in a young animal in which the preponderance of animal matter or the
semicartilaginous condition of the bone renders it tough, so that even when
considerable force is applied the bone bends, breaking on the side opposite
that to which the force was applied, after the manner in which a green
stick bends and breaks.
SIMPLE FRACTURES. Simple fracture is one in which the bone is severed in
two parts, transversely, longitudinally, or obliquely, without serious
injury to the adjoining structures.
COMPOUND FRACTURES.--Compound fracture is one in which there is an open
wound permitting the air to communicate with the ends of the broken bones.
COMMINUTED FRACTURES.--Comminuted fracture is one in which the bone is
shattered or divided into a number of fragments.
COMPLICATED FRACTURES.--Complicated fracture is one in which other
structures surrounding the bones are injured.
GENERAL SYMPTOMS OF FRACTURE.--When a fracture of one or more of the large
bones of a limb occurs, symptoms are sure to be well marked. After the
accident the animal refuses to touch the foot to the ground and, if
compelled to move, does so with great pain and reluctance. There is more or
less shortening of the limb, with trembling of the muscles in the vicinity
of the injury; deformity, and increased mobility, so that, instead of the
natural joints of the limb and the natural, muscular control of their
motion, a new joint, over which the animal has no control, is formed where
the fracture occurred. As the leg, shortened by the ends of the bones being
forced past one another from the muscular contraction which invariably
takes place, hangs dependent from the body it swings in an awkward and
unnatural manner, permitting the toe and foot to assume positions in their
relations to other parts of the body which otherwise would be impossible.
If the fractured bone is so situated that the parts may be moved one upon
another, a grating sound, known as crepitus, will be heard.
GENERAL TREATMENT OF FRACTURES.--When a fracture occurs, the advisability
of attempting treatment must first be determined. If the animal is young,
valuable, and of reasonably quiet temperament, and the fracture is not too
great in extent, the chances of recovery are fair. On the other hand, if
the animal should be of little value, irritable, advanced in years, and the
fracture is a serious compound or comminuted one, the wiser course would
generally be to put the creature out of its misery.
Having determined to attempt treatment, no time should be lost in restoring
the parts as nearly as possible to their natural position and retaining
them there. If the ends of the bones have been drawn one past the other,
they should be drawn out by firm and continuous tension, until they again
assume the position in which they were before the accident. All this can
better be done before the swelling (which is sure to result) takes place.
If the swelling has occurred before the injury is noticed, do not attempt
to treat it, but proceed at once to treat the fracture as though the
swelling were not present, for no step can be taken toward recovery until
the ends of the bone have been restored to their proper position. When that
is done and proper appliances have been used to prevent them from being
again misplaced, the swelling, which is the result of irritation, will be
relieved. In selecting the appliances to be used in the treatment of
fracture the judgment and ingenuity of the operator are of much importance.
Splints, made of wood shaped to fit the limb and padded with soft material
where they come in contact with bony prominences, and held in position by
means of bandages, are the oldest method, and with some are still most
popular. The fracture pads used in human surgery, and for sale in surgical
depots, are very convenient. After being dipped in water they may be molded
to fit the limb and be retained by means of bandages. Heavy sole leather
is also used after being soaked in warm water and molded to the shape of
the limb and holes cut in it to fit over any sharp irregularities in the
natural shape of the bones. Gutta-percha sheets are also used and answer
well. They are prepared and used in the same way as the leather.
Another and perhaps the simplest of all methods is the application of a
plaster-of-Paris bandage, which is made as follows: Strips of thin
cheesecloth 3 inches wide and 8 or 9 feet long are laid flat on a board and
on them is spread a layer of plaster of Paris about one-eighth of an inch
thick; then, starting at one end, roll carefully so as to gather the
plaster in between the layers of the bandage. It is of course important
that the cloth be thin and the plaster of Paris fresh and active. After
preparing four or five of such bandages the operator is ready to dress the
fracture, which, after the parts have been brought into position, should be
done by covering all that part of the limb to which the plaster-of-Paris
bandage is to be applied with a single layer of the dry bandage, letting it
extend both above and below the part to which the plaster bandage is to be
applied and including under the folds of the dry bandage at each end a
layer of absorbent cotton, which is intended to form a pad to prevent the
ends of the plaster bandage from chafing the skin beneath. When this is
done one of the plaster bandages should be placed in a vessel of water and
allowed to remain till the air bubbles have ceased to rise from it, which
will generally indicate that it is soaked through. Then, taking it in the
hand, wind it carefully around and around the limb, unrolling the bandage
as it is wound around the limb, occasionally smoothing down the plaster of
Paris. Should it form roughly or in ridges the hand may be dipped in water
to impart increased moisture to it. When about finished with one bandage,
place another one in the water, so that the winding operation may be
continued without delay. The bandages should be applied till the cast is
from one-half to three-quarters of an inch thick, then gently restrain the
animal for one-half or three-quarters of an hour till the plaster is
hardened. Any of the appliances used should be so manipulated as to prevent
absolutely any motion of the detached parts. If the fracture is near a
joint, it is generally best to include the joint in the appliance. The part
of the limb below the bandage should be carefully and firmly wrapped with
an ordinary cotton bandage all the way from the plaster bandage down to the
hoof. This last bandage will tend to prevent swelling, which is liable to
occur, the result of the dependent position in which the animal is forced
by nature to keep the injured limb.
When plaster-of-Paris bandages are applied to a compound fracture the
injured part may be previously dressed with a small, thick pad of cotton
immediately over the wound. In applying the bandage the operator may with a
little care so arrange it as to keep the folds of the bandages off the
cotton, or have only a thin layer over it, which may be easily cut out and
the cotton removed, leaving a convenient opening through which to dress the
wound without removing the bandage. The ends of the bandage or other
appliance should be carefully watched to see that the skin does not become
chafed, particularly at the lower end. If the bandage should become weak or
broken at any part, it may be strengthened without removal by applying
other bandages immediately over it. If swelling has taken place before the
bandage has been applied, there is liable to be some loosening as it
disappears, and even without the swelling there may be a tendency of the
bandage to slide downward. This may be overcome by fastening it to a
suspender attached to a surcingle or passed over the body and attached to
the opposite leg. If the looseness can not be overcome in this way, the
space may be filled by pouring in a thin paste of plaster of Paris. A
better method, however, is to remove the bandage and apply another. Owing
to the hardness of the bandage it will be removed with some difficulty. A
deep groove should be cut down completely through it on the opposite sides.
This may be done with a chisel and a small hammer if the bandage is
carefully held by an assistant so that the concussion of the blows is not
transmitted to the injured bones. The patient should have a roomy stall,
and should be tied by the head to prevent any attempts to move around. In
some cases slings have been used. Ordinarily, however, they are not
satisfactory in cattle practice, and if applied should be for only a few
days at a time, and with a view to lessen the animal's disposition to lie
down, rather than to prevent it. When they are used continuously the
pressure on the abdomen may interfere with digestion and the general health
of the animal.
_Modes of union._--The animal should be kept as quiet as possible and given
such feed as will have a tendency to keep the bowels slightly relaxed. The
success of the operation depends chiefly on the skill of the operator, but
not alone in the selection and use of the appliances, for as much attention
must be given to subsequent management. The patients are restless, and a
single awkward motion may undo the work of weeks so far as the union of the
parts of the bone is concerned. Union takes place after the same process
and, if the conditions are favorable, with greater rapidity than in the
human being. The injury that caused the fracture is almost sure to have
extended to some of the adjacent tissues, and even though the fracture may
be of the simplest type there is almost sure to be considerable hemorrhage
around the ends of the broken bone. This, however, is unimportant if the
skin remains intact, unless a very large vessel should be injured, or the
fracture should open some of the important cavities of the body, in which
case a fatal hemorrhage may result. If, on the other hand, the fracture is
compound the external opening furnishes a fertile field for the lodgment of
disease-producing germs.
Unless great care is taken in such cases, a suppurative process is liable
to be established which will seriously interfere with, if not entirely
arrest, the process of union between the bones; or it may become so serious
as to endanger the general health of the animal and even be attended with
fatal results. This last danger is greater if the injury has occurred to
the bones of the arm or thigh. In such cases, owing to the dense covering
of fascia which ensheathes the muscular covering pus is liable to be
imprisoned, and, burrowing downward, saturate the whole structure, not only
endangering the limb, but, by absorption, may set up blood poisoning and
seriously interfere with the general health of the patient, even to causing
death. In order so far as possible to prevent such an unfortunate
complication, the wound should be carefully cleansed with a mild solution
of carbolic acid, then dusted over with iodoform before the bandages are
applied, and cleansed and dressed daily in the same way. After dressing,
always cover with absorbent cotton. In the early process of union an
exudation of lymph takes place, which is at first fluid, gradually becoming
thicker and firmer till it forms a callus, known as the external or
ensheathing callus, in the shape of a ring or ferrule surrounding the
detached portions of the bone. It occasionally happens that this callus
forms only at the ends of the bones, filling the spaces that exist between
them, when it is known as the intermediate callus. The process of union may
be divided into five stages. In the first stage, including the first eight
days, the detached portions of the bone and the sharp projections that are
not sufficiently nourished are absorbed; the blood which escaped into the
surrounding tissues, the result of the injury, is gradually absorbed, and
the effused lymph, which is ultimately to constitute the temporary
cartilage, takes it place. In the second stage, from the tenth to the
twentieth day, the tumor or callus is formed and fibrocartilage is
developed inside and around the exposed end of the bone. In the third
stage, extending from the twentieth to the fortieth or fiftieth day,
according to the age and strength of the animal, the fibrocartilaginous
structure undergoes a change and is gradually converted into bone, forming
a ferrule on the outside and a plug on the inside, which serve to hold the
part in position. In the fourth stage, extending to about the sixth month,
the whole of the new structure is converted into bone. In the fifth stage,
extending to the end of the first year, the callus is absorbed, being no
longer necessary, and the connection between the cavities of the two bones
is again established.
_Common complications._--The process of union just described is healthy and
normal. Diseased conditions may at any time supervene during the treatment
and render the operation unsuccessful. In the case of compound fracture,
the open wound communicating with the ends of the bones, a septic condition
is liable to arise which may become so serious as to endanger the animal's
life and bring about conditions which in human surgery would indicate
amputation. Although that operation is not a general one in veterinary
practice, there is no reason why it should not be attempted as a last
resort, particularly if the animal is valuable or is one whose existence is
necessary in order to perpetuate some valuable strain. Even in the simplest
form of fracture, if the splints or bandages are improperly applied and the
fractured bone left so loosely guarded that the broken ends move one upon
another, the formation of the calluses previously described is liable to be
interfered with, and in place of a strong, rigid, and healthy union a
formation of elastic cartilage is the result. This false structure unites
the broken ends of the bones in such way that they move one upon another,
depriving the bone of its stability and usefulness. When once the healthy
process of union is interrupted in the manner just described, it is again
established with great difficulty. It no longer does any good to continue
the restraining power; in fact, the change of the temporary cartilage into
bone is more liable to be reestablished if the parts move violently upon
each other for a short time so as to set up and renew the process of
inflammation. Then if the restraint is again applied there is some chance
of union. In order so far as possible to avoid this danger, care should be
taken to see that the bandage fits closely and that it is kept on till
there is no longer any danger but that a perfect union has taken place. It
is impossible to say at just what time the splints or bandages can safely
be removed. In a young and healthy animal of quiet temperament, if the
parts have been firmly held in position throughout the whole time, from 30
to 40 days may be regarded as reasonably safe. Under more unfavorable
conditions as to age, vitality, and restraint, the period would better be
extended to 60 days, if the general condition of the animal is such as to
permit of so long a continuance. After the appliance has been removed the
animal should be allowed to stand quiet for a few days, then be given very
gentle exercise, gradually increased for a week or 10 days, by which time
the patient will be so far recovered as to be placed in pasture. It should,
however, be alone for a time, so as not to take any chance of injury from
fighting or other accidents that association with other animals might
involve.
SPECIAL FRACTURES.
FRACTURE OF THE HORNS.--Of the special fractures liable to occur, that of
the horn is perhaps the most common. It is always the result of violent
mechanical means, such as blows, injury occurring while fighting, or from
the animal getting its head locked in some manner while feeding from a
rack. When it occurs there are two ways in which the injury may affect the
animal. First and most common, the horny crust is liable to be stripped
from the bony projection which it covers. Second, the crust and bone may
both be broken or bent down, the fracture occurring in that case at the
root of the horn and involving part of the bones of the head in the
immediate vicinity. In the first case, if the horny covering is knocked
off, little attention is necessary. The animal may be relieved from
suffering if the stump is smeared with pine tar and wrapped in cloth. If
the core is much lacerated, perhaps it would be better to amputate. The
necessity for such operation must be determined by the condition of the
injury, influenced to some extent by the owner's ideas on the subject. When
the operation is performed, it should be done with a sharp, fine-toothed
saw, and by sawing the horn off close enough to include a little of the
skin and hair around its base. The practice of dehorning has grown popular
in many parts of the country. It is a simple operation, and, although
attended with some immediate suffering, does not produce serious
constitutional disturbance. The advisability of performing the operation on
all cattle is a question of expediency and must be justified by the
expectation of benefit on the part of the feeder. If the horn should be
broken so that the core and crust are bent out of shape without the
detachment of one from the other, it may be restored to its normal position
and retained there by means of a splint made to fit across the back of the
head, so as to be laced to both horns, the sound horn serving to hold the
broken one in position. Such a splint may be fastened on by means of either
a wire or cord and allowed to remain six weeks or two months.
If both the horn and core have been broken off, bleeding is usually severe
and should be checked by astringents, such as alum, or by pressure. After
the hemorrhage has ceased the exposed portion of the fracture should be
covered with pine tar, with or without a bandage. An imperfect growth of
horn will in due time cover the exposed bone.
FRACTURES OF THE BONES OF THE FACE.--These occasionally occur, and when
over the cavities of the nose produce depression, disfigurement, and
impeded respiration, owing to the lessening of the caliber of the nasal
passages.
When such accident occurs, the depressed bone should be gently forced back
to place by introducing the finger in the nostril, or if the fracture is
too far up for this, a probe may be passed and the parts retained by
placing immediately over it a plaster of thin leather or strong canvas
smeared with tar, extending out to the sound surroundings, taking care to
embed the hair over the fractured portion in the tar of the plaster, so
that it will be firmly held and prevented from again becoming depressed. If
only one nostril is involved, the depressed portion may be held in position
by packing that nostril with absorbent cotton. This practice, however, has
the objection of giving the animal great discomfort and in some cases a
disposition to aggravate the injury.
FRACTURE OF THE SKULL (CRANIUM).--Fractures of the bones forming the cavity
in which the brain is situated are, owing to their strength, comparatively
rare among cattle. Such an accident can only be the result of external
violence, and it is hardly possible that it could occur without some
fragment of the broken bone pressing upon the brain so as to cause coma or
other severe nervous derangement, or even death.
If the animal survives the first shock, the efforts should be directed
toward relieving the pressure, which may be done by making an opening in
the bone (trephining), and with a hook drawing the depressed part outward.
Interference is not so liable to be attended with good results as to be
warranted in all cases. The effects of a very severe shock which may not
have produced a fracture, although the symptoms were alarming, will in many
cases pass off, leaving the animal in a better condition than if an
operation had been performed.
FRACTURE OF THE LOWER JAW.--This occasionally occurs, and is more liable to
result from the kick of a horse than from any other cause. The front part
of the jaw may be split or shattered in any direction in which the force
may have been applied. Bloody discharges from the mouth and failure to eat
or ruminate are symptoms most likely to attract attention.
The treatment is simple and consists in first removing detached pieces of
bone, then drawing the parts together and retaining them by means of pieces
of copper wire fastened around the teeth, and feeding the animal on sloppy
feed until recovery takes place. The wound should be dressed once or twice
a day with a 3 per cent solution of carbolic acid, forced gently in with a
syringe, so as to remove any feed which may have become impacted and
interfere with the healing process.
FRACTURE OF THE VERTEBRA (SPINAL COLUMN).--This is not so common among
cattle as other animals. If the fracture should be through the body of the
bone, there may be pressure on or laceration of the spinal cord, causing
paralysis of all parts posterior to the seat of injury. Fractures of the
prominences on a vertebra occasionally occur without interfering with the
canal in which the spinal cord is situated. Such accidents are liable to
pass unnoticed, for, although the animal may suffer considerable pain, it
may not be manifested in such way as to attract attention, and the deep
covering of muscles serves effectually to conceal the injury. When the
fracture occurs in the upper part of the neck, paralysis of the muscles
used in respiration must result, and death from asphyxia very shortly
ensues. The more common accident is to the loins, and when a fracture of
the body of a vertebra occurs in this region so as to produce pressure on
the spinal cord, paralysis of the hind legs and quarters is the result.
Diagnosis of such an accident is more difficult than in the case of any
other fracture. The parts can not be moved one upon another so that
crepitus is noticeable. The heavy coating of muscles conceals
irregularities of shape, which otherwise may attract attention. About the
only reliable symptom is paralysis or loss of use and sensation of the
parts posterior to the injury. Careful examination may reveal the seat of
the injury. If it was the result of a blow, there may be some abrasion of
the skin. The diagnosis is only important as an aid in determining the
proper course to pursue.
If paralysis is present and a depression or irregularity of the spinal
column is so apparent as to leave no doubt of the existence of a fracture,
the only alternative is to destroy the animal, for of recovery there can be
no hope. If, on the other hand, the paralysis is incomplete and there is no
depression or irregularity of the spinal column or other evidence of
fracture, the patient should be made as comfortable as possible by being
placed in a well-bedded box stall and a few days permitted to elapse before
the case is abandoned. The symptoms last described may possibly be the
result of a severe strain of the muscles of the loins, in which case an
improvement will soon be noticeable.
FRACTURES OF THE PELVIS.--The pelvis, or bony framework which gives shape
to the posterior part of the body, is liable to fracture in many ways. A
common one is by a separation of the two bones which constitute the whole
pelvis along the bottom and center line (symphysis pubis). In early life
the two bones are separate and distinct. The union between them, which is
at first cartilaginous, undergoes a change and is converted into bone, so
that in adult life the whole pelvis is practically one bone. The point on
which the two bones are united is weaker than the adjoining parts of the
bone. When an animal slips violently, spreading the legs wide apart, the
weaker materials give way and the bones are divided. If the accident is
noticed when it occurs, it is likely to throw light on the nature of the
injury. The animal will immediately go stiff behind, the legs being spread
apart. Further examination may be made by introducing the hand, previously
carefully oiled, into the rectum or vagina and pressing down along the
central line, which will cause the patient to evince acute pain. In this
case no appliance can be used to advantage. The animal should be tied in a
stall until the parts become reunited and the lameness disappears.