There is no particular difference in the handling of carpal luxation and

dislocation of other bones. Where ligaments have not been destroyed to

the extent that reduction is of no practical use, the parts are kept

immobilized, if thought necessary. Later, vesication of the whole

pericarpal region is done and the subject allowed exercise at will.

Carpitis.

Etiology and Occurrence.--Inflammation of the carpus is caused by

contusions, such as are occasioned in falling, by kicks by striking the

carpus against objects in jumping and sometimes by striking it against

the manger in pawing. The condition is of rather frequent occurrence.

Symptomatology.--Evident symptoms of inflammation in carpitis are

always present--hyperthermia, supersensitiveness and swelling. Also,

there exists lameness which is characterized by an apparent inability to

flex the leg, and there is circumduction of the leg as it is advanced

because in this way little if any flexion of the carpus (which increases

pain) is necessary.

Depending upon the nature of the cause, there occurs a marked difference

in the character and amount of swelling.

[Illustration: Fig. 11--Pericarpal inflammation and enlargement due to

injury.]

Naturally, when much extravasation of serum and blood takes place, there

is occasioned a fluctuating swelling which is usually less painful to

the subject upon manipulation than is a dense inflammatory change

without marked extravasation.

In acute carpitis, there is present, then, a very painful condition

which involves the articulation, causing marked lameness, disturbance of

appetite and some elevation of temperature.

Chronic cases do not occasion serious pain or constitutional

disturbances, but do interfere with locomotion in direct proportion to

the existing articular inflammation and periarticular hypertrophy of

ligamentous and tendinous structures.

Treatment.--If possible, keep the subject absolutely quiet, employing

the sling if necessary. During the first stages of inflammation, the

application of ice packs to the affected parts, is of marked benefit.

At the end of forty-eight hours, hot applications may be used and this

treatment continued throughout several days. Anodyne liniments are of

service and should be employed throughout the acute stage of

inflammation during intervals between the hydrotherapeutic treatments.

As inflammation subsides, a counterirritating application such as a

suitable liniment and later blistering or line-firing is helpful in

stimulating resolution.

[Illustration: Fig. 12--Hygromatous condition of the right carpus, also

distension of sheaths of extensor tendons of both fore legs.]

Open Carpal Joint.

Anatomy.--The carpal bones as they articulate with one another and

with the radius and metacarpal bones, as classed by anatomists, form

three distinct articular parts of the joint as a whole and are known as

radiocarpal, intercarpal and carpometacarpal. These three pairs of

articulating surfaces are all enclosed within one capsular ligament. On

the anterior face of the bones, the capsular ligament is attached to the

carpal bones in such manner that an imperfect partitioning of the three

joint compartments is formed. Posteriorly, the capsule is very heavy and

forms a sort of padding over the irregular surfaces of the bones, and

also its reflexions constitute the sheaths of the flexor tendons. The

anterior portion of the capsular ligament forms sheaths for the extensor

tendons, and both portions of the joint have an attachment around the

distal end of the radius and another at the proximal end of the

metacarpal bones.

[Illustration: Fig. 13--Carpal exostosis in aged horse.]

Etiology and Occurrence.--Puncture wounds of any kind may serve to

perforate the joint capsule and such traumatisms are occasioned by

falls, kicks and in various ways in runaway accidents, and open carpal

joint may follow.

Symptomatology.--The pathognomonic symptoms of the existence of an

open joint is the exposure to view of articular surfaces of bones or

noting the escape of synovia from the joint capsule. As has been

previously referred to, there always exists a peculiar suspension of

carpal flexion in all cases of carpitis.

Non-infective wounds which may cause open joint are not necessarily

productive of an active carpitis--a synovitis may be the extent of the

disturbance. Unlike synovitis, which may characterize a non-infectious

penetrative wound of the capsular ligament, septic arthritis which may

supervene is a very painful inflammatory disturbance. It is

characterized by all of the symptoms which attend the case of open joint

and synovitis plus the obvious manifestation of great pain. There is an

elevation of temperature of from two to five degrees above normal;

circulation is accelerated; the pulse is bounding; respiration is

hurried; there is an expression of pain as indicated by the physiognomy;

and because of rapid erosive changes of cartilages which take place,

there is soon so much of the articulation destroyed that death is

inevitable. Death is usually due to generalization of the arthritic

infection.

[Illustration: Fig. 14--Exostosis of carpus resultant from carpitis.]

[Illustration: Fig. 15--Distal end of radius. Illustrating the effects

of chronic carpitis.]

In the meanwhile, if the character of the infectious material is not so

virulent, the disease will take on a slower course and the subject may

experience laminitis from supporting weight upon the sound member, or

because of continued recumbency, decubital gangrene and emaciation

sometimes cause death. If the subject does not soon succumb, it is

compelled to undergo days or even weeks of unnecessary suffering, and

too often in such cases, it is later deemed advisable to destroy the

animal because of the cost of continuing treatment until the horse is

serviceable. Therefore, it is evident that when such joints as the

carpus or tarsus are open and infection exists, if they are not promptly

treated and the infectious process checked, it is neither humane nor

practical to prolong treatment.

Distinction must be made between the different joints when infected as

the condition is much more serious in some cases than in others. All

things considered, perhaps open joints rank, with respect to being

serious cases as follows: elbow, navicular, stifle, tarsus, carpus,

fetlock and pastern. This, of course, is restricted to articulations of

the locomotory apparatus.

Treatment.--Preliminary care in the treatment of an open carpal joint,

is the same as has been described in this condition as it affects the

scapulohumeral articulation described on page 65. Likewise the further

treatment of such cases is along the same lines except that where it is

possible, the parts are kept covered with cotton and bandages. However,

in some cases, animals have been successfully treated without bandaging

and by keeping the patient in a standing position and on pillar reins

until recovery resulted. Such cases were of the non-infectious type and

recovery was possible within three or four weeks. Further, the condition

is not sufficiently painful in such instances as to prevent the subjects

bearing weight with the affected member; hence, no danger of resulting

laminitis is incurred. And finally, where bandages are not employed, the

frequent use of antiseptic dusting powders is substituted for cotton as

a protector.

When bandaged, such wounds need dressing more or less frequently, as

individual instances demand. The purulent infective inflammation of a

carpal joint will require daily dressing; whereas, in other cases

(non-infective), semi-weekly change of bandages is sufficient. Equal

parts of boric acid and exsiccated alum constitute a suitable

combination for the treatment of these cases, and this powder should be

liberally employed. Tincture of iodin may be injected into the joint

capsule where there is provision for its ready evacuation, as

conditions seem to require. Daily injections for three, four or five

days, are not harmful and will control infection in many instances.

Thecitis and Bursitis.

Etiology and Occurrence.--The thecae and bursae of the leg are several

in number. In the carpal region, the flexors of the phalanges are

contained together in the carpal sheath, and this is the principal theca

in the carpal region. Each of the tendons is provided with synovial

sheaths which are subject to inflammation and occasionally synovitis and

distension of these synovial sheaths occur.

Because of faulty conformation, some animals are subject to inflammation

of these sheaths, and all forms of strenuous work which taxes the

tendons greatly is apt to result in synovitis. Direct injury such as

blows may be the cause of synovial distension of thecae and the

affection is to be seen in all horses that have done much fast work on

hard road surfaces or pavements.

The usual case as it occurs in practice is a non-infective synovitis,

but where puncture wounds cause the trouble, an infectious inflammation

obtains.

Symptomatology.--No trouble is experienced in diagnosing distension of

tendon sheaths, for the affection is very palpable. During acute

inflammatory stages of this affection, some lameness is present--in

infectious inflammation lameness is intense. Local heat and pain upon

manipulation are readily discernible in all acute cases. And finally,

where there is reason for doubt, an aseptic exploratory puncture of the

wall of the fluctuating enlargement may be made with a suitable trocar,

and the discharging synovia will be proof of the existence of synovial

distension.

After the affection becomes subacute or chronic, no lameness or

inconvenience is manifested, and the condition is undesirable only

because of its being a blemish.

Treatment.--Acute non-infectious synovial distension of tendon sheaths

is treated by aspirating as much synovia as possible from the affected

theca (this is, of course, done under strict asepsis) and by means of

bandages, a uniform degree of pressure is kept over the parts for ten

days or two weeks. The patient is kept quiet and in the course of two

weeks an active blistering agent is employed over the region affected.

Usually, at the end of a month's time, complete recovery has taken place

and the subject may be gradually returned to work.

When synovial distensions are of long standing, it is necessary to take

special precautions to check excessive secretion of synovial fluid, and,

also because of the atonic condition of the tissues affected, resolution

is tardy. In addition to aspirating synovia, the introduction of equal

parts of alcohol and tincture of iodin into the theca is necessary. The

quantity of this combination injected, depends upon the size of the

sheath affected and the amount of synovia retained at the time injection

is made. Experience is necessary to judge as to this part of the work,

but one may consider that a quantity between three and ten cubic

centimeters of equal parts of tincture of iodin and alcohol constitutes

the proper amount to employ. Where much synovia is contained within the

sheath at the time of injection, there occurs great dilution of the

agent injected and consequently less irritation results.

The object of such injections is to check synovial secretion, and this

is sought by the local effect of iodin in contact with the secreting

cells together with the reactionary swelling which occasions pressure.

An increase in the local blood supply also follows. In all cases where

it is possible to employ suitable bandages, this should be done. The

ordinary derby bandages serve well and if their use is continued for a

sufficient length of time, good results follow.

There are other methods of treating these affections, and each has its

advantages and disadvantages. Line-firing, instead of the vesicant is

made use of by some, but the object desired is the same and results

obtained are similar.

Sheaths may be opened surgically by means of a knife, and the removal of

a portion of the wall of distended and atonic tendon sheaths is

possible. These operations belong to the realm of surgery and are not

properly a part of this treatise. However, in passing, it may be said

that if a perfect technic is possible in doing the last named

operation, a permanent recovery is the outcome.

Fracture of the Metacarpus.

Etiology and Occurrence.--As the result of all sorts of violence, such

as falls and injuries in accidents of various kinds wherein the

metacarpals are subjected to contusions, fractures may result. In the

horse it is unusual for fracture of one of the small metacarpal bones to

take place without there being at the same time a fracture of the third

(large) metacarpal bone.

Classification.--Fractures of the metacarpal bones as they occur, are

as likely to be compound as simple, and the multiple and comminuted

varieties are occasionally observed. The manner in which the third

(large) metacarpus is fractured, largely determines the outcome in any

given case.

Symptomatology.--Abnormal mobility of the broken parts of bone and

crepitation mark fracture of the metacarpus, and the condition is easily

diagnosed. In many instances, when compound fracture exists, broken ends

of bone are protruding through the skin. No weight is borne upon the

fractured member ordinarily, although during the excitement occasioned

by runaways, horses are sometimes seen to support weight with a broken

leg even when the protruding bone is sunk into the ground in so doing.

Prognosis.--Generally speaking, fractures other than the

simple-transverse in young animals, are considered unfavorable cases.

With the metacarpus, however, there are instances where compound

fracture occurs in colts that justify treatment. But in all cases of

compound fracture, the element of infection in addition to the increased

difficulty in maintaining immobility of the broken bone, creates almost

insuperable difficulties in the average instance. And unless the

practitioner distinctly explains to his client the various reasons which

make treatment an economic impracticability, dissatisfaction is likely

to follow if treatment is instituted without such an understanding.

Treatment.--Perfect apposition of the broken ends of bone is easily

effected and less difficulty is encountered in maintaining such

relations in metacarpal fractures than in fractures of the radius.

However, reduction and immobilization of this as in all fractures, must

be done without delay. In simple fracture, the metacarpus is covered

with enough cotton to pad the parts, and this is retained in position by

bandages. Splints of heavy leather or of thin pieces of tough flexible

wood are placed on each side of the leg and firmly held in position with

bandages. Bandages may be put on in layers and a coating of glue applied

over each layer if this is thought necessary. The advantage gained in

using glue or other adhesive materials is that the cast thus formed is

more rigid than where such material is not employed. On the other hand,

all elasticity is lost as soon as the cast adapts itself to the contour

of the extremity, and because of this rigidity, it is doubtful if

anything is gained by the incorporation of glue, except in the way of

added strength of the cast. Since the animal does not walk upon the

broken leg, it is possible to employ splints of suitable materials which

are retained in position without glue and frequent readjustment of a

part of the immobilizing apparatus is possible. This is impossible with

casts.

In compound fractures, provision ought to be made for dressing the wound

of the soft structures. This entails adjusting the splints in such

manner that one splint may be retained and others removed for dressing

the wound and readjusted as often as wound dressing is necessary.

Splints.

By this term is meant a condition where there exists an exostosis which

involves usually the second (inner small) and third (large) metacarpal

bones. While an exostosis involving any one of the splint bones, even

when directly caused by an injury, is called a "splint," the term is

employed here, in reference to exostoses not due to direct injury such

as in contusions.

Etiology and Occurrence.--This condition is one wherein there is

osseous formation following a periostitis and the region of the upper

portion of the second (inner small) metacarpal bone is the usual site of

the exostosis. There is incited an inflammation of the periosteum at

the site of the interosseous ligament which attaches the small to the

large metacarpal bone. This ligament is involved in the inflammatory

process, and according to Havemann, whose view is supported by Moller,

this inflammation is the origin of the trouble.

Various theories attempting an explanation of the frequent affection of

this one certain part so regularly involved have been offered, but no

proof of the correctness of any exists. It follows, however, that

splints occur in young animals; that the affection seldom starts in

subjects that are ten years of age or older, and that when the exostosis

has formed, lameness usually subsides. Anything which will cause undue

strain or irritation of the metacarpal bones in young animals, is quite

apt to result in a splint being formed. Concussion such as is caused by

fast work on hard roads, or work on rough or irregular road surfaces

which cause unequal distribution of weight, will cause splint lameness

and exostosis follows.

[Illustration: Fig. 16--Posterior view of radius (right) illustrative of

effects of splint. Note the extent of exostosis.]

Course.--Because of the peculiar manner in which the second and third

metacarpal bones articulate in young animals, until the bones become

ossified and permanently joined, the inflammation which attends the

acute stage of this affection, causes lameness. Later, unless an

unusually large exostosis is formed, which may cause a constant

irritation due to its size and juxtaposition to the carpus, lameness is

discontinued.

Symptomatology.--Lameness is usually the first manifestation of this

disorder, and the thing which characterizes splint lameness is its

peculiar intermittence. There is a mixed form of lameness which may not

be in evidence when an affected animal is started on a drive, but which

is marked after the subject has gone some distance. The animal may,

however, go lame throughout the whole of a drive and continue to be lame

for several days or weeks in some cases. It is noticeable that lameness

is augmented or produced when the subject travels on rough road surfaces

and that little or no difficulty is encountered when roads are smooth.

The heavy brachial fascia is inserted in part to the head of the second

metacarpal (inner small) bone together with the oblique digital extensor

(extensor metacarpi obliquus) and this explains the reason for pain

being manifested during extension of the member.

Before there is a visible exostosis, supersensitiveness is readily

recognized upon palpation of the parts, if careful comparison is made

between the sound and unsound members. However, frequently splints occur

on both forelegs at the same time and in some instances exostoses are

several in number upon each member affected. In some instances, the

affection involves the outer splint bone and no evident involvement of

the inner one exists.

Treatment.--At the onset complete rest should be provided and the

local application of some good cataplasm is in order. A stimulating

liniment is beneficial when employed several times daily and massage is

also quite helpful. Later, the application of a blistering ointment is

good treatment. The use of the actual cautery stimulates prompt

resolution, but there is seldom any resorption of products of

inflammation following firing. Whereas, in cases where other treatment

is begun early, there usually follows considerable diminution in the

size of the exostosis. A rest of four or five weeks is necessary and

very young animals should not be put to work too soon, if the character

of the work is such as to induce a recurrence of the trouble.

Many cases are treated successfully in draft types of animals (where the

subjects are not kept at work that occasions serious irritation to the

affected parts) by blistering the exostosis repeatedly and allowing the

animals to continue in service. In such cases, it is unreasonable to

expect to check the size of the exostosis and, of course, such methods

are not employed where lameness causes distress to the subject.

Firing usually causes prompt recovery from lameness and is a dependable

manner of treating such cases but there remains more blemish following

cauterization than where vesication is done.

OPEN FETLOCK JOINT.

This condition, because of the frequency with which it occurs may be

taken as typal, from the standpoint of treatment and results obtained

therefrom. While it serves to constitute a basis from which other

joints, when open, are to be considered, due allowance must be made for

the fact that, as has been previously mentioned, some articulations when

open constitute cause for grave consequences; while with others an open

capsule, even when infected, does not cause disturbance enough to be

classed as difficult to handle. Moreover, the fetlock joint is admirably

suited, anatomically, to bandaging; and when wounded, is easily kept

protected by means of surgical dressings. This fact is of great

importance in influencing the course and termination in any given case

of open fetlock joint and should not be forgotten.

There is no logical reason for comparing the pedal joint with the

pastern on the basis that it may also be completely and securely

bandaged. Open navicular joint does not occur, as a rule, except by way

of the solar surface of the foot, and the introduction of active and

virulent contagium is certain to happen; consequently, an acute

synovitis quickly resulting in an intensely septic and progressively

destructive arthritis soon follows in perforation of the capsule of the

distal interphalangeal articulation.

Etiology and Occurrence.--Wounds of the fetlock region resulting in

perforation or destruction of a part of the capsular ligament are caused

by all sorts of accidents, such as wire cuts, incised wounds occasioned

by plowshares, disc harrows, stalk cutters and other farming implements.

In runaways the joint capsule is sometimes punctured by sharp pieces of

wood or other objects. In horses driven on unpaved country roads the

fetlock is occasionally wounded by being struck against the sharp end of

some object, the other end of which is firmly embedded in the ground. In

one instance the author treated a case wherein the fetlock joint was

perforated by the sickle-guard of a self-binder. In this case there

occurred complete perforation causing two openings through the

_cul-de-sac_ of the joint. Such wounds are produced by implements which

are, to say the least, non-sterile, and this perforation of the

uncleansed skin conveys infectious material into the joint capsule. Yet

in many instances, especially in country practice, no infectious

arthritis results where cases are promptly cared for.

Symptomatology.--A difference in the character of symptoms is

evidenced when dissimilar causes exist. Small penetrant wounds which

infect the synovial membranes cause infectious arthritis in some cases,

whereas a wound of sufficient size to produce evacuation of all synovia

will, in many instances, cause no serious distress to the subject, even

when not treated for several days. If it is not evident that an open

joint exists and the articular cavity is not exposed to view a positive

diagnosis may be early established by carefully probing the wound. In

some cases where a small wound has perforated the joint capsule,

swelling and slight change of relation of the overlying tissues may

preclude all successful exploratory probing. In such instances it is

necessary to await development of symptoms. Twenty-four hours after

injury has been inflicted, there is noticeable discharge of synovia

which coagulates about the margin of the orifice, where synovial

discharge is possible. Particularly evident is this accumulation of

coagulated synovia where wounds have been bandaged--there is no

mistaking the characteristic straw-colored coagulum which, in such

cases, is somewhat tenacious.

No difference exists between other symptoms in infectious arthritis

caused by punctures, and non-infectious arthritis, excepting the

intensity of the pain occasioned, the rise in temperature, circulatory

disturbances, etc.; all of which have been previously mentioned.

Treatment.--Just as has been stated in discussions on the subject of

open joint, probing or other instrumentation is to be avoided until the

exterior of the wound and a liberal area surrounding has been thoroughly

cleansed--too much importance can not be placed on this preliminary

measure. In cases of open joint where ragged wound margins exist and the

interior of the joint capsule is contaminated, much time is required to

thoroughly cleanse all soiled parts. In some instances an hour's time is

required for this cleansing process after the subject has been

restrained and prepared. In order to thoroughly cleanse these delicate

structures without doing them serious injury, one ought to be skillful

and careful in all manipulations of the exposed parts of the joint

capsule.

The general plan of treatment, after preliminary cleansing has been

accomplished, has been outlined on page 66 in the consideration of

scapulohumeral joint affections. The injection of undiluted tincture of

iodin in ounce quantities, it must be remembered, is not to be done

unless there is provision for its free exit. Where good drainage from

the joint cavity exists all infected wounds should be thus treated, and

this treatment may be repeated as conditions seem to require--until

infection is checked.

If daily injections are necessary, dilution of the tincture of iodin

with an equal amount of alcohol is advisable in order to avoid doing

irreparable damage to the articular cartilages and synovial membranes.

An antiseptic powder composed of equal parts of boric acid and

exsiccated alum is employed to protect the wound surfaces and the

margins, and the parts are then bandaged. In bandaging wounds of this

kind a liberal amount of cotton should be employed, and after a large

surface surrounding the wound has been thoroughly cleansed, it must be

so kept thereafter. This is impossible, if one uses a small amount of

cotton, particularly if such meager quantity of dressing material is

carelessly wrapped in position with an insufficient amount of bandage

material. Mention, without description of the elemental problem of

applying cotton and bandages to a wound, would be sufficient, were it

not that this is a very important part of the handling of such cases,

and many practitioners are not only thoughtless in this part of their

work, but also apparently careless. What does it profit to prepare a

part and cleanse a wound with painstaking care and then neglect to take

every possible precaution to prevent its subsequent contamination?

In the handling of open joint capsules where the perforation of the

capsular ligament is small and discharge of synovia does not immediately

follow, there is presented a problem which is difficult to decide upon

and that is the manner in which such wounds are to be handled. One

hesitates to enlarge such openings to drain or irrigate the capsule when

there is no proof that serious trouble will follow because of infectious

material which has probably been introduced at the time the wound was

inflicted. It is especially difficult to decide upon the manner of

handling such cases where the tarsal joint is wounded, although one

hesitates to invade any joint to the extent of incising its capsule,

unless there is urgent need of so doing.

Frost[19] offers the following suggestion in such instances:

The treatment recommended by us for open joints, in which we wish

to prevent ankylosis, is, first, to shave all hair from the area

surrounding the wound, following with a thorough cleansing of the

skin and disinfection of the wound, and then to inject a twenty per

cent Lugol's solution in glycerin into the wound. This should be

repeated two or three times a day, each time enough of the solution

being injected to fill the joint capsule, thereby securing the

flushing effect. As this solution does not cause irritation to the

tissue and yet is a strong antiseptic, it serves to shorten the

period of congestion and inflammation and to overcome the infection

without causing a destruction of the secreting membrane until the

external wound has had time to heal. The injection of this solution

seems to retard the excessive secretion of synovia. The larger the

joint capsule and the smaller the external wound, the longer our

antiseptic will remain in contact with the inflamed tissues as the

glycerin, being thick, does not flow through a small opening.

After-care.--Following the initial cleansing and treatment of open

joint, subsequent dressing is necessary as frequently as conditions

demand. If the parts are badly infected and profuse discharge of pus

exists a daily change of dressings is necessary. In the average

instance, however, semi-weekly treatments are sufficient. And in many

instances where one is obliged to travel a considerable distance to

handle the affected animal one weekly dressing of the wound will suffice

after the second treatment.

The same general plan of treatment concerning the subject's comfort that

has been previously mentioned in arthritis, is carried out here. A

further and detailed consideration of the subject of handling of open

joints follows.[20]

* * * Such wounds may be classified in two general groups as

follows: First, wounds in which the trauma has exposed the

articulation to view, and second, those the result of punctures, in

which the external wound is small and free drainage is lacking.

Wounds in which the articulation is exposed to view have drainage

either all ready provided for, or it is established without

hesitancy surgically. With free drainage thus established there is

little or no chance for the adjacent tissues to become infiltrated

with infected wound discharge. This prevents an extension of the

injury and the establishment of a good field for the growth of

anaerobic bacteria.

Open joints caused by punctures, unless the puncture is aseptic,

produce a swelling which is more painful than is the open wound

which exposes the joint to view. Especially is this true if the

puncture is of small diameter, allowing the tissues to partially

close the opening immediately after the wound has been made. Where

drainage is lacking there follows an exudation which congests the

tissues surrounding the injury and all factors favoring germ growth

are present. It is perhaps advisable to establish good drainage in

such cases as soon as a diagnosis is made.

It is not always an easy matter to recognize an open-joint, when

first made, but twelve to twenty-four hours later there is no cause

for doubt. The condition is then a very painful one; lameness is

excessive; there is rise in temperature; acceleration of the pulse

and manipulation or palpation of the region affected, occasions

great pain.

The treatment of open joints must be varied to suit the disposition

of the animal, the nature and location of the injury, the length of

time intervening between the infliction of the wound and the first

attention given, and the surroundings in which the patient is kept.

In each and every case in which there exists an open wound the

surface surrounding the wound is cleansed thoroughly, the hair is

shaved if possible, and the margin of the wound is curretted and

cleansed thoroughly with antiseptic solutions.

If there is evidence that the articulation contains infective

material, it is washed out with copious quantities of peroxide of

hydrogen--usually as much as six or eight ounces. This is followed

by injection of an ounce or two of tincture of iodin. Even though

the joint appears to be clean some tincture of iodin is used, as it

checks the secretion of synovia and is, in every way, beneficial.

Care is taken to apply the iodin also to the surface immediately

surrounding the wound. The entire wound is then covered with a

dusting powder composed of zinc oxide, boric acid, exsiccated alum,

phenol and camphor.

This powder is used in abundance and the wound is then covered with

a heavy layer of absorbent cotton and well bandaged. This bandage

is not disturbed for at least three days and may be left in place

for a week. In cases in which it is necessary to keep the dressing

on for a week, or in cases where the patient is, through necessity,

kept in quarters that are wet or unclean, the first bandage is

covered with a layer of oakum which has been saturated in oil of

tar and this in turn is held in place by means of several layers of

bandages. The bandages are also saturated with oil of tar.

In from one to two months wounds so treated, unless they are

foot-wounds, will be ready to dress without being bandaged. It is

ordinarily unnecessary to dress foot-wounds oftener than every

second week after the discharge of synovia has ceased. When the

wound has filled with granulation, a protective dressing is applied

which is rendered water proof by the use of bandages covered with

oil of tar. The patient can now be turned out for a month or six

weeks without disturbing the dressing. After the removal of the

bandages, the only treatment necessary is an occasional application

of some mildly antiseptic ointment.

Except in nail pricks of the foot, occasioned by punctures, a five

per cent tincture of iodin is injected into open joints, if the

wound remains sufficiently open, and this treatment is continued so

long as there is a discharge of synovia. Surgical drainage is

established if it is considered practicable and the remainder of

the treatment is about the same as for wounds which are open.

Open joints occur in horses at pasture and are sometimes not

discovered until several days or a week after the injury, and in

some instances the wounds are filled with maggots. The only

difference in the treatment of these cases is that more time and

care is taken in cleansing the wound, more curetting is necessary,

and after cleansing the wound with peroxide of hydrogen, the joint

is thoroughly washed out with equal parts of tincture of iodin and

chloroform. This is followed by the injection of a quantity of

seventy-five percent alcohol and the wound is dressed and bandaged

as already described. At each subsequent dressing of infected

wounds so treated less suppuration is noticed and the synovial

discharge usually ceases in from one to two months.

About _ninety percent of all cases of open joint make complete

recoveries_, about four per cent partially recover and six per cent

are fatal. Among the fatal cases are the open joints with

complications as severed tendons, those occasioned by calk wounds

in horses that are stabled, and nail punctures of the feet. The

following report of twelve favorable cases is taken from a record

of sixty-two cases. The favorable ones are reported, chiefly

because there are now enough reports on record of such cases which

have terminated fatally.

Case 1.--A gray gelding used as a saddle pony received a

horizontal wire cut laying completely bare the scapulohumeral

articulation. The margins of the wound were cleansed as heretofore

described, a drainage was provided surgically, tincture of iodin

was injected and the wound was covered with equal parts of boric

acid and exsiccated alum. The horse was kept tied and a diluted

tincture of iodin was injected into the wound once daily and the

powder applied often enough to keep the wound covered. The case

made a complete recovery and the pony was again in service within

sixty days.

Case 2.--A twelve-hundred-pound bay mare with an open carpal

joint. The wound was an open one about two and one-half inches in

length, and made transversely and when the member was flexed the

articular surface of the carpal bones were presented to view. An

ounce of tincture of iodin was injected into this joint after

having cleansed the margin of the wound and the mare was cross-tied

in a single stall to keep her from lying down. The owner was

instructed to keep the outside of the wound powdered with air

slaked lime and a very unfavorable prognosis was given.

I heard nothing further from this case until fifty-nine days from

the date of the injury, when I met the owner driving this mare to a

buggy. The wound had healed by first intention and at that time so

little cicatrix remained that it was difficult to find it.

Case 3.--A brown mare with an open fetlock joint due to a

spike-nail puncture. Lameness was excessive, and joint greatly

swollen. Tincture of iodin was injected into the wound and towels

dipped in hot antiseptic solutions were applied for several hours

daily until the acute stage had passed. Later the mare was turned

out to pasture and a vesicant was applied once or twice a month

until recovery was complete which was in about six months.

Case 4.--A four-year-old bay mare having a wire-cut which opened

the tarsus joint was treated as heretofore described. The wound was

kept bandaged for about two weeks and later it was dressed without

being bandaged. In ninety days she had completely recovered.

Case 5.--A twelve-year-old mare with an open fetlock joint due to

a puncture wound. The margins of the wound were cleansed and the

external wound enlarged to facilitate drainage. Tincture of iodin

was injected; the wound was bandaged and dressed for a month in the

manner heretofore described, when all discharge had stopped. A

vesicant was applied; the mare was put to pasture and within sixty

days from the date of the injury she was being driven on short

trips.

Case 6.--A two-year-old brown gelding with a wire-cut on the left

front foot. The wound extended down through the sole and opened the

navicular joint. This colt was very wild and it was necessary to

tie it down each time the wound was dressed. The wound was dressed

weekly for a month and less frequently thereafter. It was handled

eight times; the last dressing was left in place until worn out.

Six months later the colt was practically well, a very little

lameness being shown when walking on frozen ground.

Case 7.--A seven-year-old saddle-horse weighing eleven hundred

and fifty pounds received a wound of the tarsus, laying bare the

articular surfaces of a part of the joint. It was impossible to

keep this wound bandaged because of the restless disposition of the

subject. Injections of a dilute tincture of iodin were employed

every second or third day for a month and the wound was kept

covered with the antiseptic dusting powder referred to heretofore.

In five months complete recovery had taken place, with the

exception of a stubborn skin disturbance which was successfully

treated six months after the wound was inflicted. The horse is

still in use and is absolutely free from lameness.

Case 8.--A two-year-old brown gelding with a wire-wound opening

the scapulohumeral joint. This wound was large enough to expose to

view the articular portion of the humerus. The same treatment as

that given case No. one was instituted and in ninety days the colt

was practically well.

Case 9.--A three-year-old bay filly was found at pasture with one

fore foot badly injured. The owner intended to destroy her, but a

neighbor prevailed upon him to have her treated. Apparently the

wound was of about a week's standing and in a very bad condition,

filled with maggots and dirt. Both the navicular and coronary

articulations were open. This wound was cleansed in the usual

manner and the owner cared for the case the balance of the time

because the distance from my office was too great to give her

personal attention. She made an almost complete recovery in five

months.

Case 10.--At two-year-old mule with an open navicular joint due

to a barbed wire wound. Usual care was given this case and in five

months recovery was complete and little scar is to be seen. This

case received seven treatments.

Case 11.--An eighteen-months-old colt at pasture was found down

and unable to rise without help. In addition to several wounds of

lesser importance there was a large wound on the inner side of the

elbow, the joint was open and the entire leg was greatly swollen

and in a state of acute infectious inflammation. The colt could not

walk, its temperature was 105°, pulse was rapid and respiration was

a little hurried. After advising the owner to put the poor animal

out of its misery I left the place. Four days later the owner came

to my office and asked if he could borrow some old shears to "trim

off some loose hide from that colt." He left the colt in the

pasture and all the care it received was the regular application of

a proprietary dusting powder. It made a complete recovery.

Case 12.--A family mare, heavy in foal, received a vertical wound

of the fetlock joint inflicted by a disc-harrow. The _cul-de-sac_

of the ligament of this joint was opened freely. The wound was

dressed in the usual manner and again three days later when no

suppuration had taken place. Four days later the patient gave birth

to a colt and suckled it right along through her convalescence.

This wound healed by first intention and seventy-nine days from the

date of the injury the mare was driven to town, two and one-half

miles distant, and showed but little lameness.

Phalangeal Exostosis (Ringbone)

This term is applied to exostoses involving the first and second

phalanges (suffraginis and corona), regardless of their size, extent or

location. It is a misnomer, in a sense, and the veterinarian is

frequently obliged to spend considerable time with his clients in order

to convince them that a spherodial exostosis of the proximal phalanx, in

certain cases, is in reality "ringbone," even though there exists no

exostosis which completely encircles the affected bone.

Etiology and Occurrence.--Exostosis of the first and second phalanges

is usually due to some form of injury, whether it be a contusion, a

lacerated wound which damages the periosteum, or periostititis and

osteitis incited by concussions of locomotion, or ligamentous strain.

Practically the only exception is in the rachitic form of ringbone which

affects young animals.

There are predisposing causes that merit consideration, chief among

which is the normal conformation of the coronet joint. This proclivity

is constant; the normal interphalangeal articulation is an incomplete

ginglymoid joint and while its dorso-volar diameter is great, this in no

wise compensates for its disproportionately narrow transverse diameter.

The pivotal strain which is sometimes thrown upon this articulation when

an animal turns on one foot, as well as the tension which is put on the

collateral ligaments when the inner or the outer quarter of the foot

rests in a depression of the road surface, tends to detach the insertion

of these ligaments or to cause fibrillary fractures of their substance.

Short, upright, pasterns receive greater concussion during fast travel

on hard roads than do the longer more sloping and well formed

extremities. Those who are advocates of the theory that this type of

osteitis with its complications has its origin in the articular portion

of the joint, claim that the upright pastern constitutes an important

tendency toward ringbone. Howbeit, ringbone is an active, serious and

frequent cause of lameness and it affects animals of all ages and occurs

under various conditions. Horses having good conformation and kept at

work wherein no great amount of strain is put upon these parts, are

occasionally victims of this affection.

Classification.--The arrangement employed by Moller[21] is intensely

practical and logical. He considers ringbone as _articular_,

_periarticular_, _rachitic_ and _traumatic_. A mode of classification

that is common and in a practical way, good, is, high and low ringbone.

When prognosis is considered, for instance, it is very convenient to

state that the chances for recovery are much better in high ringbone

than in low ringbone. The classification of Möller will be followed

here.

[Illustration: Fig. 17--Phalangeal exostoses.]

Symptomatology.--In all forms of incipient ringbone except rachitic,

the first manifestation of its existence, or of injury to the ligaments

in the region of the pastern joint which causes periostitis, or

affections of the articular portions of the proximal inter-phalangeal

joint, is lameness. Lameness which typifies ringbone is of the

supporting-leg variety and by compelling the subject to step from side

to side, marked flinching is observed, especially in periarticular

ringbone; causing the affected animal to turn abruptly on the diseased

member, using it as a pivot, likewise accentuates the manifestation. In

fact, many subjects that exhibit no evidence of locomotory impediment

while walking or trotting in a straight line on a smooth road surface,

will manifest the characteristic form of lameness from ringbone when the

aforementioned side to side movement is performed.

When the manner in which pain is occasioned is considered, it will be

understood why lameness is intermittent in the early stages of this

affection and may even be unnoticed by the driver. An animal may travel

on a smooth road without giving evidence of any inconvenience, but as

soon as a rough and irregular pavement or road surface is reached, will

limp. As the subject is driven farther on level streets the lameness may

disappear. This intermittent type of lameness may continue until there

is developed a large exostosis, or until articular involvement causes so

much distress during locomotion that lameness is constant. On the other

hand, resolution may occur during the stage of periosteal inflammation,

or, an exostosis forms which causes no interference with function.

[Illustration: Fig. 18--Rarefying osteitis in chronic ringbone and

ossification of lateral cartilages.]

Before there is evidence of an exostosis, diagnosis of ringbone is not

easy, for it is then a problem of detecting the presence of a

ligamentous sprain, periostitis, or osteitis. The diagnostician should

take note of local manifestations of hypersensitiveness, or heat if such

exist, and, in addition, other conditions must be excluded before

definite conclusions are possible.

In _articular_ ringbone as soon as there is developed an exostosis, it

occupies a position on the dorsal (anterior) part of the articulation

and extends around the sides of the joint.

_Periarticular_ ringbone is characterized by exostoses which are

situated on the sides of the phalanges and not extending around to the

anterior part of the joint. This type of ringbone as well as the

articular may occur "high" or "low."

[Illustration: Fig. 19--Phalangeal exostoses in chronic ringbone. Museum

specimen of the Kansas City Veterinary College.]

With the _traumatic_ form of ringbone, all consequences, as to the size

and form the exostosis is to assume, depend upon the nature and extent

of the injury.

_Rachitic_ ringbone is frequently observed in some sections of the

country and does not ordinarily cause much if any lameness. It is a

disease of colts and may affect one or all of the phalanges at the same

time. As the subject advances in age there is more or less diminution in

the size of the enlargements.

Treatment.--Rest is essential in the treatment of ringbone. If

diagnosed during its incipiency, remedial measures such as are usually

employed to treat sprains, are indicated and later the parts should be

blistered. When an exostosis has developed puncture firing is the remedy

_par excellence_. Not that this method of treatment is infallible, for

to any thinking one who takes into consideration the pathological

anatomy of this condition, it is evident that no manner of treatment is

beneficial in some cases. If the exostosis is so situated that it does

not mechanically interfere with function, and is not so large that it

may inhibit flexion and extension, and where the articular portions of

the joint are not eroded, good results attend the use of the actual

cautery.

In firing, after having anesthetized the extremity, and prepared the

surgical area, the cautery is deeply inserted in numerous places, taking

care, however, not to open the joint. The parts are immediately covered

with aseptic absorbent cotton and this dressing is left in position for

forty-eight hours and if perchance there is evidence of synovial

discharge, the parts are again aseptically dressed in order to prevent

infection of the articulation. If, as is the case usually, no

perforation of the joint capsule exists, the openings made by the

cautery have been closed by the coagulation of serum and there is then

little chance of infection causing trouble, even though the member is

left unbandaged.

In several instances, the author has treated ringbone by this method

where the periarticular type existed and lameness was marked, and in

three weeks the subjects were in service and not lame--this, in one

instance in a valuable polo pony where the subject continued in service

for more than a year without any evidence of recurrence of the lameness.

The production of a deep-seated and acute inflammation with the actual

cautery is preferable to any sort of counter-irritation which may be

produced by vesicants.

There is no occasion for any difference in the treatment of either of

the first three classes of ringbone, but in the rachitic type where

treatment is given, the application of a vesicant is all that is

required. In most instances treatment is not necessary.

The affected animals require a month to three months' time for recovery

to take place in the average favorable cases of ringbone.

Median neurectomy is of service in many instances where lameness is not

completely relieved by the use of the actual cautery and no bad results

attend the performance of this operation even though no benefit is

derived thereby. Plantar neurectomy is contraindicated in all cases

where there exists much lameness. If lameness is due to acute

inflammation bad results such as sloughing and loss of the hoof may

follow; and if large exostoses mechanically interfere with function of

the joint, or where articular erosions exist, no possible good can come

from neurectomy. Careful discrimination should be employed in selecting

cases for neurectomy for this operation; otherwise, it is very likely to

prove disappointing.

Open Sheath of the Flexors of the Phalanges.

This condition does not differ from a like affection involving other

tendons except that the function of these tendons is such that large

synovial sheaths are necessary, and when synovitis exists, the condition

then becomes more serious.

Infectious synovitis involving these tendons in the fetlock region is of

more frequent occurrence than a like affection of carpal or tarsal

sheaths. With the exception of the extent of the involvement and

distress occasioned thereby, synovitis the result of open tendon

sheaths, is similar wherever it occurs.

Etiology.--The same conditions which are responsible for open fetlock

joint and other wounds of the pastern region, cause open tendon sheaths

of the flexor tendons.

Symptomatology.--Because of the size and extent of this sheath and the

different manner in which it is opened, there is manifested dissimilar

symptoms in different cases. A nail puncture which perforates the sheath

in the pastern region and at the same time produces an infectious

synovitis, will cause a markedly different manifestation than will a

wound which freely opens the sheath above the fetlock. In the first

instance, the condition is much more painful; swelling is intense in

some cases; and if the subject does not possess sufficient resistance so

that spontaneous resolution promptly occurs, surgical evacuation of pus

is usually necessary. When these tendon sheaths are opened, there

follows a reaction which is quite analogous to that which exists in

arthritic synovitis, but instead of ankylosis, adhesions with thecal

obliteration occur. Rarely there result cartilaginous and osseous

formations.

The constitutional disturbances which characterize this condition vary

with the degree of distress occasioned. As the infection is virulent and

causes serious destruction of the affected parts, so does evidence of

malaise and finally distress appear. Detailed discussions of

symptomatology in similar conditions have heretofore been given, and

further repetition is unnecessary.

Treatment.--The same general plan of treatment which is employed for

handling open joint is put in practice in these cases. Following the

preoperative cleansing of the external wound and adjacent surfaces,

where liberal drainage exists, tincture of iodin is injected into the

sheath, the parts covered with a suitable dressing powder, and the

entire member is carefully dressed with cotton and bandages.

Subsequent treatment is the same as has been outlined in the discussion

of open fetlock joint on page 112. The same general plan of after-care

is necessary. Recovery, however, does not require so much time

ordinarily, yet punctures of the sheath occasioned by nails or other

small implements make for long drawn out cases of infective synovitis.

Luxation of the Fetlock Joint.

Etiology and Occurrence.--The manner of construction of the fetlock

joint is such that disarticulation without irreparable injury resulting,

is practically impossible. Logically, this joint in the fore legs (not

so in the pelvic limbs) should disarticulate in such manner that either

all of the inhibitory apparatus (flexor tendons and suspensory ligament)

must rupture or a lateral luxation is necessary. Lateral disarticulation

must necessarily sever the attachment of one of the common collateral

ligaments. Because of the width (transverse diameter) of the

articulating surfaces of this joint, lateral luxation requires a great

strain; and a force that is sufficient to occasion this trauma usually

causes serious additional injury. Therefore, the condition is considered

one wherein prognosis is always unfavorable in so far as practical

methods of treatment are concerned.

Mr. A. Barbier[22] reports a case of bilateral luxation of the fetlock

joints of the hind legs in a horse. This was done in jumping, and the

extensor tendon of each leg was ruptured and the anterior portion of the

metatarsus was protruding through the skin. Profuse hemorrhage had taken

place due to tearing of the blood vessels.

Symptomatology.--Entire luxation of this joint when present is so

evident that one cannot fail to recognize the condition. Complete

disarrangement of normal relation occurs and there is either a breaking

down of the inhibitory apparatus, or if a lateral disarticulation

exists, the normally straight line formed by the bones of the front leg,

as viewed from the front or rear, is broken at the fetlock.

Often fracture of bones are concomitant and then, of course, mobility is

increased and not decreased as is the case in uncomplicated luxation.

Such violence occurs at times, when this joint is disarticulated, that

the joint capsule is also completely ruptured and the articular portion

of the bones is exposed to view.

Treatment.--The condition being practically a hopeless one,

destruction of the subject is the thing which should be promptly done.

In valuable breeding animals, owners may prefer that treatment be

attempted when a lateral luxation and detachment of but one common

ligament have permitted luxation without complete disarticulation and

rupture of the joint capsule. In such cases, by immobilizing the

affected parts as in fracture, and confining the subject in a sling for

about sixty days, partial recovery may occur in some instances.

Experience has shown that where luxation with detachment of a

collateral ligament occurs, recovery is slow and incomplete--there

always results considerable exostosis at the site of injury.

Sesamoiditis.

Etiology and Occurrence.--Inflammation of the proximal sesamoid bones

is caused by any kind of irritation which may involve this part of the

inhibitory apparatus. Positioned as they are, between the bifurcations

of the suspensory ligament and the pastern joint, they serve as fulcra

and effectively assist in minimizing concussion which is received by the

suspensory ligament. The flexor tendons also, in contracting, exert

strain upon the inter-sesamoidean ligament, which has a similar effect

upon the sesamoid bones as that which is produced by the suspensory

ligament.

The condition occurs quite frequently, and because of the important

function performed by these bones, active inflammation of the sesamoids

constitutes a serious affection. Because of the fact that these bones

have proportionately large articular surfaces, when they are inflamed to

the extent that degenerative changes affect the articular cartilage,

complete recovery seldom results.

The same pathological changes occur here that are to be seen in any case

of arthritis. No special pathological condition characterizes

sesamoiditis but this condition causes incurable lameness when the

sesamoid bones are much inflamed.

Symptomatology.--In acute inflammation, there exist all the symptoms

which portray any arthritic inflammation of like character. The parts

are readily palpable and are found to be hot, supersensitive, and more

or less infiltration of the tissues contiguous to the joint causes

swelling. There is volar flexion of the phalanges when the subject is at

rest. Lameness is intense; in some acute inflammatory disturbances the

subject is unable to bear weight on the affected member.

In chronic sesamoiditis, constant lameness is the one salient feature

which marks the condition. While it is possible for one sesamoid bone to

become involved without its fellow being affected, this is not usual.

Considerable organization of tissue surrounding the joint is present and

no particular evidence of supersensitiveness exists. However,

supporting weight brings sufficient pressure to bear upon the inflamed

and more or less eroded bones so that pain is occasioned and lameness

results.

Treatment.--During acute inflammation, absolute quiet is, of course,

of first consideration. Cold packs are to be kept in contact with the

parts until acute inflammatory symptoms subside. The fetlock region is

then enveloped with a poultice or an iodin and glycerin combination

(iodin one part to seven parts of glycerin) is applied and a dressing of

cotton is kept in contact with the inflamed region. Following this, a

vesicant is employed and the subject is allowed a month's rest.

In sub-acute cases, the entire region surrounding the pastern is

blistered or the actual cautery is used. Line-firing is preferable. The

subject is given a month or six weeks rest and one may be guided by the

presence or absence of lameness as to whether improvement or recovery is

taking place.

Old chronic cases, and particularly those where there are considerable

induration and fibrous organization of tissue surrounding the joint, are

not to be benefited by treatment.

The chief consideration in handling sesamoiditis is checking

inflammation as early as possible and preventing, if this can be done,

the erosion of articular surfaces. If destruction of any part of the

articular surfaces can be prevented and the patient allowed ample time

for complete resolution of the affected parts to occur, permanent relief

is possible.

Fracture of the Proximal Sesamoids.

Etiology and Occurrence.--Fracture of the proximal sesamoid bones is

caused by violent strain when there exists _fragilitas osseum_, or by

contusions. The author treated a case where fracture of one sesamoid was

occasioned by a horse receiving a puncture wound wherein the sharp end

of a steel bar was protruding from the ground where it was firmly

embedded. The subject in this case was injured while being driven along

a country road. Frost[23] reports simultaneous fracture of all of the

proximal sesamoids occurring in a sixteen-year-old pony. The condition

is of rather common occurrence in some countries because of the fragile

condition of horses' bones.

Symptomatology.--If the parts can be examined before extravasation of

blood and swelling mask the condition, crepitation may be detected. In

other instances, it is possible to note a displacement of parts of the

sesamoid bones--this in horizontal fracture. There occurs more or less

descent of the fetlock which must not be attributed to rupture of the

superficial flexor tendon (perforatus). By outlining the course of this

tendon with the fingers, when it is passively tensed sufficiently to

follow its course, one may exclude rupture of the superficial flexor.

Finding the suspensory ligament intact from its origin to the sesamoid

attachments, one may also eliminate rupture of this structure as a cause

of the trouble. Needless to say, marked lameness and swelling of the

fetlock soon take place. The condition is painful, and ordinarily,

recovery is impossible.

Treatment.--Where treatment is attempted, immobilization as in

luxation is in order. The patient's comfort is sought, and if the

fractured parts can be kept in close proximity, their union may occur in

time. However, chances for partial recovery (which is the best to be

hoped for) are so remote that early destruction of the subject is the

humane and economical thing to do.

Where treatment is instituted, it is found that there is required a long

time for union of the fractured bones to occur (where union does take

place) and the cost of treatment together with the uncertainty of even

partial recovery, makes for an unfavorable outcome. When the best

possible results succeed treatment, a large callosity is formed and

movement of the pastern joint is restricted. Lameness, though not

intense, in the case referred to, where one bone was broken, was

permanent and the subject was out of service for nearly a year.

Inflammation of the Posterior Ligaments of the Pastern (Proximal

Interphalangeal) Joint.

Anatomy.--The ligaments here involved are the four volar ligaments

described by Sisson[24] as follows: "The _volar ligaments_ (Ligg

Volaria) consist of a central pair and a lateral and medial bands which

are attached below to the posterior margin of the proximal end of the

second phalanx and its complementary fibro-cartilage. The lateral and

medial ligaments are attached above to the middle of the borders of the

first phalanx, the central pair lower down and on the margin of the

triangular rough area."

This portion of the inhibitory apparatus is described by Strangeways'

Anatomy as two posterior ligaments which run each from three points on

the sides of the os suffraginis to a piece of fibro cartilage, described

as the glenoid cartilage, and attached to the postero-superior edge of

the os coronae; between them is the insertion of the inferior

sesamoidean ligament.

Etiology and Occurrence.--Everything tending to increase strain upon

these ligaments is contributory to possible fibrillary fracture of these

structures. Excessive leverage as furnished by long toes, long toe-calks

and low heels increases the normal tension on the posterior ligaments of

the pastern joint. Faulty conformation, which throws an abnormal strain

on these ligaments, is a predisposing cause of inflammation of these

structures. Hard pulling upon slippery and rough or frozen roads is a

common exciting cause of this injury. The condition is of comparatively

frequent occurrence and is seen affecting draft horses frequently, in

the hind legs.

Symptomatology.--Lameness is the first manifestation of this affection

and weight bearing is painful in direct proportion to the extent of

injury present. Volar flexion of the phalanges relieves tension on the

parts; therefore, this position is assumed while the subject is at rest.

When considerable tissue has been ruptured, and the condition is very

painful, the foot is held off the ground as in all painful affections of

the extremity.

By palpation evidence of pain is discernible, though very little

swelling occurs. Pain is increased by manual tension of the parts which

is done by grasping the toe of the foot and exerting traction on the

flexor apparatus. Care must be taken in executing such manipulations,

and it is only by comparison of the affected member with the sound one

and noting the difference in the manifestations of discomfort that we

may arrive at the proper conclusion.

Some hyperthermia is to be recognized in acute inflammation, by

comparing the extremities. In the fore legs, navicular disease is

differentiated by noting absence of contraction at the heel. By use of

the hoof testers one may recognize evidence of inflammation of the

navicular apparatus. In inflammation of the posterior ligaments of the

pastern joint, there is also absence of the characteristic stumbling

which is seen in navicular disease.

Treatment.--Rest is the first requisite, and in addition every

mechanical means possible to change the center of gravity in the

phalangeal region, is to be employed. This is best accomplished by

shortening the toe and paring the sole at the toe as much as conditions

will permit. The heel is raised by means of a shoe with moderately high

heel calks.

The iodin-glycerin combination heretofore mentioned may be applied and

the parts covered with cotton and bandage. Subjects require from three

weeks to several months' rest and must be returned to work carefully,

lest the incompletely regenerated tissues suffer injury.

Regeneration of tissue in such cases, as has been pointed out, is slow

and sufficient time for complete recovery must be allowed or relapses

will occur.

Fracture of the First and Second Phalanges.

Etiology and Occurrence.--Fractures of the first phalanx (suffraginis)

occur with respect to frequency, second to pelvic fractures. Often,

almost insignificant injuries cause phalangeal fractures. On city

streets, horses shod with shoes having long calks get caught in frogs of

street railways or by slipping on rails, and phalangeal bones are often

broken. The author observed a case of comminuted fracture of both the

first and second phalanges (suffraginis and corona) in a polo pony

caused by making a sudden turn while in action in a contest on the turf.

Symptomatology.--Fracture of the phalanges is nearly always signalized

by lameness, and this is marked during the period of weight bearing.

Lameness is usually intense and where the pathognomonic symptom

(crepitation) is not recognized, the intensity of the claudication, when

other causes are absent, is indicative of fracture. The subject does not

bear weight upon the affected member and where pain is intense, the foot

is held in an elevated position and swung back and forth. In hind legs

the member is often flexed in abduction and held in this position for

several minutes, being rested on the ground only during short intervals.

When compelled to walk, if pain is excruciating, the animal hops with

the sound leg, no weight being supported by the fractured member.

When an examination of the subject is possible before the extremity is

swollen, crepitation is usually found without great difficulty, except

in a subperiosteal break or in some cases of vertical or oblique

fracture. Great care is necessary in handling the injured extremity in

these cases, and particularly in nervous subjects or in excited animals

that have been recently injured in runaways, is it necessary to be

gentle in manipulating the extremity, if definite deductions are to be

made. As has been mentioned in the chapter on diagnostic principles, if

the condition is so painful that the subject does not relax the parts

and crepitation is masked, local anesthesia is necessary. An anesthetic

solution of cocain or novocain may be applied to the metacarpal or

metatarsal nerves and an entirely satisfactory examination is then

possible.

Passive movement of the phalanges in all directions is practised in

order to produce crepitation. When rotation of the parts does not

occasion crepitation, gentle flexion and extension may do so. And in

many instances, considerable manipulation of the phalanges is necessary

before the pathognomonic symptom is to be recognized.

In cases where crepitation is not found and lameness is pronounced, out

of proportion with other possible existing causes, one may by exclusion

of other causes establish a diagnosis of fracture in the course of

forty-eight hours. In the meanwhile, support is given the affected

member by applying an effective leather splint, so that pain may be

diminished. To combat inflammation, a suitable cataplasm may be applied

directly to the skin, the extremity bandaged, and the temporary

immobilizing appliance may be secured over all. In this manner one may

make repeated examinations of the subject, and if slings are used and

every other necessary precaution taken to promote comfort for the

subject, no harm will result in delaying for several days the

application of permanent immobilization--bandages and splints or casts.

In fact, where much swelling exists at the time one is called to treat

such cases, it is advisable to delay the application of a permanent

dressing or cast until inflammation has somewhat subsided.

Course and Prognosis.--Where conditions are favorable, the nature of

the fracture one that will yield to treatment, the subject not aged, and

facilities for giving good attention to the affected animal are ample,

fractures of the first and second phalanges recover completely in from

six weeks to four months. Only simple fractures are considered curable

from a practical and economical point of view, excepting in foals, where

compound, and even comminuted, fractures may be so handled that animals

may eventually become serviceable though blemished.

Age retards the process of osseous regeneration, but in one instance at

the Kansas City Veterinary College, a very aged mare suffering from a

multiple fracture of the first phalanx was treated and at the end of

sixty days was able to walk into an ambulance. Large exostoses had

developed and the subject remained lame, but union of the broken bone

took place in a surprisingly prompt and effective manner, when age of

the subject and nature of the fracture are considered.

As a rule, one is loath to recommend treatment, even in a simple

transverse fracture of the first phalanx, in animals ten years of age or

older. The conditions which exist in any given locality that regulate

the expense of caring for an animal during the period of treatment,

especially influence the course to be pursued in treating fractures.

Treatment.--For permanent immobilization of the phalanges in fracture,

materials which might adapt themselves to the irregular contour of the

member and at the same time contribute sufficient rigidity to the parts

without doing injury to the soft structures, would constitute ideal

means of treatment; but no such materials have yet been devised, and

opinions are various as to the most efficient and practical method to

employ.

After the fetlock has been shorn of hair and the ergot trimmed, the skin

is thoroughly cleansed and allowed to dry. Several thin layers of long

fiber cotton are then wrapped around the extremity--enough to pad well

the member--and this is retained in position with a wide bandage. Gauze

bandages are preferable to heavier bandages of cotton fabric because

they are somewhat more elastic and yield to the irregular contour of the

parts to a better advantage. Layers of three inch gauze bandages, which

are soaked with a cold starch paste are wound about the extremity.

Strips of leather that are flexible and not more than an inch in width

are placed in a vertical position around the leg and these are also

covered with the starch and securely held in position with the bandages.

In this way, one is able to provide a sufficient degree of rigidity and

at the same time, where the cast is carefully applied, little if any

injury is done the skin. Such a cast is not difficult to remove and is

so inexpensive that it may be removed and reapplied at any time it

should be thought preferable to do so. Of course, this does not

constitute an effective means of support if the parts are to be

frequently and thoroughly soaked with water, but animals undergoing this

sort of treatment are usually kept sheltered.

The same after-care is necessary in such cases as is given in fractures

of other bones. Two months after the injury has been done, the

application of a blistering ointment to the entire region is of benefit.

Results.--Much depends on the nature of fractures as to the success

one may attain in approximating the parts of a broken bone, and in some

cases of oblique fracture for instance, complete recovery is impossible,

despite the most skillful and painstaking attention given. On the other

hand, cases of simple transverse fractures make perfect recoveries in

some instances. All fractures are serious, and in every instance the

practitioner would best be careful to impress his client with the many

difficulties which usually attend the treatment of fracture in horses.

Tendinitis.

Inflammation of the Flexor Tendons.

One of the most common causes of lameness in light harness and saddle

horses is tendinitis, and because of the character of the structure of

tendons and because of their function, an active inflammation of these

parts is always serious.

Being almost inelastic and not well supplied with blood, tendinous

tissue is slowly regenerated, and so much time is required for complete

recovery to take place in tendinitis, that affected animals seldom fully

recover before they are in service or vigorously exercising at will. As

a result, complete recovery is delayed or prevented.

The extensor tendons, because of the nature of their function, are very

seldom strained; they are often bruised and occasionally divided, but

unlike this condition in the flexors, tendinitis of the extensors is of

rare occurrence.

For a concise discussion of this subject the most practical

classification is one made on a chronological basis and we may then

consider tendinitis as _acute_ and _chronic_.

ACUTE TENDINITIS.

Etiology and Occurrence.--Causes of tendinitis, as in almost all

diseases, may be considered under the heads of predisposing and

exciting. Among the predisposing causes of tendinitis may be mentioned,

faulty conformation. Everything which has to do with increasing the

strain upon tendons adds to the probability of their being over-taxed.

Long, sloping, pastern bones; disproportionate development of parts,

such as a heavy body and small, weak tendons and long hoofs, are the

principal factors which usually predispose to tendinous sprains.

Degenerative changes which take place in tendons following

constitutional diseases such as influenza may also be classed as a

predisposing cause.

Excessive strain when put upon tendons in any possible manner, such as

is occasioned in running and jumping; making missteps and catching up

the weight of the body with one foot, when the force thus thrown upon

the supporting structure is great because of momentum gained at a rapid

pace, are exciting causes of tendinitis.

Symptomatology.--In all cases of acute tendinitis there is presented a

characteristic attitude by the subject. Volar flexion in a sufficient

degree to relax the inflamed structures is always evident. The foot may

be rested on the toe or placed slightly in advance of the one supporting

weight, but the fetlock is always thrown forward. More or less swelling

of the inflamed tendons is present. Where the deep flexor (perforans) is

involved swelling is marked and with swelling there is present the other

symptoms of inflammation--heat and supersensitiveness.

In manipulating tendons for the purpose of detecting supersensitiveness,

care must be taken so that no false conclusion be drawn, because of the

aversion many horses have to submitting to palpation of the tendons even

when they are in a normal condition.

Supporting-leg-lameness is present and varies in degree with the

intensity of the pain caused by weight bearing. In many instances, as

soon as the subject has traveled a considerable distance, lameness

diminishes or discontinues. As soon as the affected animal is permitted

to stand long enough to "cool out" there is a return of the lameness,

which is then marked.

No difficulty is encountered in making a practical diagnosis in

tendinitis; that is, one may fail to readily recognize the extent of the

involvement as it affects the superficial flexor tendon, for instance,

but this has no practical bearing on the prognosis and treatment, when

existing inflammation of the deep flexor is recognized.

The course of each tendon is readily outlined by palpation; all parts

are easily manipulated; and with experience one may readily recognize

the extent and degree of the inflammation.

Treatment.--In some cases of acute tendinitis, pain is intense and the

application of cold packs during this stage is very beneficial in that

pain is controlled and inflammation subsides. The extremity may be

bandaged with a liberal quantity of absorbent cotton or with woolen

material. Ice water is then poured around the bandaged member every

fifteen minutes and this should be continued for about forty-eight

hours. In some cases this treatment is not necessary for more than

twelve hours; at the end of this length of time, pain has subsided and

the acute stage of inflammation has passed or its intensity has been

diminished.

Following the application of cold packs, the use of a poultice such as

some of the sterile, medicated muds, is of marked benefit. The author

has made use of tincture of iodin and glycerin in the proportion of one

part of iodin to seven parts glycerin, with very satisfactory results.

This combination is hygroscopic, anodyne and antiseptic and is easily

applied. A liberal quantity is directly applied all around the affected

tendons and the leg covered with a heavy layer of cotton, and this is

snugly held in position with bandages. The application may be used once

or twice daily, or if it is thought necessary, an attendant may pour a

quantity of the iodized-glycerin around the leg and under the bandage

once daily without removing the cotton and bandage. Needless to say,

absolute rest is imperative.

When all evidence of acute inflammation has subsided vesication is

indicated. At this stage walking exercise is beneficial and the subject

may be allowed the freedom of a paddock.

Some practitioners are partial to the use of the actual cautery in these

cases, but it is doubtful if it is necessary to produce such a great

degree of counter-irritation in cases where the subject is suffering the

first attack of tendinitis.

As has been indicated, ample time should be allowed for recovery and

depending upon conditions, it takes from three weeks to six months for

complete recovery to become established.

Chronic Tendinitis and Contraction of the Flexor Tendons.

Etiology and Occurrence.--Acute inflammation of the flexor tendons may

result in chronic tendinitis. Recurrent attacks in cases where

insufficient time is allowed for complete recovery to result, is

followed by chronic inflammation and hypertrophy of the tendons. Again,

in subjects where conformation is faulty, no amount of care will be

sufficient to prevent a recurrence of the inflammation and the condition

must become chronic.

Symptomatology.--On visual examination of the subject at rest, one may

note the hypertrophied condition of the affected tendons. Their

transverse diameter is usually perceptibly increased and in many cases,

there is an increase in the antero-posterior diameter. The latter

condition causes a bulging of the tendon that is so noticeable, because

of the convexity thus formed, it is commonly known as "bowed tendon."

[Illustration: Fig. 20--Contraction of the superficial digital flexor

tendon (perforatus) of the right hind leg, due to tendinitis.]

In chronic tendinitis there occurs repeated attacks of inflammation

wherein lameness is pronounced and there exists in reality, at such

times, acute inflammation of a hypertrophic structure, where at no time

does inflammation completely subside. Therefore, in chronic tendinitis

there is to be found at times the same conditions which characterize

acute inflammation, except that there is usually a variance of symptoms

because of the difference in the degree of inflammation and pain.

The diagnosis of contraction of tendons is an easy matter because of the

fact that relations between the phalanges are constantly changed with

tendinous contraction. If one bears in mind the attachments and function

of the digital flexors, no difficulty is encountered in recognizing

contraction of either tendon.

Contraction of the superficial digital flexor (perforatus), when

uncomplicated, is characterized by volar flexion of the pastern joint.

The foot is flat on the ground and the heel is not raised because the

superficial flexor tendon does not have its insertion to the distal

phalanx (os pedis) and therefore can not affect the position of the

foot.

By causing the subject to stand on the affected member, one may outline

the course of the flexor tendons by palpation, and in this way recognize

any lack of tenseness or contraction of tendons or of the suspensory

ligament.

[Illustration: Fig. 21--Contraction of the deep flexor tendon

(perforans) of the right hind leg, due to tendinitis.]

Contraction of the suspensory ligament would cause the pastern joint to

assume the same position as is occasioned by contraction of the

superficial digital flexor (perforatus) tendon, but when the subject is

bearing weight on the affected member, it is easy to determine that no

contraction of the suspensory ligament exists, by noting an absence of

abnormal tenseness of this structure. And finally, contraction of the

suspensory ligament is of rare occurrence.

Contraction of the deep flexor tendon (perforans) causes an elevation of

the heel. The foot can not set flat because the insertion of the deep

flexor tendon to the solar surface of the distal phalanx (os pedis)

causes when the tendon is contracted--a rotation of the distal phalanx

on its transverse axis--hence the raised heel. No other tendon has this

same effect on the distal phalanx and the condition is correctly

diagnosed without difficulty.

[Illustration: Fig. 22--A chronic case of contraction of both flexor

tendons of the phalanges. In this case (presented at a clinic of the

Kansas City Veterinary College) because of long continued contraction of

the flexors, which prevented weight being supported with any degree of

comfort, there resulted a partial paralysis of the extensors, and

consequently the extremity was dragged on the ground.]