In a horse treated by us for a contused wound of the internal face of the
leg, returned to his work a month after the accident, the tibia broke five days
later, while the animal was working. Another subject, a stallion, received



FRACTURES. 415

a kick on the upper third of the internal face of the forearm ; he was,
against our advice, taken home after twenty-two days. He had scarcely-
passed the door of the hospital, when, srnelling a mare, he reared and fell
on the lame leg ; a crack was heard, the radius was broken at the place
of the first injury. The horse recorded by Vitry had, six months before,
received a shot on the night anterior cannon, the fracture taking place while
walking ; the lameness of the first injury had disappeared five months
before.

Absolute rest constitutes the primordial indication of the treatment of
incomplete fractures. The patient should be kept in the stable, tied up
to prevent his lying down, or better, put in slings. It seems to us that
Liard and Relier have exaggerated the inconvenience of the latter. Truly,
some horses object to slings, but in the majority of cases, when they are
well applied, that the animal is not raised from the ground, he can rest com^
.fortably, specially if with them he has a good bed on the floor. If the
other legs swell, cold lotions, massage, bandages should be applied on them.
On the seat of the trauma, cold water and astringent lotions are recom-
mended. Application of a large blister is preferable. In large animals,
bandages are little used. After six weeks or two months, the animal is
returned to work, light at first. With time, the exostosis which has devel-
oped subsides gradually; alteratives and needle firing will promote its
resolution. In small animals, a diagnosticated split should be treated as
a complete fracture.

B. — Complete Fractures.

Most commonly the result of external violence (traumatism, blows, falls,
projectiles) or of muscular contraction, complete fractures, in all species,
are peculiarly frequent on bones of the extremities. They are favored
by local and general causes. Local inflammatory processes (osteitis,
necrosis, caries), in reducing the resistance of bones, predispose to secondary
fractures, which occur easily under the action of some occasional cause.
The situation of some bones (radius, tibia, metacarpals, first phalanx)
exposes them most particularly to traumatisms. Some general morbid
conditions (osteoclasty, osteoporosis) modify the constitution of the bony
tissue and reduce its resistance. Ordinarily, the lesions due to these
morbid states are apparent in examining the fractured bone ; there are
cases where they escape the simple naked eye inspection. Advanced
age is also accompanied with rarefaction of the bony tissue. In some
families of animals, a special fragility of bones has been observed and with
it numerous fractures on one subject, without discovering at the post-
mortem any manifest alteration of the bony tissue (Stockfleth, DieckerhofT).
The relative frequency of fractures of the various bones of legs differs -.



4l6 VETERINARY SURGICAL THERAPEUTICS.

with the animal species and the service to which they are used. Accord-
ing to some authors, in the horse, fractures of the superior bones are more
frequent than those of phalanges. Verlinde, in 42 cases of fractures
observed in a regiment of Belgian cavalry, during 12 years,
found only i of the coronet, i of the ossa suffraginis, i of the navicular
bone, while in 21 cases the femur was the seat of the lesions. Out
of 159 cases of fractures of the extremities we have found : 5 cases of
the scapulum, 13 of the humerus, 17 of the radius, 6 of the cubitus,
3 of the carpal bone, 30 of the pelvis, 6 of the femur, 32 of the tibia,
I of the OS calcis, i of the astragalus, 15 of the cannon, 24 of the first
phalanx, 4 of the second, 2 of the third.

As soon as a fracture is suspected, the diseased leg must be handled and
manipulated with care. To discover the " abnormal motility " or " the
crepitation," extensive movements of the bony levers should be avoided,
as they give rise to acute pains, sometimes to lacerations of the peri-bony
tissues and of the skin, or to contractions followed by irreducible fragment-
ary displacements, or again to vascular or nervous injuries. The examina-
tion must be quick, complete, methodic and made with care. The
deformity of the region, functional impotency, abnormal mobility, crepita-
tion, acute pains, impose a diagnosis. Even in the absence of one or
several of these symptoms, it can be made by the careful examination of
the region. With fractures of the leg, it is often made by a glance. But
with thick fleshy masses, as those of the arm or thigh, the diagnosis is
more difficult, on account of their thickness, which interferes with the
discovery of the essential symptoms. In the diagnosis of fractures of the
pelvis, rectal exploration is rarely doubtful.

Let us recall the possible mistake that can be made of some fractures with
contusion, tendinous rupture, a sprain, a paralysis. But, in general, the
differential diagnosis is posed as follows : Is there a fracture or a dislocation ?
Methodic exploration of the wounded part, the location of the apophysis
and the mobility, generally allow the solving of the problem. Abnormal
mobility of fractures has a special character ; it takes place in all direc-
tions and ordinarily is about as much accused whether the lower part of
the leg is carried in flexion or extension, abduction or adduction. That
of luxations is more limited ; abnormal movements are produced more or
less marked in a given direction, they are impossible in others ; and agaia
the leg left to itself is stiff, longer or shorter. When in fractures, reduc-
tion is not kept up, the deformity returns at once. In luxations, if it is
more difficult, it is generally lasting.

There is a great, a very great, difference between the importance offered
in the treatment of fractures in veterinary and human surgery. For our
large animals, the preservation of life is not sufficient ; with few excep-



FRACTURES. 417

tions a recovery perfect enough to permit the return of the freedom of
motion and work is essential ; and on the other side, treatment is often
difficult, on account of their indocility and of the numerous difficulties
one has to overcome to keep the fragments of bones in place. For
these reasons, animals that have received severe injuries are generally-
destroyed. It is not because the repairing process is insufficient ; with
animals, the bony tissue has the same structure and behaves in repairs the
same way as that of man does. The old belief that bones of animals did
not unite is dead long ago. But the duration and the expense of the
treatment, its imperfect result, the remaining lameness when it is a bone
of an extremity, frequently are objections which command the destroying
of the patient. Numerous cases exist where the interference of the
veterinarian is limited to the making of a correct diagnosis. There are
some cases, however, where treatment must be attempted, even in large
species ; it is when the regularity of locomotion is not indispensable to the
usefulness of the animal (milking females, stallions, brood mares). Some
conditions, favorable to the rapid and regular repair of fractures, must also
be taken into consideration, such as the youth of the animal, its small
weight, docility, the small displacement of the bony fragments, or the
absence of wounds. Yet, let us repeat that it is a rule to destroy all sub-
jects of little value.

Such is not the case with small animals. For dogs specially, treat-
ment we always attempt. It is easy, success is almost sure and many
owners do not hesitate on account of expense. Ankylosis, deformities,
permanent lameness, even amputation must not stop us. The preserva-
tion of life is all that is wished for.

Once treatment is decided upon, if the patient is not near the house
■where he is to be kept, he must be carried there without aggravating
the trouble. The fractured leg should not be left to itself ; it ought to be
secured at once, even by a temporary dressing. For dogs, oakum, some
linen, wooden splints, bandages are sufficient. For large animals,
■walking should be avoided ; extensive movements of the lower ex-
tremity of the leg promote useless pains and serious disorders at the
fractured center ; the bony ends may injure the skin, break it and trans-
form a closed into an open fracture. The injured region should be
enveloped with linen rags, a sheet, a thick pad of oakum ; it should be im-
mobilized with splints and bandages, and the patient placed in a wagon.
The ambulance found in some large cities is very useful. In both the
animal is kept in the standing position and secured so that he cannot lie
down. Great care must be exercised when the animal is taken from those
Tehicles as well as when he is made to enter them, so as to avoid all
struggles, mis-steps or falls by which the injury of the leg might suffer.



41 8 VETERINARY SURGICAL THERAPEUTICS.

In some cases, if there is np displacement, the bone has kept its
form, direction and normal length, the application of the contentive dress-
ing may be made at once. But these cases are rare : ordinarily it is
necessary to modify the position of the fragments. With certain fractures,
where the displacement has taken place m the thickness of the bone, re-
duction is made with the animal standing ; by pressures made upon one
end, while the other is held firm, the normal relations are reestablished. If
displacement is more marked, if it necessitates difficult manipulations, it.
is prudent, after the application of a temporary bandage, to cast the
animal. The muzzled dog should be kept on a horizontal table.

Reduction is simple if the ends are angular ; it is more complicated if
tliey are displaced in their length, overlap each other; then, there is-
shortening of the leg, which is kept up and supported by muscular
contraction.

The manipulations of reduction include: i. Extension; 2, coimter-
exte?ision ; 3, coaptation'. Extension is applied on the lower fragment,,
counter-extension on the upper, while at the same time both ends are put
in coaptation.

With small animals, most ordinarily the hands are sufficient to restore the-
muscles to their primitive length. Let us suppose a fracture of the fore-
arm. The operator takes hold of the upper fragment with one hand, and
of the lower with the other, and by opposite pullings replaces the bone in
its normal length. If the dog is of large size, an assistant ,may be neces-
sary to apply the counter-extension.

The reduction is more difficult in large animals, where muscular power is
such that it resists the combined action of several aids. The subject cast
on the side opposite to the fracture, has ropes secured on the upper seg-
ments of the leg and attached to the wall or to rings fixed on post ; these
are the mechanical agents of coiaiter-extension. Other ropes are fixed
round the coronet, the cannon or the lower extremity of the radius, always
as near the seat of the fracture as possible, avoiding to squeeze the peri-
fractured tissues ; those are held by assistants, who apply the extension
with slow, continued, regular pulling made in the direction of the axis of
the leg. Manual tractions of several assistants are difficult to regulate ;
they are made by jerks, and often give only imperfect results. Tackle
and pulleys work more regularly. Coaptation is the more delicate part of
the operation. When thick layers of muscles cover the bone (thigh, arm)
the ends of the bone are difficult to make out ; if everything seems about,
in place, precision is difficult, and yet on this part of the operation
depends the complete success or the defective recovery of the fracture.
For members, the mode of displacement of the lower fragment may be
indicated by the position of the foot, the direction of the toe ; these must:



FRACTURES. 419

"be taken into consideration. Fragments badly brought together unite, but
the callus is voluminous, irregular, the leg is shorter, deviated ; a perman-
ent lameness is the result. It is specially with heavy and strongly muscular
animals that it is difficult to obtain perfect juxtaposition of the fractured
ends. Splinters, interposed muscular fragments, a great obliquity of the
opposed bony surfaces are as many causes which render the work of co-
aptation difficult. For the olecranon, the external angle of the hip, the
point of the ischium, muscular contraction keeps the fragments apart and
renders their coaptation impossible.

In some cases, muscles, spasmodically contracted, resist so much more
that they are more pulled upon ; traction awakes contraction. To relieve
these " muscular rebellions," anesthesia must be resorted to. With dogs
an injection of morphine given first is advantageous : it throws the organism
into a state of torpor faciliating the effect of anesthesic vapors ; it reduces
to almost nothing the period of excitement ; by it, violent movements
likely to complicate fracture have been avoided, while they generally occur
if anesthetic inhalations are used alone. With large animals chloroform-
ization or mixed anesthesia should be resorted to, carefully holding the ends
of the bone close together during the period of excitement. Muscular
relaxation obtained, the fracture is reduced, the ends coaptated and the
immovable bandage applied. It is advantageous to continue the adminis-
tration of the anesthetic until the apparatus is well settled and can resist
the efforts of the animals and of the muscular contraction.

Must we in all cases of fractures apply immediately the manipulations of
reduction? If there exists a large bloody effusion, a big inflammatory
swelling, is it not better to wait until after the diminution of the swelling?
In man, Dupuytren and Velpeau have said that reduction must be im-
mediate, in whatever condition the fractured center is. If, as much as
possible, one must act before the period of inflammatory phenomena, one
must avoid acting harshly on an inflamed fracture, compress it, or
twist it, as phlegmonous or gangrenous accidents might follow. The
bony fragments are surrounded by the exudate, the clots of blood ; the
hand cannot detect them well, they are not felt, and coaptation is only
imperfect. Malgaigne has shown the enormous resistance offered by
inflamed muscles, in the reduction of fractures. A weight of one
kilogramme, attached to the paw of a rabbit whose thigh was fractured,
produced, the very day of the accident, only one centimeter of elongation ;
two days later a weight of three kilogrammes gave only one of 5 mili_
meters. In another rabbit, suffering with fracture of the tibia, the over-
lapping, which was of two centimeters, was overcome the first day with the
simple weight of 125 grammes; two days later, one of 5 kilogrammes
elongated the leg only one centimeter and half. The twelfth day, 9 kilo-



420 VETERINARY SURGICAL THERAPEUTICS.

grammes gave only an elongation of 5 millimeters; 25 kilogrammes did
not give any more, and the tibia broke under the weight. One can
judge by those data of the effort demanded, if in place of a rabbit, it was
applied on a horse or on a steeer !

Reduction, then, should be applied in the shortest time possible, 'before
the inflammation has invaded the peri-fractured tissues ; however, if in-
flammatory phenomena exist, it is better to wait for their attenuation.
Such are the indications derived from the above considerations.

The bony fragments in good position, they must be kept in it. The
internal skeleton being wanting, a temporary external one must be supplied.
Let us consider the means of contention :

In animals, specially the large ones, perfect immobilization of the center
of the fracture is not an easy matter. The difficulties are so much greater
that the patients are more rebel and heavier. The horse cannot stand
on three legs for a long while ; continually he tries to rest on the injured
extremity. And if the dog keeps quite willingly the decubital position, if
with him the dressing is easy to apply, it is rare if he does not try to get
rid of it.

There are two kinds of dressings : the movable or immovable. The
first may be changed frequently ; no hardening substances unite the
various parts composing it (oakum, splints, rollers). The immovable
must remain in place until recovery is completed ; an agglutinative substance
makes all the various consecutive pieces adhere together. These dressings
are most used in our surgery ; more solid, firmer than the others, they
offer more resistance to the teeth of dogs, and constitute an envelope of
excessive hardness, likely to take the place of the fractured bony lever.

The substances used to make these bandages are : oakum, wadding,
rollers and a great number of hardening substances or preparations.

In general, the region is first covered with a layer of oakum, filling up
hollows and forming a pad to protect the skin from the pressure of splints.
These are most ordinarily little thin boards of wood, that can be had any-
where ; those of metallic wire netting have the advantages of being light and
easily adapted to the region ; molds of zinc, gutta-percha, felt, paste-
board are also used. This last is very useful in canine surgery ; it is cut
in strips, having the form, the length and the width of the leg. In large
animals, a greater resistance being necessary, more solid pieces of wood
or iron are used. Splints must be made not only to cover the fractured
bone, but also those that are contiguous to it ; they must immobilize com-
pletely the articulations to which the fractured bone cooperated to form
above or below ; in dogs it is proper to envelop the entire extremity down
to the paw. The number of splints varies : for small animals two are
generally enough \ three or even four may be necessary for large species.



FRACTURES. 42I

The ordinary roller is that used most generally ; bands cut from old
sheets and sewed together answer the same purpose.

We have but one word to say in relation to the movable dressings.
In them, the leg being enveloped with oakum or wadding, and the splints
-well in place, the rolled bandage is applied all round from below upwards.
The Sciiltet differs from this, in having, instead of a single roller, a series
of separate bands, which are secured by pin or stitches of suture. This
permits the exposure of any one part of the dressing alone, without distur-
bance of the whole.

When a solid, permanent dressing is intended, it is necessary to unite
its various constituents together and with the skin, in using a substance,
first fluid, but becoming hard, solid by dessication, and able to give to
the leg a real fixity, to constitute, as IMalgaigne said, an " external skele-
ton " to replace the internal one, broken in its continuity — it is necessary
to apply an immovable one.

Black pitch, which is found everywhere and hardens rapidly, is much
used in veterinary practice, even for large animals. It is often mixed with.
turpentine, which renders it more fluid. The first coat applied on the skin
must be semi-liquid, so as to avoid the formation of scabs its application may
give rise to. The pitch, having a tendency to soften under the influence of
heat, must be sprayed several times a day with cold water. Gombault has
recommended the mixture of equal parts of black pitch and resine. Del-
wart advocates a preparation made of black pitch 1000, Burgundy pitch
1000, turpentine of Venise 500. The following mixtures are also recom-
mended : two parts of resine and one of yellow wax ; five parts of gutta-
percha and one and one-half of resine.

The use of guyn arable goes back to the hippocratic epoch. It
is used dissolved in warm water, or thick syrupous solution. It requires
six or eight hours to harden. It is softened with tepid water when the
bandage is to be taken off. In place of gum arable, the mixture of
Abulcasis is used, or that of glue made with flour, white of eggs and alum.
Let us again mention the agglutinative preparations of Larrey (white of
€ggs beaten in water, camphorated spirits and white lotion), that o£
Seutin (starch boiled in water), of Velpeau (100 parts of dextrine, 60 of
camphorated spirits, 50 of hot water), of Lafontaine (warm mixture of
turnt alum and alcohol). Laugier cut little bands of paper 4 or 5 cen-
timeters long, covered them with shoe-maker's wax on both faces and
rolled them round the fractured leg. This mode, undoubtedly simple,
has the objection of requiring twelve hours to harden. The mixture of
starch and plaster (Lafargue) hardens quick.

Introduced in the therapeutics of fractures by the Arabian school,
plaster was not utilized in Europe until the beginning of this century;



422 VETERINARY SURGICAL THERAPEUTICS.

in veterinary practice it was recommended by Bernard, in 1839. First it-
was used like the moulders do : the leg placed in a grooved splint, thick
plaster was moulded all round it. The dressing thus obtained was very
heavy. To Mathysen and Van de Loo is due the credit of the fortunate
innovation of plastered rollers. To prepare them, bands of tarlatan
are taken, and on both faces plaster is dusted or rubbed in ; these bands
are kept in metallic boxes. When they are to be used, they are first
sprinkled with water, or slightly moistened with wet sponges, and then
rolled round the region to immobilize, in layers more or less thick accord-
ing to the mobility of the fractured ends. To-day, bands prepared ad
hoc are used. Generally simple bands of tarlatan, dipped in paste of plaster,
are employed. The plaster paste must not be too thick, nor too thin ; it
is prepared with equal quantities of water and plaster, kept perfectly dry, and
that has not been exposed to the air. Bands impregnated with this
paste are rolled round the broken leg : solidification takes place in ten
minutes ; the dressing is so hard that it resists the most powerful efforts.
Circular plastering has some objections : it either presses the fracture
too much or not enough, and does not permit examination of the injured
region. Actually, in human surgery, plastered splints and gutters are
used. The splints made of tarlatan, folded in ten, twelve or fifteen
thickness, are covered with paste of plaster, then spread over the leg or
the fractured region, without wrinkling, and held in place by assistants;
the leg is then enrolled with a band which makes the splints adapt them-
selves well on the irregularities of the leg. When solidification is suffi-
cient, this band is removed, the various parts of the apparatus are then
secured by ligatures placed at various parts of its height. In this manner,
a very firm contentive mould is obtained, which can be applied, closed
and removed at will. Plastered gutters are cut out on the healthy leg.
This mode of application is the same as that of splints.

The bandage of Beelz, excellent for large animals, is made of plastered
bands, between which are placed coating of lint. In Germany " tripoli " is
much used ; it is a mixture of plaster, carbonate of lime, of magnesia,
coal and sand ; this mixture hardens rapidly and forms a mass more solid
than plaster. (Moller).

Advantageous as it may be, plaster cannot be of general use. It is not
as convenient for fractures of the superior parts of the legs ; its want of
fixity in these cases has been a just reproach to it in those instances.

For fractures of extremities, Simon recommends gutta-percha applied
as follows : the reduction made, the fractured region is envolped with a
pad of wadded peat, then upon that are disposed two gutters of gutta-percha,
soldered together afterwards with a cultellar iron heated red. So as to avoid
excoriation of the skin, a pad of wadding should always be placed be-



FRACTURES. 42$

tween the skin and the apparatus.' According to the indications, fenes-
tra can be made in this apparatus without diminishing its resistance.
Solidification is quick. To remove the dressing, the envelope is split with
a knife or with the cautery.

With silicate of potasse, very firm bandages can be made, but their
objection is that they take several hours to harden. Bands of linen
(Fregis) or of paper (Brun) are impregnated with it. Fregis uses it prin-
cipally for dogs.

From this rapid consideration of the various bandages we may draw
the following conclusions : In cases of simple fracture, without inflamma-
tion or marked swelling, apply immediately an immovable dressing,
giving preference to those made of plaster, silicate or dextrine. To the