nothing is easier with bovines. He says : Fix a rope at the fold of the
pastern, carry the leg forward and upward until it can be secured to
the horn of the same side and make the animal run. During this ex-
ercise, the reduction takes place. Then make an irritating friction on
the point of the shoulder. Bossetto recommends the following method :

1 Seyler: Annales de Med. Vet., 1856, p. 564.



SPRAINS. 5©i^

Cast the animal on the sound side, pass a rope at the pastern, and pull
on the leg ; the operator with one hand holds this one steady, while
with the other, it feels the relation of the articular surfaces. As soon
as they can slip over each other, a strong pressure is made upon the
humerus.

The method of Seyler seems to us better. To pull the leg forward,
backward, outward or inward, according to the displacement of the
humerus ; then by methodical pressures made, push the head of the
bone back in its cavity ; those are the requirements. In one case of
luxation forward, '"'I had the head of the horse held by a man, another
carried the leg forward, while a third pressed hard on the knee, the
humerus being held in its normal position by a fourth ; I then gave a
strong push to the head of the humerus with the palm of the right
hand, and at once heard the very distinct snap of the bone re-entering
its cavity." This method, which the author has used three times, has
given him three successes.

If, in operating this way, one does not succeed, it is necessary to cast
the animal. But reduction standing is to be preferred, as there is always
danger of disturbances by the efforts made in getting up. For this
reason, Peuch advises to throw the animal with the belly-band of the
sling, which afterwards helps to raise him. In the horse, muscular
power is overcome by the use of chloroform.

Most ordinarily, a peculiar noise indicates that the coaptation has
taken place ; if it is not heard, the conformation of the joint, and the
length of the leg, which have become normal, tell the surgeon the result
obtained.

The reduction made, next comes the contention. The iron splint of
Bourgelat, " to fix the shoulders of a horse suffering with sprain," can
be tried. (See Fracture of the Scapula.)

Mathorez, after reducing the luxation in a horse, applied a blistering
friction. Matheron, treating a calf, applied on the shoulder an iron
sheet padded with oakum and secured with the surcingle. In the three
cases he treated, Lodezzano applied a pitch' plaster. We have seen
that Kaiser made on the region only simple irritating friction ; Bossetto
placed on the point of the shoulder oakum dipped in vinegar water,
which he kept in place by rollers. Seyler used the bandage of Delwart.
(See Fractures^ He states that, as soon as the operation is ended, the
horse, subject of his first observation, " held back in its ordinary position
the leg which he had lost the use of, as if nothing had ever happened."
In the case of Smith, immediately after the reduction, the horse walked
easily, and was scarcely lame, eight days after. If the horse has to be
thrown, he must be raised with a great deal of care. In all cases it is



508 VETERINARY SURGICAL THERAPEUTICS.

indicated to keep him for some time in slings to avoid the displacement
of the bandage.. This generally drops off after some twenty days.
There is no inconvenience in allowing the horse to take a little exercise ;
relapse is not to be feared, and the best way to avoid ankylosis and
amyotrophy is to make the joint work. Generally in a month or six
weeks recovery is complete ; in few cases does it take longer. MoUer
advises destroying, after ten or fifteen days, if there is no improvement.
With small animals, recovery is generally easy. The reduction once
operated, a pitched bandage is applied like that recommended by Del-
wart for fractures of the scapula and of the humerus;

//. — Hiwiero-Radio— Cubital Joint.

Notwithstanding its powerful ligaments, luxation of this articula-
tion can take place. A violent kick on the external face of the
elbow may produce the lateral deviation of the articular surfaces
(Peuch). A similar accident may follow a fall, when the leg is carried in
abduction, in adduction, or if caught under a wheel (Lafosse, Soumille).
The mule of Lapouse,^ loaded with three hectoliters of wheat, slipped
and fell. On a first examination, the author remarked that the whole
lower part of the left leg, from the elbow down, had a direction perpen-
dicular to the median line of the body. " The superior extremity of
the forearm was throw-n inwards and beyond the condyle of the
humerus ; the lower extremity of this bone was resting on the external
face of the superior extremity of the forearm and of the point of the
olecranon." The horse treated by Decroix had a fall on the left side, the
left leg bent under the ^houlder, between it and the ground. When the
animal was up, it was observed that the forearm was oblique, forward
and outward, while from the fetlock, the foot had a vertical direction. It
was easy, by exploration, to observe the overlapping of the surfaces of the
bones ; the articular head of the radius projected outwards and that of
the humerus inwards.

Lafosse and Soumille have published observations of luxations of
the elbow in dogs. On the collie dog treated by Lafosse, the humeral
trochlea was projecting oijtwards and the articular surface of the radius
inwards. The subject cured by Soumille presented, at the external and
superior face of the forearm, a large swelling formed by the extremity
of the radius ; and on the internal face, a wound exposing the inner
condyle of the humerus.

The deformity of the articulation and the immobility of the surface.

1 Lapouse : Journal des Veter. du Midi, 1S42, p. 180.



SPRAINS. 509,-

clearly demonstrate the accident. In small' animals, the reduction is .
generally easy with recent luxation. In the dog of Lafosse, after a
few seconds of traction, a snap was heard, and the reduction obtained,
the dog arose, and ran with only slight lameness. No bandage was ap-
plied. In a case of luxation with articular wound, Soumille obtained
the reduction as easily, but the accident returned as soon as the animal
moved its leg; a contentive bandage had to be applied. Seven days
later, the dog used its leg; the bandage was removed ; the articulation
was normal, no swelling nor deformity ; the wound, much contracted,^
did not allow the escape of synovia.

If luxation is old, reduction is sometimes very difficult. We had to
treat, in a pointer, a luxation of the elbow, mistaken for a fracture and
immobilized for two months. Notwithstanding anesthesia and the help
of several assistants, it was impossible to reduce it. Arthrotomy had
to be performed from the internal face. The synovial open, a great
quantity of reddish synovia escaped ; after partial section of the in-
ternal lateral ligament, the radio-cubital articular surface, which had
deviated outwards, resumed its normal position. The recovery from
the operation was rapid, and the therapeutic result satisfactory.

In large animals, though quite difficult, the manipulations are some-
times less hard than they were expected to be. Lapouse had the head
of his mule held firmly, while two assistants supported the animal on
the right side. Placed back of the dislocated leg, he flexed the radius
to carry the olecranon backwards, then applied his right knee on the
internal face of this bone while pushing the lower extremity of the
forearm inwards and the inferior end • of the humerus towards the
thorax ; a snap was heard, the leg resumed its direction ; the animal
could walk immediately. A friction of ammoniafcal liniment was made
on the articulation. Nine days after, locomotion was normal, and
the horse resumed his work.

Decroix cast a horse and etherized him. Tractions made at the foot
to bring the bones end to end failing (there was 6 centimeters short-
ening), the cannon was flexed, then two ropes placed, one on the lower
extremity of the humerus pulled upwards, the other on the superior
part of the radius and drawn downwards, were given to assistants. In
a few minutes, the luxation was reduced. The joint was covered with
melted pitch and oakum cut in small pieces. Twenty days later, the
horse went to work.

To resume : in small animals, the reduction done early is easy, and
the contention, during a few days, with bandaging, is enough to pre-
vent relapse. In large animals, where the humero-radial joints demand
great traction, anesthesia is a great help. To flex the forearm on the



5IO VETERINARY SURGICAL THERAPEUTICS.

arm, perform extension and counter-extension, practice opposite pres-
sures on the osseous displaced surfaces, such are the requirements to
fulfil ; once the reduction obtained, a pitch bandage or the mixture of
Delwaft should be applied. To prevent displacements and the decubitus,
the animal should be slung. After ten days there is no danger of relapse.

///. — Knee Joint.

Luxations of the knee are rare. Ordinarily complicated with fractures,
tearing of ligaments and of tendons, recovery can scarcely be expected.
The treatment must not be undertaken except for very valuable animals.
In the American Veterinary Review^ Flynn has reported the case of an
entire two years colt, which was found one morning stretched on the
floor, cast with his halter, the right foreleg flexed and much swollen
on the knee. On manipulating the leg. he could feel " the carpal bones
dislocated outwards, near up to the head of the external small metacar-
pal " ; the lower surfaces of the trapezium and trapezoid could be
readily felt. By pressures made on the lateral faces of the joint, the
reduction was obtained. A contentive bandage was applied. A few
days after, the patient was placed in slings and treated by continued
irrigation. Recovery took place without complication.

IV. — Articulation of the Pelvis.

The ileo-sacral luxation, very rare, is unilateral or bilateral. Walking
is always painful ; there are at the croup abnormal movements, analogous
to those of the sprains of the loins (Barreau). In general, the animal
has great difficulty to get up ; paraplegia may be suspected. This
accident brings on a deformity of the croup and a permanent lameness.
After a difficult labor, the cow spoken of by Mollereau presented a
great drooping of the sacrum in the pelvis : " the summit of the croup
and the anterior borders of the ilium projected lo centimeters above
the body of the lumbar vertebrae." According to Weber, similar accidents
are not rare in difficult labor and produce paraplegia.

Solipeds should be placed in slings, bovines left at liberty. Repeated
blistering frictions should be made on the croup, or a pitch contentive
bandage applied.'

^ W. Dimond has recorded a case which occurred at the Hospital of the Amer-
ican Veterinary College, of a horse which had been treated for sprain of the
muscles of the loins and recovered, when a few days later he exhibited sj'mptoms
of paraplegia, lameness of the near hind leg, lancinating pains, and later on
manifestation of meningitis. The animal was destroyed. At the post-mortem
there was found extensive bloody infiltration of the sublumbar region, a fracture
of the last lumbar vertebrae, with laceration of the saro-iliac ligaments with,
diseased condition of the articular surfaces. — Am. Vet. Review, Vol. 9, p. 127.



SPRAINS. 511

The luxation of the pubic symphysis, still rarer than the preceding,
lias been observed only in bovines. In solipeds, where the ischio-pubic
symphysis ossifies rapidly, a parasymphysar fracture occurs rather
than the separation of the pubis and of the ischiums. Guy has related
the case of a five-year-old mare which, annoyed by flies, slipped on the
pavement, both hind legs in abduction. At post-mortem, with a com-
minuted fracture of the bones of the pelvis, there was an ischio-pubic
luxation. At the autopsy of a cow made by Golis, the ischio-pubic
luxation coexisted with an ileo-sacral dislocation. This animal, like the
heifer observed by Prietsch, which had a simple luxation of the sym-
physis, was unable to get up or to stand up.

The treatment consists in placing the animals in a quiet place, on a
thick bed, and the lumbo-sacral region covered with a plaster of black
pitch. Recovery takes place in two to four weeks; but there often
remains a deformity of the croup and a weakness of the hindquarters.

V. — Coxo-Fenwral Joint.

For a long time, according to classical authors, the luxation of the hip-
joint without fracture at the head of the femur was considered as im-
possible. Rigot (1832) did not admit that the round ligament could be
ruptured or stretched to permit the head of the femur to come out of the
cotyloid cavity. For him " the force of resistance of this ligament was
superior to that of cohesion of the femoral head : to such extent that
efforts made upon the articulation were to fracture the bones rather than
to have the ligaments give way and permit the luxation to take
place." ' In relation to this accident, Dietrichs says : " Luxation of the
coxo-femoral joint cannot take place in a horse except after rupture
of the round ligament, accompanied with excessive stretching of the
capsular ligament. And, unless by circumstances unknown to this day
a fracture of the head of the femur or a part of the coxal occurs rather
than the rupture of the round ligament.'"^ However, in 1840, Rigot
in his Traite (f Anatomic acknowledged his error.

Falke has related several cases of this luxation. In cadavers, he
succeeded in producing it with a weight of 8 quintals in one case, of 16
in another. Each time he saw the head of the femur and the cotyloid
cavity intact, while the round and the capsular ligaments were torn.
At the autopsy of a mule killed because of a luxation Gourdon found
the head of the femur intact, entirely out of its cavity ; the ligament
ruptured on a level with its attachment at the bottom of the cotyloid
cavity, remaining adherent to the femur in all its length. At the ;

^ Lafosse : Journal des Veter. du Midi, 1852, p. 57.

2 Dietrichs : Lehrbuch der Chirurgie.



512 VETERINARY SURGICAL THERAPEUTICS.

Lyon clinic in 1854, one analogous observation was made in the
horse ; here the coxo and pubio femoral ligaments were torn at their
insertion on the femur. In an aged mule, used for surgical purposes,
which had fallen with both hind legs carried in great abduction, the post-
mortem revealed a complete luxation of the right hip ; both articular
surfaces were intact, and the ligaments torn from the femoral head.

These facts establish beyond a doubt the possibility of a luxation of
the hip without fracture of the articular surfaces. However, in many
cases, the accident is complicated either with fracture or with epiphysar
separation of the head of the femur — in young animals (Arloing). In
the observation that Goubaux communicated to the Societe centrale de
Medecine Veterinaire (1875), ^""^ which related to an old femoral luxa-
tion, the head of the femur was fractured, and nearly its two internal
thirds had disappeared. The horse whose autopsy was made by
Peteaux, presented a complete and longitudinal fracture of the neck of
the femur; the internal half was held at the bottom of the cotyloid
cavity by the coxo and pubio femoral ligaments almost intact. In the
horse of Weber, a bony fragment from the head of the femur was loose,
and one from the coxal was adherent to the superior extremity of the
anterior straight muscle of the thigh.

As complication of luxation, one may also meet with fracture of the
trochanter or of one of the pelvic bones. The surrounding muscles are
more or less lacerated. In the mule, just spoken of, there was a com-
plete laceration of the vastus internus, at its femoral insertion ; and of
the gemini of the pelvis near their middle, as well as laceration and
partial ruptures of the psoas iliacus, internal and external obturator.

However serious the accident may be, the symptoms are imme-
diately well marked ; at rest, the standing takes place by the toe or the
plantar surface ; in walking, the leg, deviated outwards, is carried all in
one piece, with an abduction movement. The trochanter forms some-
times a marked projection in external luxation ; it partly disappears in
internal. The length of the leg is diminished or increased, according
as the head of the femur is displaced upwards or downwards. It is
generally possible to differentiate luxation from violent bruises or frac-
tures. If the injury is lef^t to itself, the animal may die from exhaustion ;
however, most ordinarily, the femoral head makes for itself a new cavity,
walking becomes possible, but there always remains great lameness.
Callot has observed two steers in which it was yet well marked thirteen
months after the accident. Lafosse has registered cases of perfect
recovery. He has seen, after nine months, emaciated muscles resume
their normal size ; the direction and the action of the extremity were
normal.



SPRAINS. 513

Reduction must be done with the animal cast and anaesthised. Coun-
ter-extension is made with a rope, embracing the groin and with its
ends attached to a fixed point. One or two ropes, placed above
the hock and held by assistants, serve for the extension. The block
and pulley permit more regular and steady pulling than assistants. The
operation is difficult, and not without danger. A cow treated by
Gamgee sustained a fracture of the neck of the femur.

The manipulations vary according to the direction of the deviation.
To this effect, one must recognize luxations in those that are forward,
backwards, outward and inwards. Extension will be made in order to
carry the leg in a direction favoring the return of the femoral head.

The following are the methods used by the various authors who have
written on the subject.

In the case of Saussol and Ranson the luxation had taken place
inwards. The horse was thrown on the opposite side, extension and
counter-extension applied in the usual manner. Under the thigh
a pail covered with straw was placed and pressure applied on the
external and inferior part of the leg, so as to make a lever of the
iirst kind. After a minute of traction, " presuming that the articular
surfaces were in apposition, extension and counter-extension were sud-
denly stopped, a sudden movement of the leg took place from back -
■wards upwards (in relation to the position of the animal from for-
ward backward), accompanied by a noise analogous to that of two stones
striking together. The luxation was reduced, and the animal able to exe-
cute the ordinary motions of that extremity." ' In similar cases Lafosse
advises to place a thick round object between both thighs and to push
against the lower extremity of the dislocated leg. For a luxation out-
wards, the same author recommends to throw the animal on the lame
leg, to place a block near the trochanter, and to act on the lower
extremity of the leg. By this process " he has operated successfully
on two horses, a cow and several dogs."

To reduce a luxation inwards of the left leg, Vautherin threw the mare
on the right side. A rope fixed in the coronet and pulled upon by
three men made the extension, the weight of the animal the counter-
extension. " By carrying with force, the superior part of the leg from
inwards outwards, the head of the femur could be brought in apposition
with the cotyloid cavity, but a little back of it ; then by a strong and
sudden pressure of both knees made by an assistant upon the projecting
trochanter, at a second attempt^ the head of the femur re-entered its
cavity, with the peculiar noise made by the striking of two articular sur-
faces."

' Saussol and Kanson : Rec. de Med. Vet., 1829, p. 223.



514 VETERINARY SURGICAL THERAPEUTICS.

Moller acts as follows : For luxation forwards (ilial luxations), once
the leg is in extension, push the head of the femur from forward back-
wards ; in luxations backwards (ischiatic luxations), carry the leg in ab-
duction, then give it a quick, double motion of adduction and rotation
outwards ; for luxations inwards (pubic luxations), similar manipula-
tions with a greater abduction ; for luxations outwards (supra cotyloid
luxations), carry the leg in extension and afterwards in adduction.

Bossetto casts bovines, places them on their back, and has the dislo-
cated leg, free from the hobble, carried backwards ; one hand rests
upon the trochanter, and with the other the movements of the femur are
regulated in order to make the head of the femur re-enter the cotyloid
cavity.

The reduction of an old luxation is rendered more difficult on
account of new-made adhesions. Peuch could not obtain it in a dog
whose injury was a month old. Anaesthesia would allow the contin-
uation of the attempts at reduction ; but the adhesions become so
strong that the traction will not let the articular head re-enter the
cotyloid cavity already partly filled with bony neoformation. And in
such case it is useless to perform open arthrotomy. It is better to leave
well alone.

To prevent relapse, Saussol and Ranson applied over the diseased
part a coat of mustard and vinegar ; the animal was kept lying down ;
the next day he was carefully raised with the slings ; recovery took
place without trouble. With the same object, Vautherin applied a
rowel, animated with blister ; after a month the mare was plowing ; the
lameness disappeared entirely.

If no complications occur, the animal can resume work after a few
weeks. In the case of Furlanetto, the patient was turned out in ten
days.

VI. — Femoro-Tibial Joint.

Luxations of this articulation are very rare. Some cases are reported
in bovines. In the observation of Stolze, the tibia was dislocated for-
ward ; the leg stiff and somewhat shortened. The luxation could be
reduced, but returned almost as quick ; the animal was slung. The
fifth reduction and the application of a stiff blister brought on re-
covery.

The cow mentioned by Hullot was lame on three legs ; the stifle
joint was a little swollen. On its level " the tibia formed on the out-
side a ressault, the width of the finger." The reduction, easy to make,
was indicated by a sudden snap, but at the slightest movement of the
animal, the tibia would resume its abnormal position.



SPRAINS. 515

Although the luxation is curable, it is one which ought not to be
treated.

VII. — Femoro-Patellar Articulation.

The very great majority of observations described under the name of
luxatiotis of the patella relates to the arrest of this bone upon the internal
lips of the femoral trochlea, which acts there as a hook. However, it is
not less established, by a certain number of facts, that the true luxation
is met with. The special anatomical disposition of the stifle joint in
bovines favors very much the appearance of this accident. The luxa-
tion takes place specially outwards, but it is possible inwards, notwith-
standing the elevation of the internal border of the femoral trochlea.
Whether the result of a traumatism, of a slip backwards, of a violent
contraction of the biceps cruralis or of a relaxation of the ligaments and
muscles, it is always a serious accident. If reduction is easy, conten-
tion is difficult.

Having " a luxation inward of the left side " to treat in a mare, Perar-
naud had the leg flexed by an assistant ; another steadied the stifle,
Avhile a third pushed the animal slightly to the right. The author,
placed on the right side and resting his right hand on the lower end of
the patella, succeeded easily in replacing the bone in position. Rest
and a friction of ammoniacal liniment brought on recovery. In a simi-
lar circumstance, HuIIot, by pulling on the patella, was able to replace
it easily, but the accident returned immediately. The cow was
destroyed.

In general, in cases of luxation of the patella, as in the pseudo-luxa-
tion, it is advised to place a rope in the coronet, to pass it over the
withers, then carry it between the forelegs backwards and hold the
leg in complete extension. By pressure over the stifle in contrary
direction to the displacement, the reduction is easy. The animal is tied
up high in his stall and a blister applied over the whole joint.

With congenital luxation Benard recommends a special means of
contention. Take a band of linen, 12 or 15 centimeters wide, and long
enough to go around the stifle region four times ; cut in its middle a
window large enough to receive the patella; at 10 or 15 centimeters
from the opening make a vertical slit. Apply the band in such a way
that the patella be lodged in the central window ; pass one of the ends