may be ascertained by the aggravated lameness, the excessive soreness on
pressure, and perhaps a certain increase of motion, with a very slight
crepitation if tested in the usual way. Displacement is not likely to
take place except when it is well up toward the olecranon or its
tuberosity, the upper segment of the bone being in that case likely to
be drawn upward. For a simple fracture of this region there is a fair
chance of recovery, but in a case of the compound and comminuted class
there is less ground for a favorable prognosis, especially if the elbow
joint has suffered injury. A fracture of the ulna alone is not of
serious importance, except when the same conditions prevail. A fracture
of the olecranon is less amenable to treatment, and promises little
better than a ligamentous union.
_Treatment._--Considering all the various conditions involving the
nature and extent of these lesions, the position and direction of the
bones of the forearm are such as to render the chances for recovery from
fracture as among the best. The reduction, by extension and
counterextension; the maintenance of the coaptation of the segments; the
adaptation of the dressing by splints, oakum, and agglutinative
mixtures; in fact, all the details of treatment may be here fulfilled
with a degree of facility and precision not attainable in any other part
of the organism. An important, if not an essential, point, however, must
be emphasized in regard to the splints. Whether they are of metal, wood,
or other material, they should reach from the elbow joint to the ground,
and should be placed on the posterior face and on both sides of the leg.
This is then to be so confined in a properly constructed box as to
preclude all possibility of motion, while yet it must sustain a certain
portion of the weight of the body. The iron splint (represented in Plate
XXX) recommended by Bourgelat is designed for fractures of the forearm,
of the knee, and of the cannon bone, and will prove to be an appliance
of great value. For small animals the preference is for an external
covering of gutta-percha, embracing the entire leg. A sheet of this
substance of suitable thickness, according to the size of the animal,
softened in lukewarm water, is, when sufficiently pliable, molded on the
outside of the leg, and when suddenly hardened by the application of
cold water forms a complete casing sufficiently rigid to resist all
motion. Patients treated in this manner have been able to use the limb
freely, without pain, immediately after the application of the dressing.
The removal of the splint is easily effected by cutting it away, either
wholly or in sections, after softening it by immersing the leg in a warm
bath.
FRACTURE OF THE KNEE.
This accident, happily, is of rare occurrence, but when it takes place
is of a severe character, and always accompanied with synovitis, with
disease of the joint.
_Cause._--It may be caused by falling upon a hard surface, and is
usually compound and comminuted. Healing seldom occurs, and when it does
there is usually a stiffness of the joint from arthritis.
_Symptoms._--As a result of this fracture there is inability to bear
weight on the foot. The leg is flexed as in complete radial paralysis,
or fracture of the ulna. There is abnormal mobility of the bones of the
knee, but crepitation is usually absent.
_Prognosis._--Healing is hard to effect, as one part of the knee is
drawn upward by the two flexor muscles which separate it from the lower
part. The callus which forms is largely fibrous, and if the animal is
put to work too quickly this callus is liable to rupture. In favorable
cases healing takes place in two or three months. Many horses during the
treatment develop founder, with consequent drop sole in the sound leg,
as a result of pressure due to continuous standing.
_Treatment._--Place the animal in the slings, bring the pieces of bone
together if possible, and try to keep them in place by a tight
plaster-of-Paris dressing about the leg, extending down to the fetlock.
Place the animal in a roomy box stall well provided with bedding so that
he can lie down, to prevent founder.
FRACTURE OF THE FEMUR.
The protection which this bone receives from the large mass of muscles
in which it is enveloped does not suffice to invest it with immunity in
regard to fractures.
_Cause._--It contributes its share to the list of accidents of this
description, sometimes in consequence of external violence and sometimes
as the result of muscular contraction; sometimes it takes place at the
upper extremity of the bone; sometimes at the lower; sometimes at the
head, when the condyles become implicated; but it is principally found
in the body or diaphysis. The fracture may be of any of the ordinary
forms, simple or compound, complete or incomplete, transverse or
oblique, etc. A case of the comminuted variety is recorded in which 85
fragments of bone were counted and removed.
The thickness of the muscular covering sometimes renders the diagnosis
difficult by interfering with the manipulation, but the crepitation test
is readily available, even when the swelling is considerable, and which
is liable to be the case as the result of the interstitial hemorrhage
which naturally follows the laceration of the blood vessels of the
region involved.
_Symptoms._--If the fracture is at the neck of the bone the muscles of
that region (the gluteal) are firmly contracted, and the leg seems to be
shortened in consequence. Locomotion is impossible. There is intense
pain and violent sweating at first. Crepitation may in some cases be
discerned by rectal examination, with one hand resting over the
coxo-femoral (hip) articulation. Fractures of the tuberosities of the
upper end of the bone, the great trochanter, may be identified by the
deformity, the swelling, the impossibility of rotation, and the dragging
of the leg in walking. Fracture of the body is always accompanied with
displacement, and as a consequence a shortening of the leg, which is
carried forward. The lameness is excessive, the foot being moved, both
when raising it from the ground and when setting it down, very timidly
and cautiously. The manipulations for the discovery of crepitation
always cause much pain. Lesions of the lower end of the bone are more
difficult to diagnosticate with certainty, though the manifestation of
pain while making heavy pressure upon the condyles will be so marked
that only crepitation will be needed to turn a suspicion into a
certainty.
_Treatment._--The question as to treatment in fractures of this
description resolves itself into the query whether any treatment can be
suggested that will avail anything practically as a curative measure;
whether, upon the hypothesis of reduction as an accomplished fact, any
permanent or efficient device as a means of retention is within the
scope of human ingenuity. If the reduction were successfully performed,
would it be possible to keep the parts in place by any known means at
our disposal? At the best the most favorable result that could be
anticipated would be a reunion of the fragments with a considerable
shortening of the bone and a helpless, limping, crippled animal to
remind us that for human achievement there is a "thus far and no
farther."
In small animals, such as dogs and cats, however, attempts at treatment
are justifiable, and we are convinced that in many cases of difficulty
in the application of splints and bandages a patient may be placed in a
condition of undisturbed quiet and left to the processes of nature for
"treatment" as safely and with as good an assurance of a favorable
result as if he had been subjected to the most heroic secundum artem
doctoring known to science. As a case in point, mention may be made of
the case of a pregnant bitch which suffered a fracture of the upper end
of the femur by being run over by a light wagon. Her "treatment"
consisted in being tied up in a large box and let alone. In due time she
was delivered of a family of puppies, and in three weeks she was running
in the streets, limping very slightly, and nothing the worse for her
accident.
FRACTURE OF THE PATELLA.
This, fortunately, is a rare accident, and can result only from direct
violence, as a kick or other blow. The lameness which follows it is
accompanied with enormous tumefaction of the joint, pain, inability to
bear weight upon the foot, and finally disease of the articulation.
Crepitation is absent, because the hip muscles draw away the upper part
of the bone. The prognosis is unavoidably adverse, destruction being the
only termination of this incurable and very painful injury. Most of the
reported cases of cures are based upon a wrong diagnosis.
FRACTURES OF THE TIBIA.
Of all fractures these are probably more frequently encountered than any
others among the class of accidents we are considering. As with injuries
of the forearm of a like character, they may be complete or incomplete;
the former when the bone is broken in the middle or at the extremities,
and transverse, oblique, or longitudinal. The incomplete kind are more
common in this bone than in any other.
_Symptoms._--Complete fractures are easy to recognize, either with or
without displacement. The animal is very lame, and the leg is either
dragged or held clear from the ground by flexion at the stifle, while
the lower part hangs down. Carrying weight or moving backward is
impossible. There is excessive mobility below the fracture, and
well-marked crepitation. If there is much displacement, as in an oblique
fracture, there will be considerable shortening of the leg.
While incomplete fractures can not be recognized in the tibia with any
greater degree of certainty than in any other bone, there are some facts
associated with them by which a diagnosis may be justified. The
hypothetical history of a case may serve as an illustration:
An animal has received an injury by a blow or a kick on the inside of
the bone, perhaps without showing any mark. Becoming very lame
immediately afterwards, he is allowed a few days' rest. If taken out
again, he seems to have recovered his soundness, but within a day or
two he betrays a little soreness, and this increasing he becomes very
lame again, to be furloughed once more, with the result of a temporary
improvement, and again a return to labor and again a relapse of the
lameness; and this alternation seems to be the rule. The leg being now
carefully examined, a local periostitis is readily discovered at the
point of the injury, the part being warm, swollen, and painful. What
further proof is necessary? Is it not evident that a fracture has
occurred, first superficial--a mere split in the bony structure, which,
fortunately, has been discovered before some extra exertion or a casual
misstep had developed it into one of the complete kind, possibly with
complications? What other inference can such a series of symptoms thus
repeated establish?
The prognosis of fracture of the tibia, as a rule, must be unfavorable.
_Treatment._--The difficulty of obtaining a union without shortening,
and consequently without lameness, is proof of the futility of ordinary
attempts at treatment, but though this may be true in respect to
fractures of the complete kind, it is not necessarily so with the
incomplete variety, and with this class the simple treatment of the
slings is all that is necessary to obtain consolidation. A few weeks of
this confinement will be sufficient.
With dogs and other small animals there are cases which may be
successfully treated. If the necessary dressings can be successfully
applied and retained, a cure will follow.
FRACTURES OF THE HOCK.
Injuries of the astragalus which had a fatal termination have been
recorded. Fractures of the os calcis have also been observed, but never
with a favorable prognosis, and attempts to induce recovery, as might
have been expected, have proved futile.
FRACTURES OF THE CANNON BONES.
Whether these occur in the fore or hind legs, they appear either in the
body or near their extremities. If in the body as a rule the three
metacarpal or metatarsal bones are affected, and the fracture is
generally transverse and oblique. On account of the absence of soft
tissue and tightness of the skin, the broken bones pierce the skin and
render the fracture a complicated one. The diagnosis is easy when all
the bones are completely broken, but the incomplete fracture can be only
suspected.
_Symptoms._--There is no displacement, but excessive mobility,
crepitation, inability to sustain weight, and the leg is kept off the
ground by the flexion of the upper joint.
No region of the body affords better facilities for the application of
treatment, and the prognosis on this account is usually favorable. We
recall a case, however, which proved fatal, though under exceptional
circumstances. The patient was a valuable stallion of highly nervous
organization, with a compound fracture of one of the cannon bones, and
his unconquerable resistance to treatment, excited by the intense pain
of the wound, precluded all chance of recovery, and ultimately caused
his death.
_Treatment._--The general form of treatment for these lesions will not
differ from that which has been already indicated for other fractures.
Reduction, sometimes necessitating the casting of the patient;
coaptation, comparatively easy by reason of the subcutaneous situation
of the bone; retention, by means of splints and bandages--applied on
both sides of the region, and reaching to the ground as in fractures of
the forearm--these are always indicated. We have obtained excellent
results by the use of a mold of thick gutta-percha, composed of two
sections and made to surround the entire lower part of the leg as in an
inflexible case.
FRACTURE OF THE FIRST PHALANX.
The hind extremity is more liable than the fore to this injury. It is
usually the result of a violent effort, or of a sudden misstep or
twisting of the leg, and may be transverse, or, as has usually been the
case in our experience, longitudinal, extending from the upper articular
surface down to the center of the bone, and generally oblique and often
comminuted. The symptoms are the swelling and tenderness of the region,
possibly crepitation; a certain abnormal mobility; an excessive degree
of lameness, and in some instances a dropping back of the fetlock, with
perhaps a straightened or upright condition of the pastern.
The difficulty of reduction and coaptation in this accident, and the
probability of bony deposits, as of ringbones, resulting in lameness,
are circumstances which tend to discourage a favorable prognosis.
The treatment is that which has been recommended for all fractures, so
far as it can be applied. The iron splint which has been mentioned gives
excellent results in many instances, but if the fracture is incomplete
and without displacement, a form of treatment less energetic and severe
should be attempted. One case is within our knowledge in which the owner
lost his horse by his refusal to subject the animal to treatment, the
post-mortem revealing only a simple fracture with very slight
displacement.
FRACTURES OF THE SECOND PHALANX (CORONET).
Though these are generally of the comminuted kind, there are often
conditions associated with them which justify the surgeon in attempting
their treatment. Though crepitation is not always easy to detect, the
excessive lameness, the soreness on pressure, the inability to carry
weight, the difficulty experienced in raising the foot, all these
suggest, as the solution of the question of diagnosis, the fracture of
the coronet, with the accompanying realization of the fact that there is
yet, by reason of the situation of the member, immobilized as it is by
its structure and its surroundings, room left for a not unfavorable
prognosis. Only a slight manipulation will be needed in the treatment of
this lesion. To render the immobility of the region more fixed, to
support the bones in their position by bandaging, and to establish
forced immobility of the entire body with the slings is usually all that
is required. Ringbone, being a common sequela of the reparative process,
must receive due attention subsequently. One of the severest
complications liable to be encountered is an immobile joint
(anchylosis). Neurectomy of the median nerve may relieve lameness after
a fracture of the phalanges.
FRACTURES OF THE THIRD PHALANX (OS PEDIS).
These lesions may result from a penetrating street nail, or follow
plantar or median neurectomy. In the latter instance it is caused by the
animal setting the foot down carelessly and too violently, and partly
due to degeneration of bone tissue which follows nerving.
Though these fractures are not of very rare occurrence, their
recognition is not easy, and there is more of speculation than of
certainty pertaining to their diagnosis. The animal is very lame and
spares the injured foot as much as possible, sometimes resting it upon
the toe alone and sometimes holding it from the ground. The foot is very
tender, and the exploring pinchers of the examining surgeon cause much
pain. During the first 24 hours there is no increased pulsation in the
digital and plantar arteries, but on the second day it is apparent.
There is nothing to encourage a favorable prognosis, and a not unusual
termination is an anchylosis with either the navicular bone or the
coronet.
No method of treatment needs to be suggested here, the hoof performing
the office of retention unaided. Local treatment by baths and
fomentations will do the rest. It may be months before there is any
mitigation of the lameness.
An ultimate recovery depends to a great extent upon whether the other
foot can support the weight during the healing process without causing a
drop sole in the supporting foot.
FRACTURE OF THE SESAMOID BONES.
This lesion has been considered by veterinarians, erroneously, we think,
as one of rare occurrence. We believe it to be more frequent than has
been supposed. Many observations and careful dissections have convinced
us that fractures of these little bones have been often mistaken for
specific lesions of the numerous ligaments that are implanted upon their
superior and inferior parts, and which have been described as a "giving
way" or "breaking down" of these ligaments. In my post-mortem
examinations I have always noted the fact that when the attachments of
the ligaments were torn from their bony connections minute fragments of
bony structure were also separated, though we have failed to detect any
diseased process of the fibrous tissue composing the ligamentous
substance.
_Cause._--From whatever cause this lesion may arise, it can hardly be
considered as of a traumatic nature, no external violence having any
apparent agency in producing it, and it is our belief that it is due to
a peculiar degeneration or softening of the bones themselves, a theory
which acquires plausibility from the consideration of the spongy
consistency of the sesamoids. The disease is a peculiar one, and the
suddenness with which different feet are successively attacked, at short
intervals and without any obvious cause, seems to prove the existence of
some latent, morbid cause which has been unsuspectedly incubating. It is
not peculiar to any particular class of horses, nor to any special
season of the year, having fallen under our observation in each of the
four seasons.
_Symptoms._--The general fact is reported in the history of most cases
that it makes its appearance without premonition in animals which, after
enjoying a considerable period of rest, are first exercised or put to
work, though in point of fact it may manifest itself while the horse is
still idle in his stable. A hypothetical case, in illustration, will
explain our theory: An animal which has been at rest in his stable is
taken out to work, and it will be presently noticed that there is
something unusual in his movement. His gait is changed, and he travels
with short, mincing steps, without any of his accustomed ease and
freedom. This may continue until his return to the stable, and then,
after being placed in his stall, he will be noticed shifting his weight
from side to side and from one leg to another, continuing the movement
until rupture of the bony structure takes place. But it may happen that
the lameness in one or more of the extremities, anterior or posterior,
suddenly increases, and it becomes evident that the rupture has taken
place in consequence of a misstep or a stumble while the horse is at
work. Then, upon coming to a standstill, he will be found with one or
more of his toes turned up; he is unable to place the affected foot flat
on the ground. The fetlock has dropped and the leg rests upon this part,
the skin of which may have remained intact or may have been more or less
extensively lacerated. It seldom happens that more than one toe at a
time will turn up, yet still the lesion in one will be followed by its
occurrence in another. Commonly two feet, either the anterior or
posterior, are affected, and we recall one case in which the two fore
and one of the hind legs were included at the same time. The accident,
however, is quite as liable to happen while the horse is at rest in his
stall, and he may be found in the morning standing on his fetlocks. One
of the earliest of the cases occurring in my own experience had been
under care for several weeks for suspected disease of the fetlocks, the
nature of which had not been made out, when, apparently improved by the
treatment which he had undergone, the patient was taken out of the
stable to be walked a short distance into the country, but had little
more than started when he was called to a halt by the fracture of the
sesamoids of both fore legs.
While there are no positive premonitory symptoms of these fractures
known, we believe that there are signs and symptoms which come but
little short of being so, and the appearance of which will always
justify a strong suspicion of the truth of the case. These have been
indicated when referring to the soreness in standing, the short, mincing
gait, and the tenderness betrayed when pressure is made over the
sesamoids on the sides of the fetlock, with others less tangible and
definable.
_Prognosis._--These injuries can never be accounted less than serious,
and in our judgment will never be other than fatal. If our theory of
their pathology is the correct one, and the cause of the lesions is
truly the softening of the sesamoidal bony structure and independent of
any changes in the ligamentous fibers, the possibility of a solid
osseous union can hardly be considered admissible.
_Treatment._--In respect to the treatment to be recommended and
instituted it can be employed only with any rational hope of benefit
during the incubation, and with the anticipatory purpose of prevention.
It must be suggested by a suspicion of the verities of the case, and
applied before any rupture has taken place. To prevent this and to
antagonize the causes which might precipitate the final catastrophe--the
elevation of the toes--resort must be had to the slings and to the
application of firm bandages or splints, perhaps of plaster of Paris,
with a high shoe, as about the only indications which science and nature
are able to offer. When the fracture is an occurred event, and the toes,
one or more, are turned up, any further resort to treatment will be
futile.
DISEASES OF JOINTS.
Three classes of injury will be considered under this head. These are,
affections of the synovial sacs, those of the joint structures, or of
the bones and their articular surfaces, and those forms of solution of
continuity known as dislocations or luxations.
DISEASES OF THE SYNOVIAL SACS.
Two forms of affection here present themselves, one being the result of
an abnormal secretion which induces a dropsical condition of the sac
without any acute, inflammatory action, while the other is characterized
by excessive inflammatory symptoms, with their modifications,
constituting synovitis.
SYNOVIAL DROPSIES.