of the band through the vertical slit ; pull hard ; bring both ends of the
bandage forward, crossing each other above and below the patella, and
secure them.

Kept in position for eight or ten days, the immovable bandage will
prevent all relapse. (See Fseudo-Luxaiion of the Patella.)



5l6 VETERINARY SURGICAL THERAPEUTICS.

VIII. — luxation of the Fibula.

Intimately fixed to the tibia by numerous short and strong fasiculi, it
is rare for tlie fibula to be violently separated from the tibia. There
are, however, some cases known. Behnke has published the case of a
mare, which, after a jump, became suddenly lame on one hind leg; this
was stiff and the standing impossible. These conditions lasted, and a
big swelling took place on the superior part of the leg. The animal, of
little value, was killed. At the post-mortem the fibula was found loose
from the tibia and imbedded in the muscles of the leg. The inter-
osseous ligaments had been torn. It is probable that the fibula could
become immobilized in its abnormal position and the locomotion
returns normal ; but recovery would take a long time.

IX. — Hock Joint.

Luxations of the hock are rare. Some observations are related
in the horse by Louchard, Blavette, Rey, Gavard, Stockfleth, Haub-
ner ; in cattle by Havemann ; in sheep, dogs and cats by Stock-
jfleth. The anatomical character and the severity of the lesions
vary. Sometimes there is luxation of the astragalus ; at others the dis-
location takes place below it, between the lower bones or between
the cuneiforms and the metatarsal. The dislocation, ordinarily incom-
plete, is often accompanied with ligamentous and cutaneous lacer-
ations, fractures or crushing of bones. Let us mention the observation
of Rey : A horse, used to pull railroad cars, caught his left hind foot
between a switch and a rail ; he was thrown. Raised, he cannot stand
on the disabled leg ; the hock is seriously injured ; there is crepitation ;
the animal is destroyed. At the post-mortem there was found a luxation
of the hock between the two rows of the flat bones of the joints with lacer-
ation of the external and interosseous ligaments, a rupture of the cord
of the flexor metatarsi, a fracture of the large cuneiform and exter-
nal metatarsal. Gavard has related a case of tibio-tarsal luxation. In
a collision between two tramways, a horse was thrown down. When
raised, at rest, there were but little or no symptoms ; but as soon as
called to move the right posterior leg was not raised from the ground but
■dragged forward. By exploration, a hard projection, formed by the
extremity of the tibia, was felt on the inside. The horse was destroyed.
" The tibia, violently raised and pushed inwards by the blow, had left
the external border of the trochlea of the astragalus and was resting by
its external groove on the internal border of the astragalus, forming
inside by its second groove the prominence found during life. The.



SPRAINS. 517

external ligaments were irregularly torn from their insertion to the tibia.
The capsule of the anterior face of the articulation was torn in its mid-
dle. There was no motion possible in the articulation." '

All varieties of luxation of the hock are very serious. Recovery,
when it is obtained, is always imperfect. On this account most animals
suffering with it are destroyed. Schrader has published a recovery
of luxation of the metatarsus in a cow ; Stockfleth, with a cat suffering
withsubastragalean luxation, had success in reducing it and immobilizing
the leg with an india-rubber band. In small species treatment might be
imdertaken. By extension, counter-extension and manipulation applied
in inverse direction upon the inferior extremity of the tibia and the
superior of the metatarsus, the luxation might be reduced. A pitched
or plastered bandage would insure immobilization.

X. — Fetlock Joint.

According to d'Arboval, metacarpo or metatarso-phalangeal luxations
are frequent. With Peuch and Toussaint, we believe that they are rare.
They occur in various circumstances, but their ordinary causes are those
which, acting with less violence, give rise to sprain of the joint. Cases
are related in solipeds and bovines.

The lesions are sometimes extensive, and death may follow rapidly
(Aureggio). On a horse seen by Lecoq, the inferior extremity of the
metacarpal, which had perforated the skin, was exposed for a length of
10 centimeters; the lateral ligaments were ruptured, the phalanges and
the foot thrown backward and outward in such a manner that
the foot was on a level with the lower end of the metacarpal. Same
serious nature of the lesions on the patient of Romary : phalanges
thrown backward of the metacarpal, which, having perforated the skin,
came in contact with the foot. In the observation of Neumann the

1 Gavard : Journal de Med. Veter. 1890, p. 410.

Wray has recorded the case of a mare, which in a runaway accident
had a complete luxation of the tibia and astragalus on the left hind leg, so that
the tibia and metatarsus formed a complete right angle. The mare was
secured, the luxation reduced, strong hickory splints and bandages were applied
and the animal placed in slings, where she was kept for nearly a month, after
■which she was discharged, apparently sound, with the exception of a slight
swelling of the joint, which gradually disappeared. — Amer. Vet. Review, Vol.
7, p. 20.

Dr. Townsend has reported the case of a cow, which had also a luxation of
the tibio-tarsal joint after a fall, in which the lower part of the leg was dislo-
cated outwards and forwards. The luxation was reduced at once. The leg was
bathed in warm water, and when the inflammation had subsided oil of tui^pen—
tine was rubbed. The cow remained lame. — Amer. Vet. Review, Vol. 7, p. 75.



5l8 VETERINARY SURGICAL THERAPEUTICS.

Jthalanges formed with the metacarpus an obtuse angle open outwards ;;
on the internal face of the fetlock there was a vertical wound, 15
centimeters long, through which the lower extremity of the metacarpus
protruded ; the ligaments were torn. Peuch has related a similar case.

Luxation of the fetlock may occur sj^ontaneously or without violent
effort. Cagny has seen a double luxation of both hind legs which
occurred in that way. It was that of a thoroughbred stallion, " Veston,"
which, a few days before the accident, presented marked alternate lame-
ness of both hind legs. Rheumatism was suspected, and treated with
morphine, salicylate of soda, sulphate of quinine. One morning the
horse was found lying down, the left hind fetlock dislocated. He tried
to get up when a bandage was about to be applied on that leg,
when the same accident occurred on the other fetlock. At the post-
mortem, the tendons of the flexors and extensors were found normal ;
the articular, synovial and lateral ligaments were lacerated. Another
example of spontaneous luxation has been published by Magnin : the
animal walked on the inferior extremity of his metatarsals. In cases of
this kind, there is certainly inflammation or previous softening of those
lateral ligaments. When the skin is torn, and the articular synovial
open, and whether these lesions are due to violent efforts, falls, or occurred
as in the cases of Cagny and of Magnin, in general, treatment must be
given up.

Fortunately the alterations are not always so complicated : for ex-
amples, the cases of Granet, Barrier, Blaise, Smith, Wilhelm, Schellhase.
With them, the skin was intact, the articular surfaces more or less
displaced forwards, backwards, inwards or outwards. In the horse of
Barrier, " the ossuffraginis, insteadof joining the metacarpal with an angle
of about 145°, was thrown backward ; the articular surfaces were no
longer in apposition, that of the metacarpal was resting on the anterior
face of the suffraginis ; the lowered digital region formed almost a right
angle with the cannon, and if, in those conditions, standing had been
possible, it could not have taken place except by the posterior face of
the phalanges and the heels." '

In the subject of Blaise, "the phalangeal region formed with the can-
non an obtuse angle, whose opening corresponded to the external side
of the leg ; the posterior face had become internal ; the foot, following
the same rotatory motion, showed its plantar face ; on the inner side of
, the leg, and on a level with the small metacarpal, the superior extremity
of the suffraginis protruded under the skin." '

Whatever may be the direction of the deviation, if it is not too great,^

• Barrier: Journal des Veter. Milit., 1S70, p. 155.
2 Blaise : Ibid., 1873-74, p. 419.



SPRAINS. 519

and if the joint is not open, there are cases where recovery may be
looked for. Sometimes the reduction is easy. Blaise, with the right
hand, took hold of the middle of the suffraginis, and, with the left hand,
of the inferior extremity of the cannon ; he pulled strongly inwards upon
the dislocated bones, felt a sudden jerk, and at the same time heard a
snapping noise. The bones had resumed their respective position.
Smith obtained the reduction as easily. Barrier threw his patient,
placed two ropes on the cannon and one on the pastern ; this last was
pulled in the direction to be resumed by the phalanges. " The leg thus
prepared, a slow, continued and strong pressure was made with one hand
on the posterior face of the fetlock, while the other, acting more parti-
cularly on the pastern, brought about the relation of the articular surfaces,
which was indicated by a marked snapping noise."

To prevent relapse, the patient should be placed in slings and the fet-
lock immobilized. Granet applied a contentive bandage of rollers and
black pitch, mixed with spirit of lavender ; twenty-one days after, the
animal resumed his work. Smith put on a shoe with two lateral vertical
rods, having the direction of the lower end of the leg from the hock
down to the foot ; to which, on a level with the fetlock, a concave metallic
padded plate was attached. These metallic rods were held in place by
straps. The treatment was completed by firing, and followed by recovery.
The patient resumed work after a few months. During the first days,
Barrier had recourse only to astringent cold lotions ; later, he fired the
region. Blaise applied successively on the fetlock a friction of tincture
of cantharides and an application of blister ; twenty-five days after the
accident, the horse returned to his owner. Cagny has obtained good
results with simple astringent applications. In the case of Wilhelm
there was luxation inwards of one hind fetlock ; the horse was slung,
the luxation reduced and kept in place with a solid bandage. In one
of the observations of Schellhase (luxation outwards) the phalangeal
region was perpendicular to the cannon, and there was, on the inner face
of the fetlock, a large wound, through which the finger entered the joint.
Treatment was, nevertheless, undertaken and the animal cured.

Immovable bandages are to be preferred in most of cases. The iron
splint of Bourgelat deserves mention. Made, of a metallic band, one
centimeter thick, two and a half wide, having the shape of the leg from
the superior part of the cannon to the heels of the foot, it is fixed on
the shoe and held in place by straps. Relier's apparatus may also be
useful. (See Fractures.)

Let us mention here the case of Fourie, relating to a luxation out-
wards of the external large sesamoid (left anterior leg), manifested by an
intermittent lameness which resisted all treatment.



520 VETERINARY SURGICAL THER4P^TTTTr<?.

In bovines, luxation of the fetlock is rare. Few observations only
Tiave been recorded. The three cases related by Strebel were heifers,
aged from fifteen months to two years. Each time the injury consisted
in an overlapping of the inside suffraginis on the metacarpal. The re-
duction was performed standing or with the animal down. In these three
cases, perfect recovery followed the application of a contentive band-
age.

XI. — Phalangeal Articulations.

Luxations of phalanges are exceptional. United by strong ligaments
and consolidated in their relation by very powerful tendons, phalanges
are very little exposed to extensive and permanent displacements.
Only very rare examples are published, all of the greatest severity.
The case of Johne relates to a luxation of the third phalanx ; the lower
extremity of the os coronse overlapped the small sesamoid backwards,
the articular ligarrjents and the perforans were lacerated.

If treatment is to be undertaken, reduction and immobilization are
indicated, as for the other luxations. Bandages recommended for
phalangeal fractures would be useful here.

XII. — Pseiido luxation of the Patella.

Solipeds and bovines are subject to a special and typical lameness
of the hind leg, due to the patella becoming, so to speak, hooked by the
summit of the femoral pulley. If the animal is made to walk ahead,
the affected leg cannot be carried forward, but remains extended,
obliquely downwards and backwards ; any flexion is impossible, and
•when the animal moves, the anterior face of the hoof drags on the
ground. Most minute exploration of the leg reveals only a slight
tension of the muscles and a slight deviation of the patella outwards.
These symptoms, however, disappear as rapidly as they occur ; it is not
rare after a few minutes' walk, or even after a few seconds, to see the
various joints of the leg flex upon each other, first spasmodically, as in
stringhalt, and then normally. And ordinarily the return of the trouble
takes place without apparent cause.

These symptoms have received various interpretations. Solleysel,.
Garsault, Lafosse, saw in them nothing but a " cramp " ; for Vitet, it was
a temporary spasm accompanied with pains. Pastureau explained them
by the arrest of the internal femoro-patellar ligament over the correspond-
ing lip of the femoral trochlea. The great majority of authors have
described this accident under the name of " luxation of the patella." But
this last is very rare, and cannot occur without the laceration of one of
the little femoropatellar ligaments.



SPRAINS.



521



lit



t;r.i



Already in 1852, Meyer attributed the cramp of solipeds and bovines
to tiie displacement upwards of the patella ; for him, this bone became
fixed on the internal border of the femoral trochlea, where it was held
by the internal and median tibio-patellar ligaments. It is the theory
advocated by Bassi in Italy, Chuchu in France, and to-day admitted
without discussion. The slight
deviation of the patella is due,
not to a luxation of that bone,
but to the fact that the in-
ternal border of the trochlea
being higher and thicker than
the external, the patella is
somewhat thrown outwards.

But how can the patella as-
sume that position and keep
it ? What power holds it there ?
Practice teaches that this ac-
cident is principally met with
in colts, in animals recently
put to work, in weak and
anaemic subjects. It is thus
that it manifests itself during
the convalescence of some
serious diseases (pneumonia,
t3'phoid fever). A special
conformation of the trochlea,
specially of the kind of plate
form which ends at its upper
extremity ; the disappearance
of the fatty cushions situated
under the tibio-patellar liga-
ments and above the trochlea,
under the insertion of the triceps cruralis ; the violent or incoordinated
contractions of the muscles ; the dry condition of the joint ; all those
are the causes of the accident.

The hooked condition is kept up by the stretching of the internal and
middle tibio-patellar ligaments, of the first one principally. Violet has
erroneously attributed it to a contraction of the patellar muscles.

Submit the young subjects to a methodical training, and give a repair-
ing diet to those weakened by serious or long disease ; such are the two
principal prophylactic measures.

The accident exists ; the patella must be returned to its place. A




Fig. 112. — Stifle joint, l.i.t., internal border
of the femoral trochlea ; t.r.i., internal
patellar ligament ; f.r., internal femoro-
patellar ligament.



522 VETERINARY SURGICAL THERAPEUTICS.

first method is to make the animal walk, holding his head high to pre-
vent its falling, and, if necessary, urge him with the whip. Most ordi-
narily after a few days the patella is unhooked and everything is in
order. If walking fails, the animal must be made to back. If those do
not succeed, apply a rope round the coronet, run it over the withers, have
the leg carried in extension, and with the hand push the patella down-
wards and inwards. Some prefer to practice this while the animal is
down and securing the lame leg in the position indicated for castra-
tion.

In general, the luxation is easily reduced ; but, as we have said, re-
lapses are frequent. Under the influence of methodical moderate work
it returns only at intervals, sometimes further and further apart, and then
disappears altogether. To hasten recovery, frequently repeated water
douches can be prescribed, or blistering ; friction on the stifle and nutri-
tious diet, the bandage of Bernard, the apparatus of Weber, to hold the
patella in place, are little used.

To overcome the " cramp of the vastus internus," Violet, after Tre-
lut, advised the administration of one or two hundred gramms of cherry
bark distilled water, diluted in honey and water. In rebel cases, to this
antispasmodic treatment he associated blisters.

When the pseudo-patellar luxation does not yield to those treatments,
it is indicated to divide the internal tibio-patellar ligament, as recom-
mended by Bossi.

The modus operandi is simple. The animal thrown on the lame
leg, the internal face of the stifle is exposed by carrying the opposite
hind leg forwards, as in the operation of castration, or in fixing it on the
corresponding fore leg, above the knee. The skin is shaved and asep-
tized. The straight tenotome, held in a very oblique direction, is im-
planted flatwise, back of the internal tibio-patellar ligament, immediately
above the superior extremity of the tibia ; withdrawing it, the curved
tenotome is introduced under the ligament, and this is divided subcuta-
neously. The blood is wiped out and the wound closed with collodion.

The adipose cushion, situated under the tibio-patellar ligaments, pro-
tects the synovial from being injured with the instrument ; by dividing
the ligament very little above the superior extremity of the tibia, where
this adipose tissue is abundant, one will readily avoid the synovial sac.
The result is immediate. The wound heals in a few days.

This operation has given good results to Bassi, Falletti, Loy, Vach-
etta, Guigas. With this last author, it was successful in a very old

In the hospital records of the American Veterinary Hospital, Dr. J. Ryder
reports the case of a stallion which was brought to the hospital for treatment
of a luxation of the patella of several months standing. With great difl&culty



WOUNDS. 523.

case. We have performed it in an animal, on a case existing for a
year. The success was complete. Our patient, " L'Orphelin," is to-day
an excellent trotter.

Vandenmaegdenberg places bovines on an inclined plane, the hind-
quarter 30 or 40 centimeters higher than the anterior ; every hour cold
water ablutions are made, and morning and evening frictions of cam-
phorated alcohol with ammonia or spirits of turpentine.

The operation of Bassi gives also good results in bovines. Savio has
had four successes out of four cases.

IV.
WOUNDS.

Among them we will consider :

1 . Superficial or peri-articular wounds.

2. Penetrating wounds, or with per/oration of the synovial sac.

I. — Peri-articular Wounds.

Frequent on the extremities, they offer, in their march and their prog-
nosis, peculiarities due to the presence, in their neighborhood, of
tendons, ligaments and tendinous burste — conditions which expose them
to various complications. Fibrous tissues, poor in blood vessels, undergo
necrosis easily if they are soaking in pus or invaded by an infectious
process ; the extension of the inflammation to the synovial is possible.
With well-managed antisepsy, those accidents may be avoided. If the
wound has been made with a soiled instrument, it must be cleaned m
all its parts with a strong antiseptic solution (sublimate 2 p. 1000,
cresyl 5 p. 100, chloride of zinc 6-8 p. 100, alcoholic phenicated so-
lution : alcohol 10 grammes, phenic acid i gramme); then apply a

the luxation was reduced first, but, as soon as pressure over the patella was re-
moved, the trouble would return. Warm fomentations and blister seemed to do
some good at first, but after a few days the deformity returned and the horse was
unable to use his leg. The case assuming a bad aspect, and the condition of
the stallion getting worse. Dr. Liautard decided to try subcutaneous division of
the anterior part of the biceps femoris, long vastus. At first this proved a
failure. One morning the horse was lying down, when, suddenly frightened,
he made a jump, and from that moment moved with perfect action. The re-
covery was perfect. The author asks if it is an error to suppose that the div-
ision of the muscle at the time of the operation was imperfect, but was com-
pleted when the animal made a sudden jump after his fright ? In which case
the propriety of such treatment in similar cases is indicated. — Amer. Vet.
Hev., Vol. 8, p. 446.



5^4 y^TERLNARy SURGICAL TJiERAP£UriCS.

wadded dressing. It is important to have an immobilization of the
joint as complete as possible. Every one knows how difficult it is
sometimes to obtain the regular cicatrization of wounds situated at the
fold of the hock or that of the knee. Absolute rest, enveloping of the
leg from the foot to above the lesion with wadding, dressing with spUnts,
slings, are very advantageous means.

Large cicatrices on a level with an articulation interfere with their
movements, hence the indication to reduce to the minimum the size of
Avounds which may leave such blemishes, by sutures and properly ap-
plied dressings.

Cicatricial indurations, so frequent in front of the knee, stiffen the
leg, render the footing less solid and predispose to new falls. The
therapeutics of broken knees in horses must benefit by modern discoveries.
Instead of the vulgar healers, careful disinfection and antiseptic dressings
must be used.

//. — Peiietratmg Wounds.

Petietrating wounds of joints and traumatic arthritis shall be con-
sidered separately. Not only is the opening of an articular synovial
not necessarily followed by its inflammation, but, thanks to antisepsy,
it can be avoided if interference is applied in time and properly.
Serous membranes, like all other tissues, repair quickly in the center of
wounds, providing they are protected from infection. The excessive
severit}'^ of articular wounds is indeed not due to the lesion of the
aponeurosis and tendons (Pare), nor to the resistance of the tissues to
the inflammatory swelling (Brasdor, Eichat, Larrey), nor to the action
of the exudate upon the synovial and the cartilages (David) ; it depends
entirely on the inoculation of the wound, the infection of the synovial.
Every day we see in horses, as well as other animals, the punctures of
synovials, made aseptically with fine trocars, cicatrize rapidly by first
intention. Here again, without contamination, no complication ; with-
out germs, no suppuration.

Sometimes the infection of the synovial is primitive, and results from
the direct introduction of the injuring agent in the interior of the arti-
cular cavity ; at others, it is secondary, consecutive to the suppuration
or necrotic inflammation of the para-articular tissues. In this last case,
the prognosis is most serious, as, ordinarily, when synovia escapes out-
side, the serous is already deeply altered.

At the onset, the symptoms are little accused ; a wide or a narrow
■wound, allowing the escape of synovia, exists on one of the faces of the
joint, locomotion remains regular, work can be kept up. But the in-



WOUNDS. 525

flammation is not slow in spreading through the joint ; this swells, be-
comes verj' painful, the synovia which escapes is cloudy. Oftener, if
the trauma is not attended to properly, after a lapse of time varying
between two and six days, the practitioner has a traumatic arthritis to
treat.

That which must be prevented, is the inflammation of the synovial.
We will see how this prophylaxy demands early aseptization of the
■wound, followed with immobilization of the joint as complete as it can be