1 Delwart— Traite de med. Vet., Vol. i. p. 530.



FRACTURES. 44I

If the bony fragments have remained in contact, it is useless to have
recourse to a bandage as complicated as that of Gombault. With Rey-
iial, Peuch and Toussaint, we prefer an emplastic bandage.

Lafosse says : When the fracture is complete, the apophysis is carried
upwards by the contraction of the olecranon muscles. The coaptation is
difficult ; too often a fibrous callus forms between the fragments. In such
cases, the flexion of the forearm makes the inter-fragmentary space " gab ; "
on the contrary, extension closes it more or less. There is then advantage
to carry the leg backwards, to extend the leg, as advised by Delwart.
To insure the coaptation, one must take pattern on the apparatus of
Malgaigne for fractures of the olecranon in man ; a padded truss, extend-
ing from the middle of the arm to that of the forearm, should be placed
in front of the elbow joint and held in position by dextrined or tarred
Toilers. A slip made on each border of this truss, a little below the joint,
would permit to secure the turns of rollers, oblique upwards and back-
wards, and which would press downwards the olecranon fragment. Im-
mobilization cannot be kept up too long ; ankylosis is as much to be
feared as the fibrous callus.

In a cow, Gombault has treated successfully a fracture of the lower
end of the radius. The bandage in such cases can be made of plaster
or pitch ; it is sufficient for recovery.

In swine, dogs and cats, the cubitus is a long bone, distinct from the
radius ; it may be fractured alone. The contention is insured by the
radius. Recovery follows always, even without dressing. Nevertheless it
is better to apply a plastered, dextrined or starched bandage.

V. — Carpus.

The serious nature of fractures of the carpus is due to the unavoidable
complication of arthritis and ankylosis. Fortunately, they are very rare.
Trelut (1868) related the case of a horse, which, falling heavily after
■rearing, crushed the bones of the knee. He was killed; 36 fragments of
bone were counted, the biggest being the size of a pea.

Causs^ has observed the fracture of the trapezmm, on a horse which
had made violent efforts to relieve hmiself from a hobble which held him
attached to the ground. After a few days of unsatisfactory treatment, he
was destroyed. Fracture of this bone seems to be produced sometimes,
principally in race-horses, by muscular contraction. It gives rise to severe
lameness, which diminishes gradually; but a difform callus is formed
which produces a lameness that sometimes lasts for months. (See
Splints).



442 VETERINARY SURGICAL THERAPEUTICS.

The articulation of the knee playing a primordial part in locomotion of
•the anterior legs, recovery of its fractures of the bones which compose it
— except the sus-carpal — is naturally very incomplete ; the treatment to
advise is only for animals that can be used for breeding purposes. A
plastered or pitched bandage should be applied. If lameness remains,
median neurotomy is indicated. The treatment of an open fracture
demands before all the antisepsy of the fractured center.'

VI. — CoxaL

Formed by the union of three bones — ilium, pubis and ischuim — the
coxal forms in uniting with that of the opposite side, almost the totality
of the pelvis. Its fractures, ordinarily produced by falls backwards or on
the sides in large animals, by being run over in dogs, may involve the
ilium, ischuim, pubis, cotyloid cavity or several of those parts together.
The two coxals may also be separated from each other at the pubic sym-
phisis or fractured simultaneously.

For the generality of cases, the diagnosis is easy, on account of the
deformation of the croup, the detection of the bony crepitation, a bloody
extravasation or a callus. Often rectal or vaginal exploration is necessary.
If lameness is rarely missing at first, it varies very much in its severity.
When the fracture has taken place forward of the cotyloid cavity, besides
the lameness there is shortening of the step forward, but the resting of
the foot is firm ; when, on the contrary, it exists back of the articulation,
there is specially pain and stiffness in resting ; when it occupies the coty-
loid cavity itself, pain is very great at rest and the lameness much accused ;
in fractures of the ischuim, the leg may be carried in abduction, even at
rest. (Moller).

The /////;;/ is frequently injured on its antero-external angle, the angle
of the haunch ; sometimes a single tuberosity is broken off and remains
attached to the bone ; then the deformity is slight and slightly marked ;
crepitation is scarcely perceptible. IMore often, the angle of the haunch,
completely loose, is more or less drawn downwards by the contraction of
the ilio-patellar and fascia lata muscles. There is no crepitation, but the
deformity of the region is characteristic: in the "hipped'''' horse, there is
an irregularity in the width of the hips, disappearance of the angle on the
corresponding side to the fracture. A hard, resisting mass, formed by
the loose piece of bone, is felt in the flank. Lameness is more or less

1 A fracture of the trapezium recovered without lameness or stiffness was recorded
by Howard (Amer. Vet. Rev., Vol. 15, p. 601).

An unsuccessful case of comminuted fracture of the os magnum and trapezium
was recorded by Harrison (Amer. Vet. Rev., Vol. i,p. 492.)



FRACTURES. 443

^accused. Coaptation and contention being impossible, permanent de-
formity of the hip is unavoidable. But all the troubles caused by this
fracture disappear always without any treatment, when it remains close and
not exposed to infection. Recovery is assisted by the application of a
pitch plaster or of a blistering preparation. Ordinarily after three weeks
or a month, the subject returns to his work. Delamotte has related a
case of fracture with numerous splints and congestive abscesses. The
animal died of septicemia.'

More serious are the fractures of the neck of the ilium. Death may
occur rapidly from internal lesions produced by the fragments of the bone.
In the filly of Tombs, which died in three hours, there was laceration of
the vagina, of the uterus and rupture of the vena cava in front of the
pelvis. Excessive lameness, of long duration, gradual lowering of the hip
on the corresponding side, crepitation when the leg rests on the ground,
such are the principal symptoms of fracture of the neck. Rectal examina-
tion establishes the diagnosis.

Treatment is attempted only with costly animals. The animal should
be left loose in a box or be placed in slings. Blistering applications
have evidently only a very mediocre efficacy. Long continued rest
must be depended upon. The callus, often large, deforms the anterior
diameter of the pelvis and renders females unfit for reproduction.

The fractures of the cotyloid cavity have for causes falls or slips ; the
articular surface of the coxal is crushed by the head of the femur. Almost
always the cotyloid cavity is divided in three parts ; the lines of fractures
do not seem to correspond to those of the union of the. three bones in
the cavity (Barrier). There is severe lameness, acute pains, sometimes
crepitation, even when the leg is not at rest. There is little deformation
at the hip, outside of a muscular depression. Rectal exploration en-
lightens the diagnosis ; but this is sometimes very difficult, specially when
the fracture is recent. At the autopsy of a horse, killed on account of
incurable lameness of a hind leg, Prietsch found a fracture of the cotyloid
cavity, which had not been diagnosed during life. Such lesion is fatally
complicated with arthritis.^

'¥\z.c\.\xxt?> oi iht floor of the pelvis take place in the same condition as

^ In the case of Dr. Kemp, the animal had sustained a fracture of the ex-
ternal angle of the ilium, but, as demonstrated at the post-mortem, a laceration of the
ilio muscular artery had occurred, giving rise to fatal hemorrhage. — Am. Vet. Rev.,
vol. 6, page 544.

2 In the case of Tritschler the horse had reared and fell backwards on the near
side. While treated, the leg had become shortened, the co.xo femoral joint very prom-
inent. At the autopsy it was found that the fracture was at the middle of the coxal
bone, the acetabulum being crushed in several pieces and the femur displaced upwards.
— Amer. Vet. Review, vol. 12, p. 513.



444 VETERINARY SURGICAL THERAPEUTICS.

the preceding ; they generally occupy the obturator foramen. Rey^
:Serres, Jouannin and many others have published cases of it. Nocard,
in the Archives of Alfort (1876), has written an article on them. There is
no deformation of the croup, but ordinarily the lameness offers special
characters ; the leg is moved in abduction ; the animal walks as if suffering
from severe sprains of the loins ; he always has difficulty to get up (Rev).
Later, there appear amyotrophies of the thigh and hip ; the callus fills the
obturator foramen, compresses and atrophies the posterior crural nerve,
which animates the inferior part of the ischio-tibial muscles and also the
obturator nerve, distributed to the muscles of the internal face of the
thigh ; the adductors and flexors of the leg are paralyzed, the leg is moved
in describing a circumference outwards by the exaggerated action of the
abductors ; the thigh alone flexes, the remainder of the leg follows the
movement, but is moved without flexion.

Rectal exammation rarely leaves the diagnosis uncertain. In some
cases, death is produced by the rupture of the obturator vessels ; in
others, the atrophic manifestations which we have mentioned prevent re-
covery. Sometimes the callus diminishes in great proportion the
diameter of the pelvis, and mares which have been treated cannot be used
for reproduction. However, recovery is possible, from the fact that the
fragments are held in place by powerful ligaments and muscular attach-
ments and have no tendency to displacement. The therapeutics consists
only in immobilization in the slings. In the case of Levrat, the right
ischium was fractured near the cotyloid cavity ; after two months the
mare was able to walk ; a month later she was working on the racing track
free from lameness ; the following year she was used as a brood mare and
delivered several colts.

In case of fracture of the iscJiiaiic tuberosity, the loosened bony piece is
pulled downwards by the ischio-tibial muscles ; the result is a peculiar
deformity of the croup : flattening at the height of the ischial tuberosity
and an abnormal projection on a level with the articulation. In some
cases this fracture gives rise to a displacement, a " luxation " forward of
the posterior portion of the long vastus. (See Muscular Luxations^

VII. — Femur.

Frequent in all species, fractures of the femur involve the diaphysis or
the epiphysis. Many cases are related of compound and comminuted
fractures of the diaphysis. Greeve has made the autopsy of a cow where
the femur was crushed in eighty-five pieces.

Fractures of the neck are quite common. Fromage de Feugre', Rigot,
Leblanc, Gurlt, Williams, Percivall, Gamgee, Nocard, Pourtanel, have



FRACTURES. 445

published many observations. Some cases have also been recorded of
fractures of the femoral head, of the inferior articular apophysis (Stock-
fleth, Moller), trochanter, subtrochanterian tuberosit)'.'

Except in this last instance, whatever is the seat of the fracture, there
is no economy in trying to treat them in large animals. Reduction is
difficult, on account of the great muscular force to overcome, and conten-
tion is nearly impossible. With few exceptions, consolidation cannot take
place without a large callus, a shortening of the leg or a permanent lame-
ness. Rey has, however, seen a horse in which a fracture of the femur
had united spontaneously. Bassini has obtained the recovery of a fracture
of the neck (?) in a bull ; the thigh was enveloped in a supporting ban-
dage and the animal left loose. Four months atter the accident, the
animal stood nearly plumb, and was able to work with its leg in normal
position.^

In small animals, fractures of the femur unite readily. On more than
20 dogs, Lafosse has always obtained union, with either pitched bandages
or by only expectation. We have used a bandage of pitch on the hip,
the external face of the thigh and of the shank, and have obtained a
recovery in a month. Delwart recommends, when the coaptation is
once made, to pass under the groin bands which cross each other over
the thigh and secured on the summit of the croup, while others are fixed
on the external face of the thigh and leg.

Beaufils has recommended the same bandage as for fractures of the
humerus. The animal kept standing, the operator with one hand pushes
the stifle of the fractured leg toward the flank, while with the other he
raises the thigh, in order to bring the broken bone parallel to the great
axis of the body; turns of rollers, starting from the injured thigh, are
passed all round the body, until it is well immobilized ; then the other
parts of the leg are flexed and supported with more rollers ; finally, to
prevent the apparatus from slipping backwards toward the tail, two bands
covered with pitch are applied over the whole length of the croup.

Felizet has invented a singular mode of contention. The animal,
laid on a board covered with straw or hay, is secured with turns of rollers,
passing several times round the body and the semi-flexed legs, and after-
wards secured to the board by means of points nailed in the board. A
dog with fracture of the neck of the femur, treated in this manner, was
let loose twelve days after " with his femur entirely and regularly con-
solidated," but a goat and two cows died in a few days. This method

1 A fracture of the internal lip of the trochlea of the femur is recorded by T. Wal-
rath in which the bony hard edges of the fractured portion, as well as the base of the
trochlea, has been removed by absorption. — Amer. Vet. Review, vol. lo, p. 7S.

2 Furlanetto, Prog. Vet., 1890, p. 362.



44^ VETERINARY SURGICAL THERAPEUTICS.

is evidently good only for animals which are not very irritable ; simple
immovable bandages are preferable.



VIII.— Patella.

Lafosse, Renault, Lenck, Goubaux, Andrieu have related interesting
cases of fractures of the patella. They are due to traumatisms or muscu-
lar contraction. Lafosse thought that transversal fractures only were pos-
sible, but the observations of Lenck and Goubaux have proved the exis-
tence of longitudinal injuries. In both varieties, the accident may be
simple or complicated ; it is always accompanied with inflammation of
the femoro-patellar, synovial and sometimes with femoro-tibial arthritis.
It is on this account that Lafosse, d'Arboral and Goubaux erroneously
thought that those fractures were incurable.

In the case of Lenck, the separation of the fractured segments was con-
siderable. On the pieces that Goubaux dissected, he has never observed
separation of the fragments. If the fracture is transversal, a piece of the
bone may be drawn upwards ; but when it is longitudinal the separation
is ordinarily very small ; the fibrous coverings which are over the an-
terior face of the patella hold the fragments in place.

With a closed fracture, pitched immovable bandages, made with bands
placed above and below the patella, then crossed over the lateral faces of
the region, or simply repeated blistering applications, are used ; Delwart
recommends two methods, which proved very good with him ; with one, the
horse is kept perfectly at rest for fifteen or twenty days, with his leg held
slightly forward by a rope ; with the other, an immovable bandage is
applied over the whole region.

Andrieu has obtained the recovery of an open fracture. Toward the mid-
dle of the patella, there was a wound allowing the introduction of the finger,
which could feel the fracture of the bone in three pieces ; this wound
opened in the patella sheath, and from it synovia escaped. Notwith-
standing the severity of the lesion, treatment was undertaken with con-
tinued irrigation. After two weeks, walking exercise was begun; after
a month all treatment was stopped, and the animal put to light work ;
a month later there remained but very little lameness in trotting.^

With open fracture of the patella, 2i fenestrated hdiW^Q-gQ with frequent
antiseptic injections m the wound is the treatment to be recommended.

^ A fracture of the patella is recorded by J. C. Meyer in which ligamentous union had
taken place between the fragments of the bone, which at the post-mortem had been
found, the external piece articulated with the external lateral surface of the femur,
and the internal was resting in the fossa between the trochlea and the inner condyle.
— American Veterinary Review, Vol. 6, p. 239.



FRACTURES. 447

Immobilization should be not carried to extremes ; massage and early
exercise will prevent articular indurations and muscular atrophy.

IX. — Tibia and Fibula.

Fracture of the tibia is one of the most frequently met with. The posi-
tion of this bone in the skeleton of the hind leg exposes it particularly to
kicks, principal occasional cause of the accident in horses. It is true that
this fracture is always serious, but it is not necessarily irremediable, as con-
sidered by many. Many cases are recorded in our journals. In 1838
d'Arboral reported those of Tamisier, Duchemin, Geant, Mullon, Bet-
tinger, Leblanc, in horses ; of Mullon, Buisson, in cattle. The cases of
Lavigne, Rossignol, Lafontaine, Poisson, have added to the proofs al-
ready obtained of the possibility of recovery in cases of fractures of the
tibia in animals. Every practitioner knows of its benignity in dogs.

The chances of success exist principally when the fracture is located
in the lower third of the bone, when it is transversal and without dis-
placement ; fractures of the middle or superior part of the bone, the
oblique one complicated with overlapping of the ends, are the most
serious.

As in most fractures, interference imposes two indications : reduction
and contention. If possible, reduce in the standing position. If the
animal has to be cast, use anesthesia. For contention, use pilch, gutta-
percha, plaster or the mixture of Piau.

In the horse treated by Bettinger, the middle part of the tibia was
the seat of an oblique complete fracture. Reduction was made in the
standing position : a first apparatus made of linen cloth, black pitch
and rollers having become loose, the author made a kind of corset
with a double piece of strong linen, between the layers of which sev-
eral flexible splints were sewed, parallel to the leg and separated more or
less from each other. This "corset" was padded on its inside and held
in place by a roller. The bandage remained in place thirty-eight days.
A chafed wound of the tendo-Achilles healed rapidly ; the gait, stiff first,
became normal gradually. Later, the callus was fired, and though he was
a little lame, the horse was able to resume his work.

Leblanc has treated several fractures of the tibia. To place the horse
in slings, lower the floor of the stall by a hole under the broken leg,
make extension with a heavy weight tied to the foot, apply a bandage on
the leg made of oakum, black pitch and splints, two of which are quite
long and extending, the external from the foot to the stifle, the internal
from the hoof to the upper third of the leg ; such is the modus operandi
he recommends.



448 VETERINARY SURGICAL THERAPEUTICS.

With his apparatus (see Fractures of the Humerus), Lafontaine has
cured a fracture of the tibia in a mare. In the same way, Poisson
obtained the recovery in a nine months filly.

Lavigne threw down a young bull that he had to treat. With a rope>
tied on the thigh, he made counter-extension ; with another fixed to the
coronet he extended the leg and adapted the fragments together. To
diminish the action of the muscles, he squeezed the tendo-Achilles on the
tibia with bands of linen rolled several times round the leg. A piece of
pasteboard, cut gutter-like, pitch, and splints from the hock to the lower
end of the thigh, served to form a strong bandage. The patient was left
loose, free to lie down and get up. After thirty days, the dressing was
removed, the callus was formed.

Rossignol has published several cases of recovery of fracture of the tibia
in swine and sheep. In one, the superior fragment protiuded through the
skin ; it was amputated ; a fenestrated bandage allowed the dressing of
the wound with tincture of aloes. Oakum impregnated with a mixture of
starch, alum and white of eggs, with splints and rollers, made a strong
supporting apparatus. In the same way, Morin cured a heifer.^

According to Delwart, when the fracture is simple and transversal,
success will always follow the application of an immovable bandage
extending from the superior part of the fetlock to the patella. The
bandage is reenforced with two strong splints, one external from the thigh
to the fetlock, the other internal from the stifle to the same point. L.
Lafosse has obtained the regular consolidation of a fracture of the tibia in
a colt, a calf, six pigs, three sheep and a large number of dogs.

In this last animal, those fractures recover very easily. Two pieces of
pasteboard, cut in the shape of the leg and extending from the lower end
of the leg to above the stifle, are applied over a pad of oakum enrolling
the leg, and kept in place by turns of rollers coated with dextrine, silicate
of potash or pitch. (See Fractures of the Humerus.) This bandage must
be left in place from three weeks to a month. If it gets loose or becomes
displaced, it is consoUdated or replaced by another made in the same
way.

With open fractures, the fragments are immobilized with an immovable
apparatus, placed after careful disinfection and the wound well enveloped
with wadding ; but as the asepsy of the wound is often insufficient, a
fenestrated bandage is preferable.

Fracture of the fibula exists most generally in common with that of the

1 H. D. Fenimore delivered a calf which had a consolidated fracture of the right
tibia near the lower third of the bone. The bone was bent a right angle and this de-
formity was the cause of the distokia of which the mother suffered. — American
Veter. Review, vol. 21, page 566.



FRACTURES. 44^

tibia. As a distinct lesion it is rare. External violence on the supero-
€xternal part of the leg may give rise to it ; ordinarily there is no dis-
placement ; with a simple primitive bandage, consolidation takes place
rapidly.

X. — Tarsus.

Fractures of the os calcis are rare ; they are caused by external violence
or muscular contractions. Jumps, slips, falls are the ordinary causes.

In general, their recovery is attempted only in small animals. In the
large species the treatment demands often more than three months
(Haase). However, recovery has been obtained in cattle, in a few weeks,
by an immovable bandage of plaster or pitch and resine (Brauer, Detroye).
The patient of Detroye — a fifteen months bull — in trying to cover a cow,
raised himself on his hind legs : a peculiar noise was heard, like " that of a
dry branch of wood breaking ; " the animal falling suddenly, the os calcis
was found fractured obliquely in the middle of its height. A strip of
iron, gutter-like, adapted to the front part of the leg and extending
from the middle of the leg to that of the cannon, was held in place
with four straps, two above and two below the hock. Well padded in-
side, this bandage kept the hock extended and insured the coaptation
of the bony fragments, thanks to the relaxation of the tendo-Achillis.
It was removed after three weeks. At first the animal stood hesitatingly,
"but by degrees it improved and the lameness disappeared, notwithstand-
ing a permanent deformity of the hock due to the callus. The result is
not, however, always as satisfactory. A horse and a calf treated by the
same author had to be destroyed.^

Fractures of the astragalus, still rarer than the preceding, is ordinarily
the result of a sudden rotation of the hind leg on its axis, the foot rest-
ing on the ground and not obeying the motion started by the superior
muscles ; the tibia pivots on the astragalus, the median projection of the
articular surface of the tibia breaks off the tarsal pulley. Moller has
seen the lesion in a horse making a sudden volt. Furlanetto claims to
have seen it in a cow that had fallen in a hole ; he applied an immovable
b)andage reenforced by two wooden splints extending from the middle of