John Victor Lacroix - Lameness of the Horse
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John Victor Lacroix >> Lameness of the Horse
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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.
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