About ninety percent of all cases of open joint make complete recoveries, about four per cent partially recover and six per cent are fatal.
Among the fatal cases are the open joints with complications as severed tendons, those occasioned by calk wounds in horses that are stabled, and nail punctures of the feet.
The following report of twelve favorable cases is taken from a record of sixty-two cases.
The favorable ones are reported, chiefly because there are now enough reports on record of such cases which have terminated fatally. Case 1.—A gray gelding used as a saddle pony received a horizontal wire cut laying completely bare the scapulohumeral articulation.
The margins of the wound were cleansed as heretofore described, a drainage was provided surgically, tincture of iodin was injected and the wound was covered with equal parts of boric acid and exsiccated alum.
The horse was kept tied and a diluted tincture of iodin was injected into the wound once daily and the powder applied often enough to keep the wound covered.
The case made a complete recovery and the pony was again in service within sixty days. Case 2.—A twelve-hundred-pound bay mare with an open carpal joint.
The wound was an open one about two and one-half inches in length, and made transversely and when the member was flexed the articular surface of the carpal bones were presented to view.
An ounce of tincture of iodin was injected into this joint after having cleansed the margin of the wound and the mare was cross-tied in a single stall to keep her from lying down.
The owner was instructed to keep the outside of the wound powdered with air slaked lime and a very unfavorable prognosis was given. I heard nothing further from this case until fifty-nine days from the date of the injury, when I met the owner driving this mare to a buggy.
The wound had healed by first intention and at that time so little cicatrix remained that it was difficult to find it. Case 3.—A brown mare with an open fetlock joint due to a spike-nail puncture.
Lameness was excessive, and joint greatly swollen.
Tincture of iodin was injected into the wound and towels dipped in hot antiseptic solutions were applied for several hours daily until the acute stage had passed.
Later the mare was turned out to pasture and a vesicant was applied once or twice a month until recovery was complete which was in about six months. Case 4.—A four-year-old bay mare having a wire-cut which opened the tarsus joint was treated as heretofore described.
The wound was kept bandaged for about two weeks and later it was dressed without being bandaged.
In ninety days she had completely recovered. Case 5.—A twelve-year-old mare with an open fetlock joint due to a puncture wound.
The margins of the wound were cleansed and the external wound enlarged to facilitate drainage.
Tincture of iodin was injected; the wound was bandaged and dressed for a month in the manner heretofore described, when all discharge had stopped.
A vesicant was applied; the mare was put to pasture and within sixty days from the date of the injury she was being driven on short trips. Case 6.—A two-year-old brown gelding with a wire-cut on the left front foot.
The wound extended down through the sole and opened the navicular joint.
This colt was very wild and it was necessary to tie it down each time the wound was dressed.
The wound was dressed weekly for a month and less frequently thereafter.
It was handled eight times; the last dressing was left in place until worn out.
Six months later the colt was practically well, a very little lameness being shown when walking on frozen ground. Case 7.—A seven-year-old saddle-horse weighing eleven hundred and fifty pounds received a wound of the tarsus, laying bare the articular surfaces of a part of the joint.
It was impossible to keep this wound bandaged because of the restless disposition of the subject.
Injections of a dilute tincture of iodin were employed every second or third day for a month and the wound was kept covered with the antiseptic dusting powder referred to heretofore.
In five months complete recovery had taken place, with the exception of a stubborn skin disturbance which was successfully treated six months after the wound was inflicted.
The horse is still in use and is absolutely free from lameness. Case 8.—A two-year-old brown gelding with a wire-wound opening the scapulohumeral joint.
This wound was large enough to expose to view the articular portion of the humerus.
The same treatment as that given case No.
One was instituted and in ninety days the colt was practically well. Case 9.—A three-year-old bay filly was found at pasture with one fore foot badly injured.
The owner intended to destroy her, but a neighbor prevailed upon him to have her treated.
Apparently the wound was of about a week’s standing and in a very bad condition, filled with maggots and dirt.
Both the navicular and coronary articulations were open.
This wound was cleansed in the usual manner and the owner cared for the case the balance of the time because the distance from my office was too great to give her personal attention.
She made an almost complete recovery in five months. Case 10.—At two-year-old mule with an open navicular joint due to a barbed wire wound.
Usual care was given this case and in five months recovery was complete and little scar is to be seen.
This case received seven treatments. Case 11.—An eighteen-months-old colt at pasture was found down and unable to rise without help.
In addition to several wounds of lesser importance there was a large wound on the inner side of the elbow, the joint was open and the entire leg was greatly swollen and in a state of acute infectious inflammation.
The colt could not walk, its temperature was 105°, pulse was rapid and respiration was a little hurried.
After advising the owner to put the poor animal out of its misery I left the place.
Four days later the owner came to my office and asked if he could borrow some old shears to “trim off some loose hide from that colt.” He left the colt in the pasture and all the care it received was the regular application of a proprietary dusting powder.
It made a complete recovery. Case 12.—A family mare, heavy in foal, received a vertical wound of the fetlock joint inflicted by a disc-harrow.
The cul-de-sac of the ligament of this joint was opened freely.
The wound was dressed in the usual manner and again three days later when no suppuration had taken place.
Four days later the patient gave birth to a colt and suckled it right along through her convalescence.
This wound healed by first intention and seventy-nine days from the date of the injury the mare was driven to town, two and one-half miles distant, and showed but little lameness. Phalangeal Exostosis (Ringbone) This term is applied to exostoses involving the first and second phalanges (suffraginis and corona), regardless of their size, extent or location.
It is a misnomer, in a sense, and the veterinarian is frequently obliged to spend considerable time with his clients in order to convince them that a spherodial exostosis of the proximal phalanx, in certain cases, is in reality “ringbone,” even though there exists no exostosis which completely encircles the affected bone. Etiology and Occurrence.—Exostosis of the first and second phalanges is usually due to some form of injury, whether it be a contusion, a lacerated wound which damages the periosteum, or periostititis and osteitis incited by concussions of locomotion, or ligamentous strain.
Practically the only exception is in the rachitic form of ringbone which affects young animals. There are predisposing causes that merit consideration, chief among which is the normal conformation of the coronet joint.
This proclivity is constant; the normal interphalangeal articulation is an incomplete ginglymoid joint and while its dorso-volar diameter is great, this in no wise compensates for its disproportionately narrow transverse diameter.
The pivotal strain which is sometimes thrown upon this articulation when an animal turns on one foot, as well as the tension which is put on the collateral ligaments when the inner or the outer quarter of the foot rests in a depression of the road surface, tends to detach the insertion of these ligaments or to cause fibrillary fractures of their substance. Short, upright, pasterns receive greater concussion during fast travel on hard roads than do the longer more sloping and well formed extremities.
Those who are advocates of the theory that this type of osteitis with its complications has its origin in the articular portion of the joint, claim that the upright pastern constitutes an important tendency toward ringbone.
Howbeit, ringbone is an active, serious and frequent cause of lameness and it affects animals of all ages and occurs under various conditions.
Horses having good conformation and kept at work wherein no great amount of strain is put upon these parts, are occasionally victims of this affection. Classification.—The arrangement employed by Moller HYPERLINK “file:///C:\\Users\\Flori\\Desktop\\Horse_lameness\\16370-h.htm” \l “Footnote_21_21”  is intensely practical and logical.
He considers ringbone as articular, periarticular, rachitic and traumatic.
A mode of classification that is common and in a practical way, good, is, high and low ringbone.
When prognosis is considered, for instance, it is very convenient to state that the chances for recovery are much better in high ringbone than in low ringbone.
The classification of Möller will be followed here. HYPERLINK “file:///C:\\Users\\Flori\\Desktop\\Horse_lameness\\images\\img17-full.jpg” INCLUDEPICTURE “../AppData/Local/Temp/Horse_lameness/images/img17.jpg” \* MERGEFORMATINET Fig. 17—Phalangeal exostoses. Symptomatology.—In all forms of incipient ringbone except rachitic, the first manifestation of its existence, or of injury to the ligaments in the region of the pastern joint which causes periostitis, or affections of the articular portions of the proximal inter-phalangeal joint, is lameness.
Lameness which typifies ringbone is of the supporting-leg variety and by compelling the subject to step from side to side, marked flinching is observed, especially in periarticular ringbone; causing the affected animal to turn abruptly on the diseased member, using it as a pivot, likewise accentuates the manifestation.
In fact, many subjects that exhibit no evidence of locomotory impediment while walking or trotting in a straight line on a smooth road surface, will manifest the characteristic form of lameness from ringbone when the aforementioned side to side movement is performed. When the manner in which pain is occasioned is considered, it will be understood why lameness is intermittent in the early stages of this affection and may even be unnoticed by the driver.
An animal may travel on a smooth road without giving evidence of any inconvenience, but as soon as a rough and irregular pavement or road surface is reached, will limp.
As the subject is driven farther on level streets the lameness may disappear.
This intermittent type of lameness may continue until there is developed a large exostosis, or until articular involvement causes so much distress during locomotion that lameness is constant.
On the other hand, resolution may occur during the stage of periosteal inflammation, or, an exostosis forms which causes no interference with function. HYPERLINK “file:///C:\\Users\\Flori\\Desktop\\Horse_lameness\\images\\img18-full.jpg” INCLUDEPICTURE “../AppData/Local/Temp/Horse_lameness/images/img18.jpg” \* MERGEFORMATINET Fig. 18—Rarefying osteitis in chronic ringbone and ossification of lateral cartilages. Before there is evidence of an exostosis, diagnosis of ringbone is not easy, for it is then a problem of detecting the presence of a ligamentous sprain, periostitis, or osteitis.
The diagnostician should take note of local manifestations of hypersensitiveness, or heat if such exist, and, in addition, other conditions must be excluded before definite conclusions are possible. In articular ringbone as soon as there is developed an exostosis, it occupies a position on the dorsal (anterior) part of the articulation and extends around the sides of the joint.
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