EXERCISE-1: EXAMINATION OF LAMENESS IN HORSE

Lameness
It is an indication of a structural or functional disorder in one or more limbs that is
manifested during progression or in the standing position
Synonym: Claudication
Classification (By Dollar 1952)
Supporting limb lameness
o This is evidenced when the horse supports the weight on the foot.
o e.g., injury to bones, joints, collateral ligaments
Swinging limb lameness
o This is evident when the limb is in motion.
o e.g., pathologic changes involving joint capsules, muscles, tendons, and
tendon sheaths.
Mixed lameness
o This is evident both when the limb is in motion and when it is supporting the
weight.
Complementary lameness
o Pain in one limb cause uneven distribution if weight on the another limb or
limbs which can produce lameness in lameness in previously sound limb.
EXAMINATION OF HORSE FOR CONFORMATION OF BODY
Forelimb and hindlimb
To evaluate conformation the horse should be
o Observed from a distance and also closely
o Examine at rest and also in motion
o Examine for proper length, angulation from anterior, lateral and rear views
o Examine for various limb contacts
o Limb determine Shape of feet, Wear of feet , Distribution of weight and
Flight of the feet
Faulty conformations of body
Short backed Horses
Long backed Horses
Examination of Lame limb suspected
Examination of seat of lameness
Faulty conformations of forelimbs
Base Narrow: The distance between the Centre lines of feet at their placement on
the ground is LESS THAN the distance between the centre lines of limbs at their
origin.
Base wide: Distance between the centre lines of the feet at their placement on the
ground is GREATER THAN distance between the center lines of limbs at their origin
in chest.
Toe in: Toes point towards one another when viewed from front
Toe out: Toes point away from one another
Base narrow-toe in
Base narrow -toe out
Base wide Toe Out
Base wide Toe in
Plainting: Placement of one forefoot directly infront of the other
Posterior deviation of carpal joint
Anterior deviation of carpal joint
Medial deviation of carpal joint
Lateral deviation of carpal joint
Open Knees: refers to irregular arrangement of carpal joint when viewed from side.
Lateral deviation of metacarpal bone
Tied in knees: When viewed from side floxor tendons appears to be too close to the
cannon bone just below carpus.
Cut out under knees: When viewed from side this condition causes a cutout
appearance just below carpus on anterior surface of cannon bone.
Standing under infront: When viewed from side entire forelimb from the elbow
down is placed to back of perpendicular and too far under the body.
Camped in front: When viewed from side entire forelumb from body to ground is
too far forward.
Short upright pastern
Long sloping pastern
Long upright pastern
Faulty conformations of hindlimbs
Base narrow: distance between center lines of feet is less than distance between
center lines at thigh region.
Base wide: Distance center lines of feet their placement on ground is greater than
distance between center line at thigh region.
Medial deviation of hock joints.
Excessive angulation of Hock joints
Base narrow from fetlock down.
Excessively straight legs / straight behind.
Standing under behind entire limb is placed too far forward / sickle hocks are
present.
Camped behind : Entire limb is placed far posteriorly.
DIAGNOSIS OF LAMENESS
Anamnesis
o Duration of condition
o Information about past incidence
o Breed , sex , age, nutrition others
o Past & immediate symptoms
o History of shoeing.
o Prevention, treatment & response
Character of stride of limb
o Phases of stride
o Arc of foot flight
o Path of foot in flight
o Landing of foot
Visual examination
The swellings, enlargements, faulty conformations.
o Fore Limbs & Hind Limbs
At rest
During motion
Landing of foot, placement of hoof, toe, heel
Movement of head
Arc of foot
Swellings, faulty conformation
Movement of all joints
Various limb contacts
Examination by Palpation
Start palpation from the bottom of foot and make a complete examination of entire
limb.
Forelimb
Examination of bottom of foot
o Contraction of heels
o Condition of frog
o Condition of sole
o Area of sensitively
o Bruises, wounds, necrosis
Hoof wall
o Excess dryness
o Contraction, cracks
o Wear & tear
Coronary band - Presence of heat, wounds
Lateral cartilages side bones
Pastern area - Swellings, change in temp pulsation
Fetlock Joint Pain, osselets, distention, joint disease
Cannon Bone Splints, periostitis
Suspensary ligament
o - Pain
o - Scar, Rupture, Sprain
Inferior check ligament
Superficial & deep flexor tendons
Carpus
Soft tissues
Elbow & Shoulder joints
Hind limbs
Hock joint Bog spavin, bone spavin, occult spavin, curb, capped hock.
Stifle joint - Gonitis
o Upward fixation of patella
o Rupture of collateral or
cruciate ligaments
Hip Joint - Round liagament,
Acetabular fracture, gait
Pelvis - Fracture
Tubercoxae, Tuber ischeii
Special examinations
o Using Hoof tester
o Local nerve blocks to determine site of lameness
o Radiography
o Thermography
o Ultrasonography



EXERCISE-2: DEMONSTRATION OF EQUINE SHOEING -
INTRODUCTION
Good shoeing is an art and a science. For farriers to do their best work, a proper area
should be provided, and well-mannered (tractable) horses should be presented.
There should be a place to tie horses safely at a height above the withers, and the
area should be well lighted, uncluttered, and level. A concrete slab covered with a
rubber mat is ideal. Shade and shelter should be provided for summer as well as for
winter work. Access to electrical outlets for power tools is essential. It is the horse
owners responsibility to present the farrier with a cooperative horse that has been
trained to have its limbs handled and its hooves worked on.
o The horses movement should be evaluated at a walk and at a trot in a straight
line so that the farrier can watch (from the front, rear, and side) the manner
in which the horse picks up its hooves, moves them, and puts them down.
o From the side view, the hoof should land flat or slightly heel first but generally
not toe first. From the front and rear view, the hooves should land flat.
o A hoof that does not land properly when it is time for a reset may indicate that
the hoof was not correctly shod in the first place, the hoof has grown out of
balance since the last shoeing, the horse is compensating for pain, or the
horses conformation is such that the hoof does not land flat.
o The way a hoof lands differs with each gait and from forelimb to hindlimb.
Most horses require shoeing every 5 to 8 weeks, partly because the hoof wall
at the toe grows faster than that at the heels, which causes the hoof to become
imbalanced.
o After removing the old shoes, each hoof and shoe are examined for clues to
wear patterns.
o The hoof angle can be determined by using a hoof gauge, and the length of the
untrimmed hoof can be measured with dividers or a ruler.
o The balance, shape, and symmetry of the hoof are assessed, and any
tendencies to form flares or dishes are noted. Hoof symmetry and size are
evaluated by comparing one hoof to the other.
HOW TO REMOVE A SHOE
Assemble the necessary tools for removing a shoe: the clinch cutter, hammer, pull-
offs, and crease nail puller.
Using the chisel end of the clinch cutter, open the clinches by tapping the spine of the
clinch cutter with the hammer.
The clinch is the end of the nail that is folded over; this needs to be opened so that
the nails can be pulled through the hoof wall without breaking off large hunks of the
hoof.
If the shoe is creased, use the crease nail puller to extract each nail individually,
which allows the shoe to come off.
Nails with protruding heads can be pulled out by using the pull-offs.
If the nails cannot be pulled out individually, remove the shoe with the pull-offs.
After the clinches have been opened, grab the shoe heel and pry toward the center of
the frog. Do the same with the other shoe heel.
When both heels are loose, grab one side of the shoe at the toe and pry toward the
center of the frog. Repeat around the shoe until it is removed.
Never pry toward the outside of the hoof, or you risk ripping big pieces out of the
hoof wall. As the nail heads protrude while the shoe is loosened, pull them out with
the pull-offs.
Pull out any nails that may remain in the hoof.
To protect the hoof until the shoe is replaced, either wrap the hoof edges with tape,
or, if the horse has a tender sole, tape a cloth over the bottom of the hoof or use a
protective boot. If the shoes are being pulled to let the horse go barefoot, a qualified
farrier should trim the hoof to minimize breakage and ensure balance.
Next, the sole is pared (if necessary), the hoof wall is nipped or rasped, and any
excess frog is trimmed.
The outside of the hoof wall is rasped (dressed) if it has flares or dishes. Once
trimming is completed, the hoof angle and length are measured, and the levelness of
the hoof wall is evaluated.
Shoes of the proper size and type for the horse are then selected.
The farrier should shape the shoe to fit a prepared hoof, not the other way around.
When the farrier is satisfied with the shape of the shoe and the way it seats on the
hoof wall, he or she begins nailing.
Usually, two nails are driven, the sharp tips are wrung off or bent over, and the hoof
is set down to see how the shoe positioned. The shoe is adjusted in necessary, and the
remain nails are driven and wrung off or bent over.
After the nails have been driven, the clinches are set or tightened and filed or cut to a
short, consistent length. The clinches are then folded flat against the hoof wall and
filed smooth.
A hoof sealer can be applied to prevent the hoof from drying out, especially if the
outer surface of the hoof wall required rasping.
Wax or another substance is used to fill all nail holes, which prevents mud, urine,
and water from invading and weakening the hoof.
PRINCIPLES OF PREVENTIVE SHOEING
Preventive trimming and shoeing should be a part of the routine hoof care program
for every horse.
The balance, support, and protection afforded by preventive shoeing contribute to a
horses comfort during movement.
Balance
Balance as it applies to horse shoeing is three-dimensional and may be defined as an
equal weight or force around the center of gravity of the hoses limb. Ideally, the
limbs center of gravity is identical with that of the foot.
STATIC VERSUS DYNAMIC BALANCE
Static
Static (geometric) balance refers to a geometric equilibrium of the limb and the hoof
in the standing position.
Generally, when the ground surface of the hoof is perpendicular to the axis of the
limb (when viewed from the front, the medial and lateral hoof walls are equal in
length, and the coronet is parallel to the ground), the hoof is in static balance.
Dynamic
Dynamic (functional) balance refers to the placement of the foot on (flat, level)
ground during movement.
When a hoof is in dynamic balance, it lands flat. This does not mean there is equal
weight distributed on the bottom of the foot, however, since more weight is normally
placed on the caudomedial side of the hoof during the stance phase.
For a hoof to be dynamically balanced for efficient motion and symmetric strides, the
trimming and shoeing must take conformation and other factors into consideration.
Achieving dynamic balance, especially when working on a gait abnormality, often
involves trial and error.
The more the conformation deviates from standard guidelines, the less likely static
and dynamic trimming techniques will produce similar results.
TOE-HEEL TUBULE ALIGNMENT
The angle of the hoof at the heel should be parallel to the angle at the toe. When the
heel angle is 5
o
less then the toe angle, the hoof is said to have underrun heels.
In such a case, the horn tubules at the heel may be crushed and collapsed forward
and may be more nearly parallel than perpendicular to the ground surface.
Rarely is the heel angle steeper than the toe angle, but it may appear that way if the
toe is allowed to grow out with a dish.
DORSAL - PALMAR / PLANTAR BALANCE
Dorsal - palmar / plantar (DP) balance refers to the hoof angle (relationship between
the dorsal wall of the hoof and the ground) and the alignment of the hoof angle and
the pastern angle.
Hoof angle is measured at the toe with a hoof protractor. For years, textbooks cited
45 to 50
o
as normal for the fore hoof angle and 50 to 55
o
for a hind hoof angle. But
observations by farriers indicate that normal forelimb pastern and hoof angles for
domestic riding horses range from 53 to 58
o
and normal hindlimb pastern and hoof
angles range from 55 to 60
o
, with the angles of an occasional normal horse falling
outside these ranges.
One study found that the mean forelimb hoof angle was 53.8
o
(range: 48 to 55
o
) and
the hindlimb mean hoof angle was 54.8
o
(range: 49 to 60
o
), with an occasional
steeper angle being observed in the fore hooves than in the hind hooves.
It is interesting to note that the dorsal hoof angles in wild horses were found to
depend on the terrain.
They ranged from 57 to 68
o
in soft, sandy environments; 54 to 62
o
in packed sod; and
51 to 57
o
in gravel and hard rock.
Each horse has its own ideal hoof angle.
The angle of the hoof is considered correct when the hoof and pastern are in
alignment; i.e., the dorsal surface of the hoof is paralles to an imaginary line (axis)
passing through the center of the long pastern bone (proximal phalanx).
The goal is to align the dorsal surface of the coffin bone with the long pastern bone
axis.
The hoof wall can be used as a guide only when it has no flares or distortions,
particularly in the area just below the coronary band.
The hoof wall should be straight all the way to the ground. If there are no flares or
distortions in the normal hoof, the dorsal surfaces of the hoof wall and coffin bone
are parallel.
This alignment is best viewed from the side of the horse with the horse standing
squarely on a hard, level surface with the cannon bone vertical.
An imaginary line through the center of the long pastern bone is used for the pastern
angle; it needs to be remembered that the pastern joint is invariably slightly
overextended regardless of hoof angle.
Using the irregular surface formed by hair and skin at the dorsal (front) surface of
the pastern can result in inaccurate alignment.
MEDIAL - LATERAL BALANCE
Medial-lateral (ML) balance refers to the relationship between the medial (inside)
wall of the hoof and the lateral (outside) wall of the hoof.
Determining ML balance is one of the most challenging aspects of farriery and relies
as much on art as it does on science.
The goal is to trim the hoof in such a way that the ground surface of the hoof is
centered beneath the limb. This allows the hoof structure to bear the weight of the
limb evenly.
Altering the relative lengths of the sides of the hoof shifts the position of the hoof
beneath the limb.
Lowering the lateral wall tends to position the hoof more toward the midline of the
horse, whereas lowering the medial wall tends to position the hoof away from the
midline of the horse.
Repositioning the limb by trimming, however, may have undesirable consequences.
One study evaluating the effects of ML balance showed that elevation of the medial
heel in sound horses increased the peak force and impulse on that side of the foot.
Problems associated with inappropriate ML hoof balance that lead to
disproportionate forces applied to the hoof wall include laterally distorted hooves;
chronic heel soreness; sheared heels; quarter, heel, and bar cracks; thrush; side
bones; navicular syndrome; and chronic metacarpophalangeal (fetlock) joint
synovitis.
LENGTH
The length of the hoof is measured at the center of the toe from the point where the
soft coronet (Periople) meets the hard hoof wall (stratum externum) to the ground
surface.
The toe length determines the length of the lever that the limb must break or pivot
over.
Long toes create a longer lever arm, a delayed breakover, and increased tension on
the palmar/plantar soft tissue support structures.
Extreme toe length may cause a prominent flare of the distal border of the hoof wall
and tearing of the lamina.
In cases in which the entire hoof wall is too long, the heels often contract and the
walls narrow, causing the foot to become hoof bound.
In chronic cases, the sole flattern and lameness usually develops.
The appropriate toe length of a freshly trimmed hoof ready for shoeing varies
according to the horses size, body weight, and breed.
For example, the toe length of a small 360-to 400-kg Arabian might be 7.6 cm (3
inches), that of a medium 425 to 475-kg Quarter Horse might be 8.25 cm (3.3
inches), and that of a large 525-to 575-kg Warmblood might be 8.9 cm (3.6 inches).
If a horse is to be barefoot, the hoof is left 0.25 inch longer than if it is to be shod.
One must keep in mind that the optimum length of the hoof wall is really dictated by
the optimum thickness of the sole.
In a study done in wild horses, toe lengths ranged from 6.7 cm (2.5 inches) to 8.3 cm
(3.25 inches).
LEVELNESS
The entire bottom of the hoof wall should be level so that it makes perfect (even)
contact with a smooth ground surface or a flat shoe.
Any unevenness will cause the hoof to bear weight unevenly.
In some cases, a farrier may purposely remove a portion of the hoof wall at the
ground surface to relieve a crack, flare, or displaced coronet.
In most instances, however, the hoof wall should be level.
SOLE
The natural sole is slightly cupped from side to side as well as from front to rear.
At the time of trimming, the sole is pared evenly to a concave shape down to the sole
plane.
If the sole is trimmed excessively, it will cause the horse to be sore when it walks on
gravel.
If the sole is left too thick, however, it can reduce hoof expansion during weight
bearing and may inhibit the natural springing action of the hoof capsule, which has
an important shock-absorbing function.
Also, a thick sole may prevent the farrier from trimming the toe sufficiently to attain
DP balance. Excessive trimming of the sole can weaken the bars.

FROG
The frog should be smoothly pared, with no loose or overgrown tissue that could trap
dirt and manure and harbor microorganisms.
The clefts of the frog at the heels should be trimmed out so that the hoof can self-
clean. It is not necessary or desirable for the frog to bear weight when the horse
stands on level ground.
Contrary to this is the concept is that the frog is designed to bear weight, since the
proprioceptive (sensory) receptors are found in the frog buttress.
Also, the lip that forms at the sides of the frog is designed to trap and hold dirt in the
frog commissure, which in turn provides support.




SHAPE
The inside wall of the hoof is generally steeper than the outside wall. The wall at the
toe is thicker than at the quarters.
The entire hoof wall from the coronary band to the ground should be straight, i.e.,
without dips or bulges.
Flares and dishes tend to be self-perpetuating. It there are any dishes (concavity in
the hoof wall at the toe) or flares (concavity in the sides of the hoof), the wall should
be rasped straight. This encourages the growth of a normal hoof shape.
To evaluate shape, the farrier finds the normal center of the bottom of the foot, most
recently referred to as Ducketts dot.
On the average riding horse, Ducketts dot is located 3/8 to inch back from the tip
of the trimmed frog.
A line drawn from the dot vertically through the foot would intersect the center of the
coffin bone and the articulation of the extensor process.
The dot is considered the external landmark for the foot vertical center axis.
Once the horses hoof has been trimmed and shaped, the distance from the dot to the
toe should equal that from the dot to the outermost border of the medial wall.
The distance from the dot to the lateral wall is usually greater.
SHOEING IMAGES

Concave shoe Deep seated shoe Shoe with side calk Shoe for draft horses
with traction
devices(Hind)

Heel elevated shoe Shoe for draft horse
with traction device
Bar shoe with
traction device
Shoe for ice walk

Extension shoe Extended shoe for
soft tissue pathology
Deep seated shoe Hind bar shoe with
one side extension

Shoe with trailer Moveable bar shoe Moveable bar shoe Hind shoe with side
clips


SHOEING IMAGES

Deep seated shoe
with side clips
Shoe with extension
to increase ground
force reaction
Traction device shoe
with toe and heel
calk
Deep seated shoe

Trailer shoe Bar shoe Shoe to increase
ground force
reaction on one side
Concave shoe



One missed



EXERCISE-3: EXTERNAL IMMOBILISATION
What are the functions of bandages?
o Cover and protect open wounds,
o Reduce edema, hemorrhage, and dead space,
o Promote wound healing,
o Immobilize osseous and soft tissue structures.
What are the components of a bandage?
o Inner, primary (contact) layer,
o Middle, secondary (intermediate) layer,
o Outer, tertiary (external) layer.
What are the types of and indications for dressings used in the contact layer?
o Adherent: wet or dry gauze used to absorb exudates or mechanically debride
necrotic tissue.
o No adherent:
Semi occlusive dressings that retain moisture and promote
epithelialization; used during reparative stages,
occlusive dressings, completely impermeable to air and promote
epithelialization and collagen synthesis.
Is topical antibiotic lavage useful in reducing wound infections?
o Not likely; some surgeons are convinced a reduction of bacterial
contamination in the suction units may be the major benefit.
What are some general guidelines for applying bandages to small animals?
o Animals often require chemical restraint
o Limbs and joints should be placed in near- normal positions, unless
elimination of weight bearing is required
o Joints above and below the injury need to be stabilized
o Bandages and splints should be evaluated weekly for damage, soiling, or
constriction of tissues
o Postsplintage radiographs are useful in confirming adequacy of bone
alignment.
What is a Robert Jones bandage?
o A bulky and compressive cotton roll applied to injuries below the elbow and
stifle joints. In general, 1 lb of cotton is used per 20 lb of body weight;
correctly applied, it should sound like a ripe watermelon when tapped.
Named after the British surgeon, Sir Robert Jones (1858- 1933).
What is Velpeau sling?
o A padded bandage applied to a flexed forelimb held in close apposition to the
thorax used to treat shoulder luxation and scapular fracture injuries; Name is
derived from a French surgeon, Alfred Armed Louis Velpeau(1795- 1867).
What is an Ehmer sling?
o Tape and bandaging material applied to a pelvic limb to produce non- weight
bearing, internal rotation, and abduction; used to treat coxofemoral fracture
and luxations. Named after Anton Emerson Ehmer, a Washington State
University Veterinary alumnus (1918).
What are some differences between plaster of Paris and fiberglass casts?
o Plaster of Paris is stronger in compression than tension because of its
crystalline structure, whereas fiberglass casting tapes are stronger in tension.
Synthetic casts are lightweight, radiolucent, easy to apply, and more
expensive than plaster casts.
DRESSING AND EXTERNAL COAPTATION
What are the functions of bandages?
o Cover and protect open wounds,
o Reduce edema, hemorrhage, and dead space,
o Promote wound healing,
o Immobilize osseous and soft tissue structures.
What are the components of a bandage?
o Inner, primary (contact) layer,
o Middle, secondary (intermediate) layer,
o Outer, tertiary (external) layer.
What are the types of and indications for dressings used in the contact layer?
o Adherent: wet or dry gauze used to absorb exudates or mechanically
debride necrotic tissue.
o No adherent:
Semi occlusive dressings that retain moisture and
promote epithelialization; used during reparative stages,
Occlusive dressings, completely impermeable to air and
promote epithelialization and collagen synthesis.
Is topical antibiotic lavage useful in reducing wound infections?
o Not likely; some surgeons are convinced a reduction of bacterial
contamination in the suction units may be the major benefit.
What are some general guidelines for applying bandages to small animals?
o Animals often require chemical restraint
o Limbs and joints should be placed in near- normal positions, unless
elimination of weight bearing is required
o Joints above and below the injury need to be stabilized
o Bandages and splints should be evaluated weekly for damage, soiling, or
constriction of tissues
o Postsplintage radiographs are useful in confirming adequacy of bone
alignment.
What is a Robert Jones bandage?
o A bulky and compressive cotton roll applied to injuries below the elbow and
stifle joints. In general, 1 lb of cotton is used per 20 lb of body weight;
correctly applied, it should sound like a ripe watermelon when tapped.
Named after the British surgeon, Sir Robert Jones (1858- 1933).
What is Velpeau sling?
o A padded bandage applied to a flexed forelimb held in close apposition to the
thorax used to treat shoulder luxation and scapular fracture injuries ; Name is
derived from a French surgeon, Alfred Armed Louis Velpeau(1795- 1867).
What is an Ehmer sling?
o Tape and bandaging material applied to a pelvic limb to produce non- weight
bearing, internal rotation, and abduction; used to treat coxofemoral fracture
and luxations. Named after Anton Emerson Ehmer, a Washington State
University Veterinary alumnus (1918).
What are some differences between plaster of Paris and fiberglass casts?
o Plaster of Paris is stronger in compression than tension because of its
crystalline structure, whereas fiberglass casting tapes are stronger in tension.
Synthetic casts are lightweight, radiolucent, easy to apply, and more
expensive than plaster casts.
STEPS FOR MAKING A POP SPLINT
Place strips of adhesive tape applied are applied on the caudal and carnial surface of
the foot protruding a few inches distal to the end
An orthopaedic stockinet is applied
The cast is unrolled and the limb is premeasured enclosing two joints
The cast material is cut according to the premeasured length
Five to six layers of cast material are placed over each other, each end rolled towards
the other and submerged in warm water for 15 seconds
The water is squeezed from the plaster strips
The cast strips are moulded to the contour of the bone involved and allowed to
harden
The bone is placed in extension and the strip applied to the caudal surface of the
bone.
Adhesive tapes are applied to keep the plaster strip in place
A roil bandage is applied over the strip
The distal edges of the plaster should be rounded and trimmed with scissors to
conform to uniformity of the limb
The cast can be further reinforced with elastic bandage

Bandage care
Daily bandage check is essential
Weekly bandage change-essential
Watch for foul odour, self mutilation, pressure necrosis on skin and limb swelling
Amputation is the price paid for poor care
BANDAGE CARE
Keep bandage/splint clean and dry
Observe digits for coolness/swelling
Observe for evidence of self mutilation/foul odour
( If problems noted, remove and reassess)
Observe for evidence of pressure sores
Keep bandage/splint intact for 3-4 weeks
PVC SPLINT

PVC Splint with padding file

PVC Splint in a Bullock

THOMAS SPLINT IN A CALF

Thomas splint in a calf

Thomas splint in a calf

FIBRE GLASS SPLINT

Fibre glass Splint-Calf Fibre glass splint-Horse Fibre glass splint in position-Goat

Fibre glass splint-Goat Fibre glass splint-Horse Fibre glass splint

Fibre glass splint application Fibre galss splint application-Calf Completed fibre glass splint
application





EXERCISE-4: DEMONSTRATION OF TRANSFIXATION
TECHNIQUE

Drilling guide holes with twist drill bit Insertion of Steinmann pin through the
guide hole

PVC splints fixed on to the transfixation
pins
Transfixation pins with plaster cast

Sliding guide pin-gripper technique Transfixation with bilateral type II
external skeletal fixator

Metacarpal fracture in a calf stabilized
with transfixation pinning and casting
showing weight bearing
Metacarpal fracture in a calf stabilized
with bilateral type II external skeletal
fixator showing weight bearing


MANAGEMENT OF FRACTURE-TIBIA-CALF



Diaphyseal short oblique fracture -calf Transfixation pins in position



Reinforced fibre glass slab and transfixation
pins in position
Post operative outcome