Lameness of the Horse / Veterinary Practitioners' Series, No. 1

by John Victor Lacroix

The general plan of treatment, after preliminary cleansing has been accomplished, has been outlined on page [66] in the consideration of scapulohumeral joint affections. The injection of undiluted tincture of iodin in ounce quantities, it must be remembered, is not to be done unless there is provision for its free exit. Where good drainage from the joint cavity exists all infected wounds should be thus treated, and this treatment may be repeated as conditions seem to require—until infection is checked.

If daily injections are necessary, dilution of the tincture of iodin with an equal amount of alcohol is advisable in order to avoid doing irreparable damage to the articular cartilages and synovial membranes.

An antiseptic powder composed of equal parts of boric acid and exsiccated alum is employed to protect the wound surfaces and the margins, and the parts are then bandaged. In bandaging wounds of this kind a liberal amount of cotton should be employed, and after a large surface surrounding the wound has been thoroughly cleansed, it must be so kept thereafter. This is impossible, if one uses a small amount of cotton, particularly if such meager quantity of dressing material is carelessly wrapped in position with an insufficient amount of bandage material. Mention, without description of the elemental problem of applying cotton and bandages to a wound, would be sufficient, were it not that this is a very important part of the handling of such cases, and many practitioners are not only thoughtless in this part of their work, but also apparently careless. What does it profit to prepare a part and cleanse a wound with painstaking care and then neglect to take every possible precaution to prevent its subsequent contamination?

In the handling of open joint capsules where the perforation of the capsular ligament is small and discharge of synovia does not immediately follow, there is presented a problem which is difficult to decide upon and that is the manner in which such wounds are to be handled. One hesitates to enlarge such openings to drain or irrigate the capsule when there is no proof that serious trouble will follow because of infectious material which has probably been introduced at the time the wound was inflicted. It is especially difficult to decide upon the manner of handling such cases where the tarsal joint is wounded, although one hesitates to invade any joint to the extent of incising its capsule, unless there is urgent need of so doing.

Frost[19] offers the following suggestion in such instances:

The treatment recommended by us for open joints, in which we wish to prevent ankylosis, is, first, to shave all hair from the area surrounding the wound, following with a thorough cleansing of the skin and disinfection of the wound, and then to inject a twenty per cent Lugol's solution in glycerin into the wound. This should be repeated two or three times a day, each time enough of the solution being injected to fill the joint capsule, thereby securing the flushing effect. As this solution does not cause irritation to the tissue and yet is a strong antiseptic, it serves to shorten the period of congestion and inflammation and to overcome the infection without causing a destruction of the secreting membrane until the external wound has had time to heal. The injection of this solution seems to retard the excessive secretion of synovia. The larger the joint capsule and the smaller the external wound, the longer our antiseptic will remain in contact with the inflamed tissues as the glycerin, being thick, does not flow through a small opening.

After-care.—Following the initial cleansing and treatment of open joint, subsequent dressing is necessary as frequently as conditions demand. If the parts are badly infected and profuse discharge of pus exists a daily change of dressings is necessary. In the average instance, however, semi-weekly treatments are sufficient. And in many instances where one is obliged to travel a considerable distance to handle the affected animal one weekly dressing of the wound will suffice after the second treatment.

The same general plan of treatment concerning the subject's comfort that has been previously mentioned in arthritis, is carried out here. A further and detailed consideration of the subject of handling of open joints follows.[20]

* * * Such wounds may be classified in two general groups as follows: First, wounds in which the trauma has exposed the articulation to view, and second, those the result of punctures, in which the external wound is small and free drainage is lacking.

Wounds in which the articulation is exposed to view have drainage either all ready provided for, or it is established without hesitancy surgically. With free drainage thus established there is little or no chance for the adjacent tissues to become infiltrated with infected wound discharge. This prevents an extension of the injury and the establishment of a good field for the growth of anaerobic bacteria.