Treatment.—Rest is the first requisite, and in addition every mechanical means possible to change the center of gravity in the phalangeal region, is to be employed. This is best accomplished by shortening the toe and paring the sole at the toe as much as conditions will permit. The heel is raised by means of a shoe with moderately high heel calks.
The iodin-glycerin combination heretofore mentioned may be applied and the parts covered with cotton and bandage. Subjects require from three weeks to several months' rest and must be returned to work carefully, lest the incompletely regenerated tissues suffer injury.
Regeneration of tissue in such cases, as has been pointed out, is slow and sufficient time for complete recovery must be allowed or relapses will occur.
Fracture of the First and Second Phalanges.
Etiology and Occurrence.—Fractures of the first phalanx (suffraginis) occur with respect to frequency, second to pelvic fractures. Often, almost insignificant injuries cause phalangeal fractures. On city streets, horses shod with shoes having long calks get caught in frogs of street railways or by slipping on rails, and phalangeal bones are often broken. The author observed a case of comminuted fracture of both the first and second phalanges (suffraginis and corona) in a polo pony caused by making a sudden turn while in action in a contest on the turf.
Symptomatology.—Fracture of the phalanges is nearly always signalized by lameness, and this is marked during the period of weight bearing. Lameness is usually intense and where the pathognomonic symptom (crepitation) is not recognized, the intensity of the claudication, when other causes are absent, is indicative of fracture. The subject does not bear weight upon the affected member and where pain is intense, the foot is held in an elevated position and swung back and forth. In hind legs the member is often flexed in abduction and held in this position for several minutes, being rested on the ground only during short intervals. When compelled to walk, if pain is excruciating, the animal hops with the sound leg, no weight being supported by the fractured member.
When an examination of the subject is possible before the extremity is swollen, crepitation is usually found without great difficulty, except in a subperiosteal break or in some cases of vertical or oblique fracture. Great care is necessary in handling the injured extremity in these cases, and particularly in nervous subjects or in excited animals that have been recently injured in runaways, is it necessary to be gentle in manipulating the extremity, if definite deductions are to be made. As has been mentioned in the chapter on diagnostic principles, if the condition is so painful that the subject does not relax the parts and crepitation is masked, local anesthesia is necessary. An anesthetic solution of cocain or novocain may be applied to the metacarpal or metatarsal nerves and an entirely satisfactory examination is then possible.
Passive movement of the phalanges in all directions is practised in order to produce crepitation. When rotation of the parts does not occasion crepitation, gentle flexion and extension may do so. And in many instances, considerable manipulation of the phalanges is necessary before the pathognomonic symptom is to be recognized.
In cases where crepitation is not found and lameness is pronounced, out of proportion with other possible existing causes, one may by exclusion of other causes establish a diagnosis of fracture in the course of forty-eight hours. In the meanwhile, support is given the affected member by applying an effective leather splint, so that pain may be diminished. To combat inflammation, a suitable cataplasm may be applied directly to the skin, the extremity bandaged, and the temporary immobilizing appliance may be secured over all. In this manner one may make repeated examinations of the subject, and if slings are used and every other necessary precaution taken to promote comfort for the subject, no harm will result in delaying for several days the application of permanent immobilization—bandages and splints or casts. In fact, where much swelling exists at the time one is called to treat such cases, it is advisable to delay the application of a permanent dressing or cast until inflammation has somewhat subsided.
Course and Prognosis.—Where conditions are favorable, the nature of the fracture one that will yield to treatment, the subject not aged, and facilities for giving good attention to the affected animal are ample, fractures of the first and second phalanges recover completely in from six weeks to four months. Only simple fractures are considered curable from a practical and economical point of view, excepting in foals, where compound, and even comminuted, fractures may be so handled that animals may eventually become serviceable though blemished.