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Ankylosis of the Fetlock Joint
CLINICAL ARTICLES.
Clinique on the 11th of February 1896, and was then absolutely unable to do any work. Two grains of biniodide of mercury, dissolved by the aid of 5 grains of potassium iodide in an ounce of water, were given twice daily in linseed gruel. A week later there was a decided improvement in the wax the patient walked, and on 2nd March the horse was sent to slow work. 9tlt Marek The scirrhous cord was perceptibly less, the alterative effect of the medicine was well shown in the animal's improved appearance, and the dose of biniodide was increased to 4 grains twice daily, this being dissolved by 6 grains of potassium iodide. Treatment was continued until 8th May, the animal now working regularly in a cab, and the cord perceptibly decreasing. On this date the dose of biniodide was increased to 6 grains, 10 grains of potassium iodide being necessary to ensure its solution. On the 22nd the scirrhous cords appeared small enough to permit of removal by the knife and ecraseur, and unfortunately this was attempted. The animal died of shock and collapse two hours later. In the treatment of chronic elephantiasis and of tumours of the shoulder and elbow we have used the biniodide in the Clinique as a substitute for potassium iodide, and have got an equal amount of success, together with the advantage of obtaining the alterative effect of the mercury. Professor Edgar has recently told me that he has also tried it successfully in the horse for the dispersal of glandular enlargements, for capped elbows, and for scirrhous cord; also that he has found it a valuable agent' to use as an astringent to the lacteal secretion in mares and cows, and that on this account it must be used with a certain amount of care in milking animals unless it is desired to arrest the secretion. Summing up the results, it must be admitted (I) That the agent is very much cheaper to use than potassium iodide. (2) That the results which I have been able to collect regarding its value in actinomycosis confirm those which Professor Edgar had already obtained. (3) That the observations which Professor Edgar and myself had been independently making at the same time upon its therapeutic effects as a resolvent, specific, and alterative in certain diseases of the horse appear to demonstrate its value, and to agree in almost every detail. (4) We have each found that, as is frequently the case with potassium iodide, failure to continue with the medicine for a sufficiently long time may cause a relapse, the tumours again enlarging.
ANKYLOSIS
OF THE FETLOCK JOINT.
By E. E. MARTIN, Vet.-Lieut., A.V.D., Barrackpore, India. A well-marked case of this affection came under my notice a short time ago, and as I had an opportunity of photographing the legs during life and the bones after death, I thought a short account of it migh t interest the readers of this Journal. The case was a country-bred chestnut pony mare, aged, height about 13 hands 3 inches. The owner, an artillery officer in this station, had purchased her about a year previous to the time I saw
CLINICAL ARTICLES.
her. At the time of purchase the fetlocks were both rather enlarged and round, but she was going quite sound. He had her examined, and the veterinary surgeon told him that there was a doubt about the fetlocks; she might keep sound, but the condition might get worse. A few months after purchase the enlargement increased, and her gait got stiffer and stiffer. Various applications were tried, and, in addition, she was blistered twice. The condition gradually got worse, and when I saw her first the appearance of the fetlocks was such as is seen in the photo. She was very lame at a trot. slightly worse on the off fore, her action being peculiarly (( proppy," just as one might expect from almost rigid fetlocks. She made rather a good canter-in fact at that time the owner was playing polo on her regularly. Examination showed practically entire loss of power of flexion of the fetlock
joints, and attempts at flexion were greatly resented as being very painful. I recommended forcible flexion, and accordingly had her cast and chloroformed, and then flexed the joint until I could get the pastern at right angles to the cannon. The noise made by the snapping of adhesions was very marked. Both fetlocks were flexed in this way. After the operation, when she was permitted to get up, a cotton wool pressure bandage was applied to both joints, in order to prevent any effusion that might take place from the ruptured and strained adhesions. Next day there was considerable improvement in going. Systematic daily flexion was then carried out. A fortnight later she was again cast, chloroformed, and the fetlocks flexed, and this was repeated ten days later. After each operation temporary improvement resulted, but this was not maintained, the joints gradually stiffening again. After the failure of the flexion treatment, I decided to perform neurotomy. The reason for this decision was that I had seen a case similar to this some time previously, in which both fetlocks were quite 2 B
CLINICAL ARTICLES.
rigid, but it was performing its regular work, and beyond a little stiffness in trotting no exception could be taken to its paces. So I came to the conclusion that in these cases lameness is more the result of pain than of mechanical interference. I therefore performed plantar neurotomy on both forc. I regret very much that I did not perform median neurotomy, as I consider it would have been a good case for this operation. However, she derived considerable benefit irom this, most of the intense lameness disappearing, and she did her ordinary work for some months. The owner then, having got six months leave, decided to have her destroyed. The bones were mounted by Farrier-Sergeant T. Gill, and I photographed them. The photo shows the front aspect of the off fore and the back of the ncar fore leg. It will be seen that the lower portion
of the metacarpal bone and the upper portion of the os suffraginis are thickly covered with ossific deposit. This deposit extends upwards as far as the bulbs of the splint bones, which are also involved. The articular faces of the joint were free from the deposit. Since the above was written The Veterinary Retord of 2nd October 1897 has come to hand, in which there is a case reported by Vet.Major Joshua Nunn, entitled "Fibrous Ankylosis of the Fetlock Joint." From what I can gather, his case is similar to the one I have just described, but his was not in nearly so advanced a condition. I think the photograph of the bones may help to throw some light on the pathological conditions of the part, about which he does not venture an opinion. Some details as to the further progress of his case would be interesting, as my experience with the flexion treatment of lameness in the fetlock is that beneficial results are often obtained temporarily, but are very seldom of any permanence.
Clinique on the 11th of February 1896, and was then absolutely unable to do any work. Two grains of biniodide of mercury, dissolved by the aid of 5 grains of potassium iodide in an ounce of water, were given twice daily in linseed gruel. A week later there was a decided improvement in the wax the patient walked, and on 2nd March the horse was sent to slow work. 9tlt Marek The scirrhous cord was perceptibly less, the alterative effect of the medicine was well shown in the animal's improved appearance, and the dose of biniodide was increased to 4 grains twice daily, this being dissolved by 6 grains of potassium iodide. Treatment was continued until 8th May, the animal now working regularly in a cab, and the cord perceptibly decreasing. On this date the dose of biniodide was increased to 6 grains, 10 grains of potassium iodide being necessary to ensure its solution. On the 22nd the scirrhous cords appeared small enough to permit of removal by the knife and ecraseur, and unfortunately this was attempted. The animal died of shock and collapse two hours later. In the treatment of chronic elephantiasis and of tumours of the shoulder and elbow we have used the biniodide in the Clinique as a substitute for potassium iodide, and have got an equal amount of success, together with the advantage of obtaining the alterative effect of the mercury. Professor Edgar has recently told me that he has also tried it successfully in the horse for the dispersal of glandular enlargements, for capped elbows, and for scirrhous cord; also that he has found it a valuable agent' to use as an astringent to the lacteal secretion in mares and cows, and that on this account it must be used with a certain amount of care in milking animals unless it is desired to arrest the secretion. Summing up the results, it must be admitted (I) That the agent is very much cheaper to use than potassium iodide. (2) That the results which I have been able to collect regarding its value in actinomycosis confirm those which Professor Edgar had already obtained. (3) That the observations which Professor Edgar and myself had been independently making at the same time upon its therapeutic effects as a resolvent, specific, and alterative in certain diseases of the horse appear to demonstrate its value, and to agree in almost every detail. (4) We have each found that, as is frequently the case with potassium iodide, failure to continue with the medicine for a sufficiently long time may cause a relapse, the tumours again enlarging.
ANKYLOSIS
OF THE FETLOCK JOINT.
By E. E. MARTIN, Vet.-Lieut., A.V.D., Barrackpore, India. A well-marked case of this affection came under my notice a short time ago, and as I had an opportunity of photographing the legs during life and the bones after death, I thought a short account of it migh t interest the readers of this Journal. The case was a country-bred chestnut pony mare, aged, height about 13 hands 3 inches. The owner, an artillery officer in this station, had purchased her about a year previous to the time I saw
CLINICAL ARTICLES.
her. At the time of purchase the fetlocks were both rather enlarged and round, but she was going quite sound. He had her examined, and the veterinary surgeon told him that there was a doubt about the fetlocks; she might keep sound, but the condition might get worse. A few months after purchase the enlargement increased, and her gait got stiffer and stiffer. Various applications were tried, and, in addition, she was blistered twice. The condition gradually got worse, and when I saw her first the appearance of the fetlocks was such as is seen in the photo. She was very lame at a trot. slightly worse on the off fore, her action being peculiarly (( proppy," just as one might expect from almost rigid fetlocks. She made rather a good canter-in fact at that time the owner was playing polo on her regularly. Examination showed practically entire loss of power of flexion of the fetlock
joints, and attempts at flexion were greatly resented as being very painful. I recommended forcible flexion, and accordingly had her cast and chloroformed, and then flexed the joint until I could get the pastern at right angles to the cannon. The noise made by the snapping of adhesions was very marked. Both fetlocks were flexed in this way. After the operation, when she was permitted to get up, a cotton wool pressure bandage was applied to both joints, in order to prevent any effusion that might take place from the ruptured and strained adhesions. Next day there was considerable improvement in going. Systematic daily flexion was then carried out. A fortnight later she was again cast, chloroformed, and the fetlocks flexed, and this was repeated ten days later. After each operation temporary improvement resulted, but this was not maintained, the joints gradually stiffening again. After the failure of the flexion treatment, I decided to perform neurotomy. The reason for this decision was that I had seen a case similar to this some time previously, in which both fetlocks were quite 2 B
CLINICAL ARTICLES.
rigid, but it was performing its regular work, and beyond a little stiffness in trotting no exception could be taken to its paces. So I came to the conclusion that in these cases lameness is more the result of pain than of mechanical interference. I therefore performed plantar neurotomy on both forc. I regret very much that I did not perform median neurotomy, as I consider it would have been a good case for this operation. However, she derived considerable benefit irom this, most of the intense lameness disappearing, and she did her ordinary work for some months. The owner then, having got six months leave, decided to have her destroyed. The bones were mounted by Farrier-Sergeant T. Gill, and I photographed them. The photo shows the front aspect of the off fore and the back of the ncar fore leg. It will be seen that the lower portion
of the metacarpal bone and the upper portion of the os suffraginis are thickly covered with ossific deposit. This deposit extends upwards as far as the bulbs of the splint bones, which are also involved. The articular faces of the joint were free from the deposit. Since the above was written The Veterinary Retord of 2nd October 1897 has come to hand, in which there is a case reported by Vet.Major Joshua Nunn, entitled "Fibrous Ankylosis of the Fetlock Joint." From what I can gather, his case is similar to the one I have just described, but his was not in nearly so advanced a condition. I think the photograph of the bones may help to throw some light on the pathological conditions of the part, about which he does not venture an opinion. Some details as to the further progress of his case would be interesting, as my experience with the flexion treatment of lameness in the fetlock is that beneficial results are often obtained temporarily, but are very seldom of any permanence.