Part 46

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.

We have already considered in a general way the presence of these peculiar oil bags in the joints, and in some regions of the legs where the passage of the tendons takes place, and have noticed the similarity of structure and function of both the articular and the tendinous bursae, as well as the etiology of their injuries and their pathological history, and we will now treat of the affections of both.

WINDGALLS.

This name is given to the dilated bursae found at the posterior part of the fetlock joint. They have their origin in a dropsical condition of the bursae of the joint itself, also of the tendon which slides behind it, and are therefore further known by the designations of articular and tendinous windgalls, or puffs. (See also p. 401.)

They appear in the form of soft and somewhat symmetrical tumors, of varying dimensions, and generally well defined in their circumference. They are more or less tense, according to the quantity of secretion they contain, apparently becoming softer as the foot is raised and the fetlock flexed. Usually they are painless and only cause lameness under certain conditions, as when they begin to develop themselves under the stimulus of inflammatory action, or when large enough to interfere with the functions of the tendons, or again when they have undergone certain pathological changes, such as calcification, which is among their tendencies.

Cause.—Windgalls may be attributed to external causes, such as severe labor or strains resulting from heavy pulling, fast driving, or jumping, or they may be among the sequelae of internal disorders, such as strangles or the resultants of a pleuritic or pneumonic attack.

Unnecessary anxiety is sometimes experienced respecting these growths, with much questioning touching the expediency of their removal, all of which might be spared, for, while they constitute a blemish, their unsightliness will not hinder the usefulness of the animal, and in any case they rarely fail to show themselves easily amenable to treatment.

Treatment.—When in their acute stage, and when the dropsical condition is not excessive, the inflammation may be checked during the day by continuous, cold-water irrigation by means of a hose or soaking tub and at night by applying a moderately tight-roller bandage. Later absorption may be promoted by a Priessnitz bandage, pressure by roller bandages, sweating, the use of liniments, or if necessary by a sharp blister of biniodid of mercury. This treatment should subdue the inflammation, abate the soreness, absorb the excess of secretion, strengthen the walls of the sac, and finally cause the windgalls to disappear, provided the animal is not too quickly returned to labor and exposed to the same factors that occasioned them at first.

If the inflammation has become chronic, however, and the enlargement has been of considerable duration, the negative course will be the wiser one. If any benefit results from treatment it will be of only a transient kind, the dilatation returning when the patient is again subjected to labor, and it will be a fortunate circumstance if inflammation has not supervened.

Notwithstanding the generally benignant nature of the swelling there are exceptional cases, usually when it is probably undergoing certain pathological changes, which may result in lameness and disable the animal, in which case surgical treatment will be indicated, especially if repeated blisters have failed to improve the symptoms. Line firing is then a preeminent suggestion, and many a useful life has received a new lease as the result of this operation timely performed. Another method of firing, which consists in emptying the sac by means of punctures through and through, made with a red-hot needle or wire, and the subsequent injection of certain irritating and alterative compounds into the cavity, designed to effect its closure by exciting adhesive inflammation, such as tincture of iodin, may be commended. But they are all too active and energetic in their effects and require too much special attention and intelligent management to be trusted to any hands other than those of an expert veterinarian.

BLOOD SPAVIN, BOG SPAVIN, AND THOROUGHPIN.

The blood spavin is situated in front and to the inside of the hock and is merely a varicose or dilated condition of the saphena vein. It occurs directly over the point where the bog spavin is found, and has thus been frequently confused with the latter.

The complicated arrangement of the hock joint, and the powerful tendons which pass on the posterior part, are lubricated with the product of secretion from one tendinous synovial and several articular synovial sacs. A large articular sac contributes to the lubrication of the shank bone (the tibia) and one of the bones of the hock (the astragalus). The tendinous sac lies back of the articulation itself and extends upward and downward in the groove of that joint through which the flexor tendons slide. The dilatation of this articular synovial sac is what is denominated bog spavin, the term thoroughpin being applied to the dilatation of the tendinous capsule.

The bog spavin is a round, smooth, well-defined, fluctuating tumor situated in front and a little inward of the hock. On pressure it disappears at this point to reappear on the outside and just behind the hock. If pressed to the front from the outside it will then appear on the inside of the hock. On its outer surface it presents a vein which is quite prominent, running from below upward, and it is to the preternatural dilatation of this blood vessel that the term blood spavin is applied.

The thoroughpin is found at the back and on the top of the hock in that part known as the "hollows," immediately behind the shank bone. It is round and smooth, but not so regularly formed as the bog spavin, and is most apparent when viewed from behind. The swelling is usually on both sides and a little in front of the so-called hamstring, but may be more noticeable on the inside or on the outside.