Chapter 16

FRACTURES

These are of not unfrequent occurrence in the dog; and I once had five cases in my hospital at the same time.

In the human subject, fractures are more frequent in adults, and, perhaps, in old men, than in infants; but this is not the case with the smaller animals generally, and particularly with dogs. Five-sixths of the fractures occur between the time of weaning and the animal being six months old; not, perhaps, because of their chemical composition, that the bones are more fragile at this age; but because young dogs are more exposed to fall from the hands of the persons who carry them, and from the places to which they climb; and the extremities of the bones, then being in the state of epiphysis, are easily separated from the body of the bone. When the fracture takes place in the body of the bone, it is transverse or somewhat oblique, but there is scarcely any displacement.

A simple bandage will be sufficient for the reduction of these fractures, which may be removed in ten or twelve days, when the preparatory callus has acquired some consistence. One only out of twenty dogs that were brought to me with fractures of the extremities, in the year 1834, died. Two dogs had their jaws fractured by kicks from horses, and lost several of their teeth. In one of them the anterior part of the jaw was fractured perpendicularly; in the other, both branches were fractured. Plenty of good soup was injected into their mouths. Ten or twelve days afterwards, they were suffered to lap it; and in a little while they were dismissed cured.

It will be desirable, perhaps, to describe our usual method of reducing the greater part of the fractures which come under our notice.

I.--The 'humerus' was fractured just above the elbow and close to the joint. The limb was enclosed in adhesive plaster, and supported by a firm bandage. The bones were beginning to unite, when, by some means concerning which I could never satisfy myself, the 'tibia' was broken a little above the hock. Nothing could well be done with this second fracture; but great care was taken with regard to the former. The lower head of the humerus remained somewhat enlarged; but the lameness became very slight, and in three weeks had nearly or quite disappeared. Nothing was done to the second fracture; in fact, nothing more than a slight, annular enlargement, surrounding the part, remained--a proof of the renovating power of nature.

II.--A spaniel was run over by a light carriage. It was unable to put the left hind leg to the ground, and at the upper tuberosity of the ileum some crepitus could be distinguished. I subtracted six ounces of blood, administered a physic-ball, and ordered the patient to be well fomented with warm water several times during the night. On the following day no wound could be discovered, but there was great tenderness. I continued the fomentation. Two or three days afterwards she was evidently easier. I then had the hair cut close, and covered the loins and back with a pitch-plaster. At the expiration of six days the plaster was getting somewhat loose, and was replaced by another with which a very small quantity of powdered cantharides was mingled. At the expiration of the fifth week she was quite well.

III.--The 'thigh-bone' had been broken a fortnight. It was a compound fracture: the divided edges of the bone protruded through the integuments, and there was no disposition to unite. It is not in one case in a hundred that an animal thus situated can be saved. We failed in our efforts, and the dog was ultimately destroyed.

IV.--The 'femur' was broken near the hip. I saw it on the third day, when much heat and swelling had taken place. I ordered the parts to be frequently bathed with warm water. The heat and tenderness to a considerable degree subsided, and the pitch-plaster was carefully applied. At the expiration of a week the plaster began to be loosened. A second one was applied, and when a fortnight longer had passed, a slight degree of tenderness alone remained.

V.--The following account is characteristic of the bull terrier. The 'radius' had been broken, and was set, and the bones were decidedly united, when the dog, in a moment of frantic rage, seized his own leg and crushed some of the bones. They were once more united, but his wrist bent under him in the form of a concave semicircle, as if some of the ligaments of the joint had been ruptured in the moment of rage. It was evident on the following day that it was impossible to control him, and he was destroyed.

VI.--A spaniel, three months old, became fractured half-way between the wrist and the 'elbow'. A surgeon bound it up, and it became swollen to an enormous size, from the adhesive plaster that had been applied and the manner of placing the splints. I removed the splints. On the following morning I had the arm frequently fomented: a very indistinct crepitus could be perceived at the point of the humerus: I applied another plaster higher up, and including the elbow. The hair not having been cut sufficiently close, the plaster was removed, applied much more neatly and closely, and the original fracture was firmly bound together. No crepitus was now to be perceived.

I saw no more of our patient for four days, when I found that he had fallen, and that the elbow on the other side was fractured within the capsular ligament. A very distinct crepitus could be felt, and the dog cried sadly when the joint was moved. I would have destroyed him, but he was a favourite with his master, and we tried what a few days more would produce. I enclosed the whole of the limb in a plaster of pitch, and bound it up without splints. Both the bandages remained on nearly a fortnight, when the fractures were found to be perfectly united, and the lameness in both legs gradually disappeared.

VII.--July 22, 1843. A spaniel was frightened with something on the bed, and fell from it, and cried very much. The instep, or wrist, of the right leg, before was evidently bowed, and there was considerable heat and tenderness. It was well fomented on the two following days, and then set, and adhesive plaster was tightly applied, and a splint bound over that.

24th. The foot began to swell, and was evidently painful. The outer bandage was loosened a little, but the inner bandage was not touched.

Aug. 4. The bandage, that had not been meddled with for eleven days, now appeared to give him some pain. For the last two days he has been gently licking and gnawing it. The splints were removed; but the adhesive plaster appearing even and firm, was suffered to remain.

26th. Everything appeared to be going on well, when he again leaped from his bed. The wrist was much more bowed, and was tender and hot. Simple lint and a firm calico bandage were had recourse to.

27th. He is unable to put his foot to the ground, and the joint is certainly enlarging. An adhesive plaster, made by a Frenchman, was applied at the owners request, over which was placed a splint. The dog soon began to gnaw the plaster, which formed a sticky but not very adhesive mass. Before night the pain appeared to be very great, and the dog cried excessively. I was sent for. We well fomented the leg, and then returned to our former treatment. There was evidently a great deal of pain, but it gradually passed over, and a slight degree of lameness alone remained.

I have great pleasure in adding the following accounts of the successful treatment of fractures in dogs by Mr. Percivall:

"Hopeless as cases of fracture in horses generally are, from the difficulty experienced in managing the patient, they are by no means to be so regarded in dogs. I have in several instances seen dogs recover, and with very good use of the parts, if not perfect restoration of them, when the accidents have been considered, at the time they took place, of a nature so irremediable as to render it advisable to destroy the animals.

"May 4, 1839. A valuable Irish spaniel fell from a high wall, and fractured his 'off shoulder'. On examination, I found the 'os humeri' fractured about an inch above its radial extremity, causing the limb to drop pendulously from the side, and depriving the animal of all use of it. The arm, by which I mean the fore arm, was movable in any direction upon the shoulder, and there was distinct crepitus: in a word, the nature of the accident was too plain to admit of doubt; nor was there any splinter or loose piece of bone discoverable. I directed that the animal might be laid flat upon his sound side in a hamper, or covered basket or box, of sufficient dimensions, but not large enough to admit of his moving about; to have his hind legs fettered, his mouth muzzled, and his injured parts covered with a linen cloth wetted with a spirit lotion.

'May' 5. The parts are tumefied, but not more, nor even so much as one night have expected. Continue the lotion.

'6th'. At my request, Mr. Youatt was called in to give his opinion as to the probability of effecting a cure. He thought from the inconvenient situation of the fracture, that the chances of success were doubtful; and recommended that a plaster, composed of thick sheep-skin and pitch, cut to the shape of the parts, should be applied, extending from the upper part of the shoulder down upon the arm, and reaching to the knee; and that the whole should be enveloped in well-applied bandages, one of them being carried over the shoulders and brought round between the fore legs, to support the limb, and aid in retaining the fractured ends in apposition. Prior to the application of the pitch plaster the hair was closely shorn off. Thus bound up, the dog was replaced in his hamper, and had some aperient medicine given to him.

'8th'. The medicine has operated; and he appears going on well, his appetite continuing unimpaired.

'10th'. He growls when I open the basket to look at him. On examining him (while his keeper had hold of him), I found the plaster loosening from its adhesion; I took it off altogether, and applied a fresh one, composed of the stopping composition I use for horses' feet.

June 7. Up to this time everything appears to have been going on properly. The fracture feels as if it were completely united, and, as the plaster continues to adhere firmly, I thought the bandages enveloping it, as they were often getting loose, might now he dispensed with, and that the dog might with benefit be chained to a kennel, instead of being so closely confined as he has been. In moving, he does not attempt to use the fractured limb, but hops along upon the three other legs.

July. He has acquired pretty good use of the limb. Being now at liberty, he runs about a good deal; halting, from there being some shortness of the limb, but not so much as to prevent him being serviceable, as a 'slow' hunter, in the sporting-field.

"About a twelvemonth ago," continues Mr. Percivall, "I was consulted concerning a blood-hound of great size and beauty, and of the cost of £50, that had been a cripple in one of his hind limbs for some considerable time past, owing, it was said or thought, to having received some injury. After a very careful handling, and examination of the parts about the hips, the places where he expressed pain, I came to the conclusion that there had been, and still existed, some fracture of 'the ischial portion of the pelvis', but precisely where, or of what nature, I could not determine; and all the treatment I could recommend was, that the animal should be shut up within a basket or box of some, sort, of dimensions only sufficient to enable him to lie at ease, and that he be kept there for at least six months, without being taken out, save for the purpose of having his bed cleansed or renewed. His owner had previously made up his mind to have him destroyed; understanding, however, from me, that there still remained a chance of his recovery, he ordered his groom to procure a proper basket, and see that the dog's confinement was such as I had prescribed. The man asked me to allow him to have his kennel, which, being no larger than was requisite for him, I did not object to; and to this he had an iron lattice-door made, converting it into a sort of wild beast cage. After two months' confinement, I had him let out for a short run, and perceived evident amendment. I believe altogether that he was imprisoned five months, and then was found so much improved that I had him chained to his kennel for the remaining month, and this, I believe, was continued for another month. The issue was the complete recovery of the animal, very much to the gratification and joy of his master, by whom he is regarded as a kind of unique or unobtainable production.

"The fractures of dogs and other animals must, of course, be treated in accordance with all the circumstances of their cases; but I have always considered it a most essential part of their treatment that such portable patients as dogs and cats, &c., should be placed and kept in a state of confinement, where they either could not, or were not likely to, use or move the fractured parts; and, moreover, I have thought that failure, where it has resulted after such treatment, has arisen from its not having been sufficiently long persisted in."

In the opinion of Professor Simonds, when there is fracture of the bones of the extremities, a starch bandage is the best that can be employed. If applied wet, it adapts itself to the irregularities of the limbs; and if allowed to remain on twelve hours undisturbed, it forms a complete case for the part, and affords more equal support than anything else that can possibly be used.

The following case was one of considerable interest. It came under the care of Professor Simonds. Two gentlemen were playing at quoits, and the dog of one of them was struck on the head by a quoit, and supposed to be killed. His owner took him up, and found that he was not dead, although dreadfully injured. It being near the Thames, his owner took him to the edge of the river, and dashed some water over him, and he rallied a little. Professor Simonds detected a fracture of the skull, with pressure on the brain, arising from a portion of depressed bone. The dog was perfectly unconscious, frequently moaning, quite incapable of standing, and continually turning round upon his belly, his straw, or his bed. It was a case of coma; he took no food, and the pulsation at the heart was very indistinct.

"I told the proprietor that there was no chance of recovery except by an operation; and, even then, I thought it exceedingly doubtful. I was desired to operate, and I took him home.

"The head was now almost twice as large as when the accident occurred, proceeding from a quantity of coagulated blood that had been effused under the skin covering the skull. I gave him a dose of aperient medicine, and on the following morning commenced my operation.

"The hair was clipped from the head, and an incision carried immediately from between the eye-brows to the back part of the skull, in the direction of the sagittal suture. Another incision was made from this towards the root of the ear. This triangular flap was then turned back, in order to remove the coagulated blood and make a thorough exposure of the skull. I was provided with a trephine, thinking that only a portion of the bone had been depressed on the brain, and it would be necessary, with that instrument, to separate it from its attachment, and then with an elevator remove it; but I found that the greater part of the parietal bone was depressed, and that the fracture extended along the sagittal suture from the coronal and lamdoidal sutures. At three-fourths of the width of the bone, the fracture ran parallel with the sagittal suture, and this large portion was depressed upon the tunics of the brain, the dura mater being considerably lacerated. The depressed bone was raised with an elevator, and I found, from its lacerated edges and the extent of the mischief done, that it was far wiser to remove it entirely, than to allow it to remain and take the chance of its uniting.

"In a few days, the dog began to experience relief from the operation, and to be somewhat conscious of what was taking place around him. He still requires care and attention, and proper medicinal agents to be administered from time to time; but with the exception of occasionally turning round when on the floor, he takes his food well, and obeys his master's call."[1]

[Footnote 1: Trans. Vet. Med. Assoc., i. 51.]

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