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

by John Victor Lacroix

Open joints caused by punctures, unless the puncture is aseptic, produce a swelling which is more painful than is the open wound which exposes the joint to view. Especially is this true if the puncture is of small diameter, allowing the tissues to partially close the opening immediately after the wound has been made. Where drainage is lacking there follows an exudation which congests the tissues surrounding the injury and all factors favoring germ growth are present. It is perhaps advisable to establish good drainage in such cases as soon as a diagnosis is made.

It is not always an easy matter to recognize an open-joint, when first made, but twelve to twenty-four hours later there is no cause for doubt. The condition is then a very painful one; lameness is excessive; there is rise in temperature; acceleration of the pulse and manipulation or palpation of the region affected, occasions great pain.

The treatment of open joints must be varied to suit the disposition of the animal, the nature and location of the injury, the length of time intervening between the infliction of the wound and the first attention given, and the surroundings in which the patient is kept.

In each and every case in which there exists an open wound the surface surrounding the wound is cleansed thoroughly, the hair is shaved if possible, and the margin of the wound is curretted and cleansed thoroughly with antiseptic solutions.

If there is evidence that the articulation contains infective material, it is washed out with copious quantities of peroxide of hydrogen—usually as much as six or eight ounces. This is followed by injection of an ounce or two of tincture of iodin. Even though the joint appears to be clean some tincture of iodin is used, as it checks the secretion of synovia and is, in every way, beneficial. Care is taken to apply the iodin also to the surface immediately surrounding the wound. The entire wound is then covered with a dusting powder composed of zinc oxide, boric acid, exsiccated alum, phenol and camphor.

This powder is used in abundance and the wound is then covered with a heavy layer of absorbent cotton and well bandaged. This bandage is not disturbed for at least three days and may be left in place for a week. In cases in which it is necessary to keep the dressing on for a week, or in cases where the patient is, through necessity, kept in quarters that are wet or unclean, the first bandage is covered with a layer of oakum which has been saturated in oil of tar and this in turn is held in place by means of several layers of bandages. The bandages are also saturated with oil of tar.

In from one to two months wounds so treated, unless they are foot-wounds, will be ready to dress without being bandaged. It is ordinarily unnecessary to dress foot-wounds oftener than every second week after the discharge of synovia has ceased. When the wound has filled with granulation, a protective dressing is applied which is rendered water proof by the use of bandages covered with oil of tar. The patient can now be turned out for a month or six weeks without disturbing the dressing. After the removal of the bandages, the only treatment necessary is an occasional application of some mildly antiseptic ointment.

Except in nail pricks of the foot, occasioned by punctures, a five per cent tincture of iodin is injected into open joints, if the wound remains sufficiently open, and this treatment is continued so long as there is a discharge of synovia. Surgical drainage is established if it is considered practicable and the remainder of the treatment is about the same as for wounds which are open.

Open joints occur in horses at pasture and are sometimes not discovered until several days or a week after the injury, and in some instances the wounds are filled with maggots. The only difference in the treatment of these cases is that more time and care is taken in cleansing the wound, more curetting is necessary, and after cleansing the wound with peroxide of hydrogen, the joint is thoroughly washed out with equal parts of tincture of iodin and chloroform. This is followed by the injection of a quantity of seventy-five percent alcohol and the wound is dressed and bandaged as already described. At each subsequent dressing of infected wounds so treated less suppuration is noticed and the synovial discharge usually ceases in from one to two months.

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.