Stabilizing Thoracic Limb Fractures
Andrea Sundholm, DVM, DACVS-SA
Figure 1
Splinting Thoracic Limb Fractures
External coaptation can be applied for temporary stabilization as well as long-term management for some select fractures. The focus should be to provide stabilization and comfort while minimizing complications. This article will focus on three main fracture zones in the forelimb with tips and tricks for success.
Metacarpal Fractures
Metacarpal fractures (Fig. 1) vary in their severity based on the number and location of fractures. Regardless of the fracture location in the forelimb, your goal should be to stabilize the joint above and below the fracture. Therefore, the bandage should span from just below the elbow and incorporate the entire manus. Splint location can be caudal (“spoon splint”) or lateral. The decision to enclose the paw should depend on location of wounds, if any, and ability to frequently monitor the bandage (frequent changes). With simple metacarpal fractures, I still strive to have the central two toes visible to monitor for swelling.
Radius/ulna Fractures
In order to effectively stabilize these fractures (Fig. 2), your bandage needs to go above the elbow as far as you can get. I personally find the best way to do this is with a lateral splint. The olecranon will interfere with your ability to get a caudal splint high enough to provide stability. With long term bandaging, place “donuts” around boney prominences like the olecranon to avoid pressure sores (Fig. 3). These are made of folded pieces of cast padding with holes ripped in the middle. The hole is placed directly over the boney prominence before the limb is wrapped with cast padding.
Figure 2
Figure 3
Humeral Fractures
Although rare overall, we do see a fair number of condylar fractures (Fig. 4). In order to stabilize these fractures, you must immobilize the shoulder joint. A rigid spica bandage that goes over the top line of the patients’ thoracic spine is the only way to achieve this. If you cannot make one of these (typically from fiberglass) do NOT place any bandage at all. A lateral splint/soft padded bandage that ends in the axillary region only creates a fulcrum on the fracture and causes more motion and likely pain for the patient. Confinement and pain management is appropriate until definitive care is achieved.
Figure 4
Materials Check-list
- Popsicle stick and tape for stirrups
(I like to place the popsicle stick between the tape distal to the foot to make it easier to pull apart)
- Telfa to cover abrasion/wound
- Cast padding
- Cling
- Vetwrap
- Fiberglass/splint
Tips for Success
- Molded casts and splints are more efficient stabilizers because they are custom fit and cause fewer soft tissue problems.
- Cast padding should be as tight as possible.
- Two central toes should be exposed otherwise paw can become swollen.
- Make the bandage a “tube” as cone shaped bandages will slip (much more important for pelvic limb bandages).
- Excessive cast padding compresses and the bandage will become loose. Try not to make it too bulky.
- Don’t “fan” the fiberglass to make it wider. Lay each layer on top of each other.
Considerations for Discharge Instructions
- Observe toes twice daily, looking for signs that the toenails are spreading apart.
- Keep indoors and activity restricted, bathroom breaks only.
- Booty or plastic bag when going outside to protect from wet conditions.
- Bandage change every 7-10 days, sooner if monitoring wounds.
- Recheck immediately if: foul odor, loosening, chafing, instability, obsessive licking.