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.
Fig. S3J
Suction drains are inserted immediately postoperatively.
3.3 The day after surgery
Typically, perioperative prophylactic antibiotics are administered throughout the 24-hour post-surgical period, then discontinued. The horse's vital signs are monitored twice daily and recorded in the case record.
A report of the surgical procedure is generated and sent to the client, the referring veterinarian, and any other interested parties. The report should deal with any changes in diagnosis or prognosis made at the operating table and should detail the responsibilities of the animal's caretakers in the long and short terms postoperatively. In a practice or clinic with a heavy orthopedic load, it is probably best to develop certain standard aftercare programs that can be tailored to fit individual circumstances.
Physical therapy [13] and controlled exercise should begin as early as possible during the recovery phase and continue at home. This commitment to the animal's final well-being is extremely important to the successful outcome of any given surgical procedure. Many surgeries of the distal limb such as those considered later in this manual require little or no protection by external fixation in the postoperative period. This allows for early joint and tendon mobilization, and prevents the capsular fibrosis and stiffness that are otherwise almost inevitable. The use of non-steroidal anti-inflammatory agents in the early postoperative phase permits passive joint manipulation by limiting the development of capsular and subcutaneous edema. Movement reduces the formation of adhesions, improves the nutrition of articular tissues, and aborts progression of degenerative changes [14].
Plans for follow-up radiography are made and the dates calculated based upon the date of surgery. Computer programs with “datebook alarms” can be helpful in reminding the surgeon of these dates. The follow-up information is essential to an adequate documentation of results, and to developing improvements and modifications of technique for the future.
Generate the surgical report immediately postoperatively.
3.4 Summary—Checklist
Day before...
Completeness of medical record concerning biographical data and medical history checked.
Owner made aware of alternatives and risks.
Complete physical examination performed.
Preoperative plan developed, indicating needs for implants and instrumentation.
Patient bathed; operative site clipped, scrubbed, and protected with a sterile wrap.
Antibiotic therapy instituted.
Food withheld 12 hours preoperatively.
Begin physical therapy and controlled exercise as early as possible.
Day of...
Final check of patient, personnel, and equipment.
Positioning of patient determined based upon accessibility and ease of intraoperative radiographic monitoring.
Appropriate drainage of the surgical site provided (if necessary).
Day after...
Surgical report generated and distributed.
Physical therapy instituted, its continuance described in writing, and discussed with owner/trainer.
Dates set for follow-up radiographs and examinations.
3.5 References
1. Bramlage LR (1983) Current concepts of first aid and transportation of the equine fracture patient. Comp Cont Educ Pract Vet; 5(suppl):564.
2. Fackelman GE, Peutz IP, Norris JC, et al. (1993) The development of an equine fracture documentation system. Vet Comp Orthop Traumatol; 6:47.
3. Wilson JF (1992) Professional liability in equine surgery. In: Auer JA, editor. Equine Surgery. Philadelphia: W.B. Saunders Co, 13.