for success in treatment of laminitis. Immobilization of P-3 and Navicular Fractures Treatment of fractures to the distal sesamoid (navicular bone) and P-3 are both helped by reducing movement to the hoof capsule and, in the case of the navicular bone, the deep digital flexor tendon. Where surgical fixation is used for treatment of cases of P-3 sagital fractures, hygiene is very important. The hoof should be lightly rasped from the distal border to the coronary band. The frog and sole should be trimmed to expose new, clean horn. The bar shoe may be attached before surgery. When treating either sagittal or wing fractures of P-3, internal fixation may or may not be used by the surgeon. Whether the bone is fixated or not, a bar shoe with large quarter clips, fit tightly to the wall, will greatly reduce expansion and movement. Shoeing therapy with these clipped bar shoes should continue for an extended period even after radiographic healing and soundness have been observed. The frog should be trimmed so that it does not come into contact with either the shoe or the ground during full weightbearing. In the case of navicular bone fracture, heel elevation will reduce pressure on the bone from the deep digital flexor tendon. In recent years, another shoe has been recommended for P-3 fractures; it envelopes the hoof capsule and is filled in with acrylic to give total hoof wall immobilization. Casting with plaster of paris or tape, used in conjunction with a bar shoe, has also been recommended. A Dalric cuff can be used effectively in some cases, particularly when working on young horses. Removal of P-3 Pathological Fractures or Sequestra In cases where bone fragments or sequestra require surgical removal, farriers often utilize hospital plates, which allow the lesion to be easily managed while eliminating bandages. Complete protection from trauma to the legion is a key benefit of this treatment. Pressure applied to the wound is a significant factor in the quality of healing. The foot should be prepared before the horse enters surgery. The shoe and hospital plate are made so that they are ready to be nailed on immediately after the surgery is complete. This allows the horse to be shod while ti is still tranquilized. Once nailed on and clenched, a total seal can be obtained by applying silicon filler. Pressure should be applied to the lesion to prevent exuberant new tissue by packing the cavity with medicated swabs and bolting the plate on in the best configuration possible. Use of large (10mm) bolts allows easier management by the owner or groom. When the lesion is cornified, any remaining cavity can be illed with medicated hoof putty and a thermally molded TAK pad. The foot can then be shod with a conventional shoe. Although this procedure can be used when a horse is anesthetized, it is easier and more economical for all parties when the operation is carried out as standing surgery. Simon Curtis is a farrier in Newmarket, England and provides surgical shoeing services to Rossdale and Partners, veterinary surgeons. He is a contributing editor to Hoofcare & Lameness. References: Bathe A: Personal communication Butler KD: Principles of Horseshoeing II, Revised Edition, 1985. Pettersson, H: Personal communication. Stashak TS: Adam's Lameness in Horses, 4th edition, 1987. For further reading, H&L suggests "Distal Phalanx Fractures" by William Moyer DVM in Equine Lameness and Foot Conditions, and "Diagnosis and Treatment of Fractures of the Second and Third Phalanges" by Larry Bramlage DVM in Athletic Injuries in the Performance Horse; both books area available through the magazine. This article originally appeared in Hoofcare & Lameness: The Journal of Equine Foot Science and is available for your personal use only. Re-publication is prohibited without the express written permission of Hoofcare & Lameness. Detailed information on this and many other hoofcare topics can be found in Hoofcare & Lameness publisher Fran Jurga's award-winning guide to hoofcare, "Understanding the Equine Foot". For more information, or to order, click here Back to the articles table of contents Write to H&L: PO Box 6600, Gloucester, MA 01930. Tel 978 281 3222; fax 978 283 8775. Email webinquiry@hoofcare.com. Internet http://www.hoofcare.com. © 1998
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