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THESIS
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FRACTURE OF BONES
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LOWER ANIMALS
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THESI5

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LOWER ANIMAL s/

By J. G. Veldhuis.

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THESIS
[32
6249
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Fractures of bones have not received as much attention
in the lower animals as they have in man. Indeed, it is
Only very rarely that the Veterinarian is called upon to
treat a case Of fracture.
One of the main reasons for this seeming neglect of this
form of injury, especially in the case of smaller enimals is

that it does not pay the woner to gall in a veterinarion, as

two or three calls from the practitioner would cost as much

if not more than the whole animal i s worth. The owner

can better afford to kill the sheep or hog tnat is #» unfor-

tunate as to sustain an injury of this kind, and, by thus

supplying his own table with meat, the loss will be small.

Another reason, and this is especially true of the dog
is that the p tient will in the case of a simple fracture,
usually do very well if left to itself.

In the case the bones are seldom fr ctured and if they
arethe owner will probably think it less trouple md expense
to end the poor creature's life am to consume the meat.

In the case of the horse, especiall: if the :nimal is
valuable and the fracture a simple one, the practitioner
Will probably be called upon to treat this injury. If
however, the fracture is a severe one the owner will probably
-Onsider the difficulty wd cost effecting a cure too great

id he will kill the animal. hs it will probably never

104 G16

@ able to do good work again even if the case should be
|
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treated. In man it is a question of life and death, but
in the lower animals it is simply a question of gain or 1oss.
Many stock owners are skilfull enough to assist

nature by putting on some rude splints of bass wood ard the

like and tre practitioner will again be left out of the

' case.

With so few opportunities for the practitioner to

treat fractures it is not at all surprising that the

' treatment of the fractures of bones is not on a level with

that of other diseases to which the animal is heir.
C-2-u-s-e.

A fracture may occur in one of three ways; By
external violence directly upon the fractured part, by exter-
nal violence producing concussion which will break the bone
at some other place, or by severe muscular contraction.

Some bones are more easily fractured or are more
liable to fracture than others. Bones are often rendered
more liable to fracture by a diseased condition of the bone.
The bones of the leg are more easily broken than those of
Other parts of the body, on account of the weight resting
upon them, and because they are more exposed. Bones of
Old animals are more liable to be fractured than those of
younger animals because they are more brittle.

Some of the external causes of fracture are: Vio-

lent contacts, collisions, falls, blows, extreme muscular
contraction, violent efforts in moving heavy loads, a quick
move to avoid a fall or a blow, stopping too suddenly, strug-
gling to liberate a foot and concussion or exertion as a re-
sult of throwing the animal to perform some operation.
C-1-a-s-s-i-f-i-c-a-t-i-o-n.

Fracture or solution of the continuity of bone
may be, transverse, oblique or longitudinal, according to the
direction with reference to the bone affected.

If the bone is broken only in one part without in-
jury to the soft parts it is called a simple fracture; when
there is an open wound in connection with it, it is called
a compound fracture; when the bone is broken into several
fragments it is comminuted; when besides the broken bone
there is serious injury to the adjoining tissue, muscles,
blood-vessels etc., it is called a complicated one; when one
fragment has been formed into another it is impracted, and
When the bone is only patly broken it is called a partial

fracture. Bending may take place, but this is rare in any

but young animals.
S-y-m-p-t-o-m-s.
In a fracture there is usually some deformity in

the part, particularly e swelling caused by the accumulation

of blood and the like. The animal will be more or less lame,

according to the bone affected. In the case of a broken
 

rib the animal may not show much l:meness, and even in the
case of a fracture of the cannon bone the animal mzy not be
able to rest its own weight upon the injured member, but in
the case of a fracture of one of the long bones, especially
in a compound fracture the limeness will] be very evident.

In the case of a fwacture of the lower jaw the pro-
cess of mastication will be seriously interfered with.

The most reliable sign of fracture is the crepita-
tion produced by the friction of one fragment upon the other.
It is not necessary as a rule to exhort to severe manipula-
tion, a gentle, careful manipulation of the affected part
will be sufficient to diagnose the case. The history of the
case and perhaps the external appearance of the injury will
be Of great service in the diagnosis.

M-o-d-e-s of U-n-i-o-n.

The first step towards the repair of the injury is
the exudation of lymph. This is at first fhid, but it soon
thickens, becoming elastic and moderately firm. At this
stage it is called callus. This callus may either inclose
the broken ends forming a sheath around it, when it is termed
provisional callus, or it may be simply between those parts

which are directly opposite each other and uniting them as

though glueing the two parts together, this is the interme-

diate callus. In the ordinary fracture the sheath is com-
mone

During the first stage the fracments of bone become
surrounded with blood and raise up the periosteum near the
fracture. This blood either becomes oOrranized or is replaced
by liquor s::nguinis. This stage occupies from eight to ten
days.

During the second stage which occuples from ten to twelv>
days, thi: substance between the periosteum and the bone is
changed to fibro cartilare,and the same change dsoakes place
with that in the m edullary canals,that between the gragments,
however, still remains a liquid.

During the third stage which occupies from ten to thirty
days, according to the age and oondition of the animal, this
fforo -cartilare is converted to bone forming a ring around
the outside and a plug in the medullary cenal. These two
are for the purpose of keeping the bone in place and at rest
while the formation of new bone between the fragments is going
On. The substance between the fragments has now an oppor-
tunity for solidifyjng,:nd as a result it is chonged to fibro-
cartil: ce.

During the fourth stage occupying from three to four
months this fibro-cartilage between the fragments is converted
into true bone.

During the fifth stage oofupying from five to six months,

the provisional callus or sheath around the bone,and the plug
 
medullary canal is absorbed.

These are the views of Duyupten,and Prof. Williams adds
that the only exceptions he has seen have been in the lower
jaw, when the fractures have been longitudinal and admitted
of no motion between the fragments. In such cases the

|

healing is by intermediate and permanent callus, no sheath
|:

os provisional callus being formed on the outside.
| In order to secure a perfect union the ends must be
kept at rest, it is however rarely possible to prevent motion
between the two ends, and in order to overcome this, nature
has provided this method.
| After the new bone has been firmly established between
the fragments, the process is to absorb all that material
that is not needed by the bone. Sharp projecting points
are removed ard the injury assumes the general outline of
the bone. The medullary tissue is closed up, the periosteum
again covers the bone, and the compact external and the can-
celated interior is formed and made continuous with the
original. The new bone gradually acquires the same micro-
Beopic character as that of the rest of the bone.
T-r-e-a-t-m-e-n-t.

The question of whether a fracture shall be treated or
|

not is one that should be decided first of all.

There are.scveral fractures that are incurable, besides
this many animals are not worth the cost of treatment.

The nature of the fracture bs of very great importance.

If the fracture is simple and the ends can be readily brought

into place and kept there, the prospects of recovery are,

very good indeed. Simple fractures are alwuys easier to

treat than compound fractures. The compound fracture is

liable to set up) an inflammation which may soon develop into

an angry looking sore, and prevent the healing of the bone.
A comrinuted or impacted fracture is liable to set up such
an extensive irritation that pus will be formed, and besides

this the different fragments of bones may become deceased and

result in necrosis of the bone. Pesides this it is hard to
keep the different fregments of bone so immovable that the
proces:s of repair can go on.

Fractures wnich may be considered curable are those
which suffer no great displ::'cement and have no great lacer-
ation of the soft tissues or shattering of the bones. They
are usually curable if the patient aids materially in the
treatment. A very nervous and irritable animal is dificult
to cure. A compound, complicated or comminuted fracture
Wherever the injury may be is considered incurable.

Fractures are less serious in smal] than in larger anim-

als. They are easier to handle and thcre wil! be less weight

upon the affected part.

Another important question is whether it will] pay to
 

 

treat the animal. T'e animal will be idle for a few months,
will lose in flesh and in the horse will probably never be
able to do the full amount of work again.

The age and mndition of the animal is also very impor-
tant. In a young and vigorous animal the injury will probab-
ly heal in a very short time, while in an old and weak animal
it will be very slow and tedious.

In the treatment of fractures the firststep is to reduce
it, that is, to bring thebroken ends in place again. If the
patient is away from home, it will be necessary to put on a
dressing for the time being am the animal then removed as
carefully as possible. tf there is no displacement there
will be no reduction am the necessary splints can be applied
at once.

The manipulation of the fracture to bring it tnto place
varies with the kind of fracture and with different bones.

If the fracture is transverse the bones are brought in place
in the easiest manner possible and simply pressure brought to
bear on the sides. If the fracture is oblique, extension
will be necessary to bring them totheir original place.

As a rule the manipulation will be readily Sugcested by the

diagnosis of the case. The manipulation should always be

gentle but firm, giving the animl as little pain and excit-

ing the muscular contractions as little as possible.
 

 

 

 

 

 

 

 

The injured parts should be brought togeth r aS sOon as

possible, before there is any amount of swelling, thus making

it easier to get them in »lace and also overcoming the injur-
hous effects of irritation caused by tre fractured ends
lacerating the soft tissue. If swelling has already taken
place this will probably gradually disappear if the fracture
is only reduced at once.

Several materials are used for splints. some of those
used generally are, leather, plaster of paris, poroplaster,
putta percha, card board, basswood, laths, birchbark,tin
and silver.

Prof. Liautard recommends, oakum, bandages, splints and
a compound forming a cement aml consisting of black pitch,
rosin and Venice turpentine. This dressing may be applied
directly to the skin or a thin linen covering placed between.
He mentions some other compounds which are of an adhesive
nature and will become firm on drying out.

His method of applying is to pad the injuyy with a
cushion of oakum, to equalize the surface and to prement the
Skin from chaffing. Over this the splints are placed, and
these are again covered with cloth bandages, soaked in the
adhesive solution. These tfandages are to be carefully app-
lied and to embrace the whole length of the leg.

Prof. Williams favors the"bend leather." The pieces are

made large enough to extend some distunce above and below
 

 

 

 

the fracture, and wide enough to encircle the limb. If there
is some projecting, point in the way, holes may be made in the
leather so it will fit close to_the limb.

(No.II.)
Before the leather is applied it is soaked in warm

water to make it soft and pliable.

The leather is held in place by bandages. If the limb
is swollen the bandages must be changed as soon as the swell-
ing disappears, and in its place bandages soaked in starch
or flour paste, put on. The starch soon stiffens and
makes the whole immovable so that the animal will soon be
‘able to bear its own weight on the injured limb.

‘Dr Grapee prefers the poroplaster. This material is used
‘much the same wag as the leather. It is soaked in warm
water at the temperature of about 140 derrees F. when it
becomes very soft and pliable. It can now be moulded to

‘any shepe of the limb am upon cooling it regains it stiff
condition and becomes a rigid splint. Aroung this the ban-
dages are placed the same as in the case of the"bend leather."
‘This material possesses the advantage of being porous thus
‘all owing the escape of inflammation, and of being soft and

pleasant to the skin, thus ading very materially to the com-

fort of the animal as well as to the healing of the injury.
10 .
1

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I;

The plaster of paris is perhaps most extensively uscd.
This materialis, however, likely to crack and thus looses
its immobility if it does not set up an irritation of the
‘skin. The plaster is spread on a Strip of cheese cloth to
_ the depth of about an eighth of an inch and then rolled up.
‘This rool is dropped into wathr and as soon as it ceases to
bubble is taken out and wound around the injured part.

The flannel side should be next to the skin. The winding
is made about a quarter of an inch thich and if any of the
‘plaster is dry, wet plaster should be put on in its place.
Splints may be also made of basswood. The strips of
‘wood should be soft and somewhat pliable. They should be
stiff enough to hold the limb in place after they have all
been put on am the vdsndages have been applied both under-
‘neath and over the strips but each individual splint should
be pliable enough to conform to some extent to the outline
of the limb. Pandages are to be applied after the splints

. he ve been put in place, and these may be soaked in an adhes-

_ivc solution to make the whole more rigid. These bandages

should extend both above and below the splints.

The card boarg,bah#chbark and lath wouldbe put on in a

| Simigar manner to the basswood.

|

If the fracture is near a joint where it is hard to mke

 
:
}

|
the splint immovable or where the joint itself is involved,

block tin or copper cut in strips is perhaps the best. It
might be well to have a thin layer of poroplaster beneath
'the strips, because it is less liable to produce inflammation

of the sxin, at any rate, something should be put in between

the skin and ‘the strips.

| The strips of metal are held in place by bancages the

“srme as those already described.

'
| 1
{
t

: When the best m terials are not at hand a splint @an
easily pe mde from thin splints of wood which will answer

|r purpose very well, and if it is necessary or thoumt

desirable, these can aftcrwards be replaced by better mater-

sfal.

ft
‘

Horses unless young and restless are usually place’ in
Slings fromtwo to three months. This would of course,
depend On wnat bone is fractured. If the bone in the head
was fractured the sling would be of no use, but if a bone

One of the extremities is fractured, or if the spine is

 

fractured, the sling is very serviceable.
 

15

 

Youngs horses or those th-t ure very restless will not
tolerate the sling, and these should be in as comfortable,
loose box, with plenty of good dry pbed:‘ing. In this way
they will usually do very well.

Cattle as well as hogs and sheep are treated the same
way as a horse, except that it is usually impracticable to
put them into slings.

The limbs of dogs usually need only the starch bandage,
and the animal will soon be completely recovered.

The animal will probably be lame for some time, but if
no joint is involved, am if the fracture has properly united
it will gradually recover from the injury. Care should be
taken that the animal does not use the limb too soon. The
inability of the none to support the weieht may not be noticed
at first put it will gradually bend over and become a Serious
case. The starch bandage should be kept on for some time
and the animal kept easy in a box stall for a few weeks
after it has peen removed from the slings.

The time of tiealing varies very much. The fretful hore
will often cause the non-union of tne bone, in even the sim le

transverse fracture, from its continually moving the limbs so

' that no union can take place.

ee
.,

This is the method 86r a simple fracture. If the fractum
 

|
is compound, however, the injury is not as easily reduced, in

this case the open wound is liable to cause inflammation am
fever and end in suppuration. In treating this kind of
fracture the injury should be reduced to a simple fracture as
‘soon as possible, by obtaining immediate union of the wound.
‘In the lower animals the treatment is often unsatisfactory and
the animal had better bs killed at once unless it is very
valuable, or unless the wound is small. If the compound
‘fracture is to be treated reduce at once. This may be wery
difficult and the wound may have to be opened and the sharp
projecting points of the bone taken out with the forceps, but
‘as soon as the fracture has been brought into place the lips
‘of the wound should be brought together and mde to heal as
quickly as possible. For this purpose,or rather to aid this
the washing with dilute carboli c acid or with hypo:supphite
of soda is very food. These will prevent suppuration and
aid in reducing the inflammation.

The splints should be applied the sume as in simple
fractures with the exceppbion of an opening for the escape of
mattor and to allow the washing out with the antiseptic with-
out removing the bandages. The poroplaster would be a
excellent thing in compo und fractures as it would admit

‘more readily of the escape of the material than the other

materials would.

14
15

 

 

The constitutional treatment should be the same for the
different kinds of fractures. The powels should be kept
mildly laxative, nutritious but not bulky food should be piven
a diarrhetic administered to keep the kidneys active, and if
the pain is acute an anodyne should be given:

If suppuration has alreidy texen place or if it takes

 

 

| place in spite of the dressing, the wound must be kept wet
| wi th tepid water, no pus must remain in the wound, and the

carbolic acid solution must be frequently applied. If the

wound will not heal the process of amputation may be resorted

| to.

F-a-l-s-e- J-o-i-n-t-s & N-o-n-u-n-i-o-n.
It sometimes thut the fracture does not unite or that

the ends are simply connected bv a fiberous material.

 

 

 

 

One of the most common causes is that often the two encs

can not be brought well in place. In this case there may

 

 

be a union of one side but the union wil] be unnatural. It
may also be the result of fever, hemorra:e, rheumatism, para-
lysis, necrosis of the bone and other constitutional and locel
|causes.

In order to secure the reunion there must be immobility
of the pieces, no foreign material or frapments ofdiseased
bone must be left between and a proper supply of healthy

blood is necessary.

¢

 

 

 

 

 
 

16

In the treatment of such cases we must expect a large
percentage of deaths and there is a great liability that the
fracture may never heal properly.

Various methods have been tried for thetreatment of
obstinate cases to cause the union. Among others we find
the seton, ivory peys, blisters, caustics, a long needle
thrust through the end... of the bone am the drill.

The seton, blisters, caustics and the long needle are us@
to excite the formation of the callus, while the ivory pegs
and the drill are used to fasten the two fragments together
and thus give it an oppurtunity to unite.

The seton is pessed through the limb and in between
the fragments, it causes an ittitation which will excitethe
formation of callus. The blistering on the surface would
seem to have little effect on the bone, unless the fracture
was at a place where the pone was next to the skin. The
caustics are often applied to the ends of the bone this may
be done bv a canula. The ends may have to be exposed in
some cases. Care should be taken that the caustic does not
cauterize the flesh any more than can be helped. The long
needle is thrust through the skin at different points near
the end of the bone and is used to excite the formation of
callus. The ivory pegs are inserted after a hole has been
drilled ti:*:¢h one fragment and well into the other. These

ivory pegs sometimes cau:e necrosis of the bone. The drill
 

 

 

 

 

 

 

 

 

 

 

is sometimes used. The drill is passed through one and
into the other fragment and allowed to stvy there a while.

This is perhaps the best of the two

A-m-p-u-t-a-t-1-0-n.

Sometimes when the fracture is incurable and the animal
valuable for breeding or for other purposes, the limb may be
amputated with very good results.

TO ampuca.. ‘ft. Jimb place a compress of somekind above
the injury. Maxe an incision through the skin around the
limb in such a manner that when the laps have been dissecte:
back and the limb cut off, the flaps of skin will] entirely
cover the wound. Dissect back this skin and cut off the bone
as far back as possible. Tie up the arteries am bring the
two flaps together. Suture the wound carefully and firmly.
Tow or something of that kind of material is put on the end
of the stump and the whole is bendaged up. After the wound

has healed a woodne leg may be made buckled on similar to

 

 

that in the humans.

 

 

P-a-r-t-1-c-u-l-a-r- F-r-a-c-t-u-r-e-s.
Fractured Cranium is usually fatal. If the bones pro-

ject inward the trephine ma: be used am then the part lifted

 

 

up. All foreighnn matter mustbe carefully removed. ABandage

4s put on, after this a plaster of paris or poroplaster

 

 

dressing may be applied. If the bone does not project
 

 

inward the treatment will be simply to apply the dressing.
Bones of the Face, should be restored as well as possible
and kept in place by splints and bandages covering the entire
face. In case the naval bones being fractured hemorrhage 1s
often the result. In this casdstyptic or other means of
Stopping the blood should be resorted to.
Lower Jaw, is frequently fractured. The symptoms are
well marked, and often a bloody saliva will run out. For
a Simple fracture the plasterbandace or the poroplaster may
be all that is necessary. If, however, the bone is displaced
the bone must first be brought in place and then proper steps
be taken to keep it there. Mr Walker in William's Prin-
ciples and Practice of Veterinary Surgery has a very ingen-
lous arranzement for holding the parts in pleice. The::app-
aratus consists of a cradle made to fit the lower jaw. Two
pieces of wood run along the side of tne jaw, and are joined
together at the back of the lad. These pieces extend down
as far as the lip. To these strips is fastened on each
Side of the jaw a piece of metal, which is mide to fit on
top of the bone, inside the mouth. The first molars will

probably have to be filed down to make room for this plece,

and in order that it may fit closely to the bone. Underneath

the jawis anotherstrip which is wider and not as long, This
 

 
 

 

 

 

 

 

piece of wood is curved at the lower end so as to fit to the
end of the bone. Straps pass under the jaw and hols these
three strips torether. A strap also passes over the brow
and another down along the throat thus holding tne apparatus
firmly in place. In this way the bone is kept rigid and if
the animal is fed soft food for a few davs it will soon be
able to use its teeth to masticate the food. The mouth
Should be cleaned frequently with water. A weak solution of
hydro-chloric acid is also very good. The bowels should be
kept open and laxative food given.

If the cradle is not at hand and the bandage is used,
liquid food must be supplied. These may ve such as hay tea,
bran tea am the lixe. Liquid food should also be supplied
per rectum.

FRACTURE of the SPINE. Is not very common. It is often
very hard to diagnosé. The history of the case should make
the operator suspicious. There are however certain pecul-
lar signs. The patient becomes suddenly quiet, perhaps a
trembling 1 sting for a few minutes, the posterior part of the
body will be more or less paralyzed, and there may be a
Slight depression in the back at the place of injury. Rec-
Overy is very rare.

The patient should be placed in Slings and kept as quiet

ais possible. If the pone h s been displaced the injury will

 

 
20

 

he

 

 

"Nprobably prove fatal, if nowt it may recover.

¢

FRACTURE OF THE RIBS. is not always noticed or able to

jbe diagnosed. The true ribs beyond the elbow are most lia-

Ible to fracture. The free ribs have more motion. The way

detect fracture of the ribs is to run the hand along the side

Ito feel for any irregularity, press slightly on this and lis-

ten for crepitation.
If the bones remain in place simply a plaster of Burgundy
pitch spread on a cloth and poured over the injury is all

that is necessary. If a bandage is also wound around the

{chest the breathing will be limited but it will be beneficial

to the injury. If one part projects a compress may be good.
If, however, the part projects inward the injruy is more
serious but the treatment will still be the same.

FRACTURED PELVIS is rare but Waite serious. To examine
it insert the hand in the rectim and feel for crepitation.
Quiet and right kind of food is all that can be done.

VRACTURE O* RONES OF THE TAIL. Simply apply the starch-
ed bandage.

FRACTURE OF THE SCAPULA, is rere. Put on bandage and
plaster.

FRACTURE OF HUMERUS is quite common. Often oblique

{thus making it quite serious. Bandaging is all thiut can be

done.
2] |

— — «+

| A

 

 

 

 

FRACTURE OF FEMUR is similar to tnit of humerus.

FRACTURED LEG. Quite common. The treatment has already
been described.

FRACTURED PASTERN. If the fracture is longitudinal it w
will probably extend into other bones, am the healing will
produce anchylosis. If it is transverse it is easy to treat.

FRACTURED SESAMOID. Usually the fracture is the result
of disease.

FRACTURE OF THE COFFIN BONE is difficult to diagnose.

No displacement is possible and it usually heals itself.

FRACTURE OF NAVICULAR BONE. This often happens after
neurotomy has been performed it is usually the result of

disease,

The authorities tnat have been consulted are Prof. W.
Williams, Dr. E. A. A. Grange, Prof. A. Liautard, William
Percivall, EF. Courtany, Dr. HW. Agnew, and Dr. F. '’. Hamnmil-

ton.
 

  

Miia