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Cast away


DVM360 MAGAZINE



The right balance: Proper case selection for cast use is important, equine veterinary experts say. Experience is required for correct application.
A good cast will provide rigid immobilization and support, and these are the two features that make fiberglass casts a good choice for some equine patients. The correct casting principles are not always easy or even possible to follow. Equine practitioners often fear the complications of improper cast placement, which can be more devastating than the initial injury itself, and are reluctant to utilize casts.

"Many wounds, fractures and lacerations are associated with a good deal of swelling which can make cast application difficult," says Dr. Norm Ducharme, equine surgeon and medical director of the equine and farm animal hospitals at the New York State College of Veterinary Medicine at Cornell University. "If a cast needs to be applied when swelling exists, then as the swelling resolves the cast will loosen. It will need to be changed throughout the healing process," Ducharme explains. Constant and vigilant monitoring of these horses is required which is difficult for some owners and hard to ensure with field cases.

Likewise, young foals and growing horses will need frequent cast changes because their limbs will constantly be altered due to growth. Ducharme estimates the general maximal time for a single cast use to be roughly three weeks in an adult horse under the best of situations and 10 days or so for young horses. When surgeons began factoring the experience needed for proper cast placement and management, the cost of fiberglass cast changes and the risks of anesthesia and/or sedation for each change, it soon became obvious that perhaps a better system was needed.

Dr. Augusto Sarmiento, a human physician practicing at the University of Miami in 1963, began using a series of metal hinges along with plaster and other casting material to create braces to help in the repair of various fractures.

This was the beginning of fracture bracing, and this method of stabilizing fractures and other various limb injuries emerged into a very functional, extremely versatile and increasingly accepted way to stabilize limb injuries. Materials have evolved and now low-temperature thermo-moldable plastics are used to create these braces.

Bob Frank, a board-certified orthotist, prosthetist and president of Equine Bracing Solutions in Trumansburg, N.Y., acknowledges, "Even though fracture bracing was introduced more than 25 years ago many surgeons, human and equine, initially said that they felt more comfortable putting patients in fiberglass casts, but now it is about 50-50 between fiberglass casts and bracing products."

Ducharme is quick to point out that fiberglass casting still provides the best stability.

"A good cast will immobilize better than the best brace," he says. But newer braces are constantly improving the amount of stability. Both experts agree there are some significant advantages to bracing products. Equine braces are generally bi-valved, meaning they are made of two molded sections that fit together to encase the injured area. A series of straps or hook-and-loop attachments hold the two pieces together, and the resultant brace is form fitted and rigid but can be easily removed and put back on quickly.

This aspect of braces makes them less likely to produce sores, inflammation and irritation along the limb. The horse generally tolerates these devices very well, and the constant monitoring that is possible with easy removal and replacement allows for better management of open wounds. Additionally braces can be continually adjusted to account for changes in swelling reduction, muscle atrophy or growth.

Cost equation

"Economics can also be a factor because a brace (prices can be up to $800 or more for custom models) may be less expensive if a standard fiberglass cast (including anesthesia/sedation, bandage and cast materials and doctor time) must be replaced more than twice," Ducharme says.

While bracing techniques may not totally replace the use of fiberglass casts, these devices "should be considered as a viable option for fracture and injury management and as an economical alternative to standard circumferential casting methods," according to Dr. Paul Webber, a member of the American Academy of Orthotists and Prosthetists.

Ducharme agrees and feels that equine practitioners will gradually begin to increase their use of these devices stating, "I think bracing techniques will replace a lot of cast use when practitioners become more comfortable with them."

Comfort was certainly a factor in the disappearance of the old itchy plaster cast and a comfort level with what bracing devices can do for horses.


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Source: DVM360 MAGAZINE,
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