CHAPTER III.. Apparatus of Locomotion.

APPARATUS OF LOCOMOTION.

The customary operations on the apparatus of locomotion are almost entirely confined to the feet. They consist in operations for sand crack, picked-up nail, stabs by nails and bruising of the sole, elsewhere mentioned. As they call for no special precautions they need not be further mentioned here.

SURGICAL DRESSING FOR A CLAW.

The surgical dressing necessitated by the operation for sand crack, picked-up nail, or injury to the heels is often very difficult to fix in the ox, and necessitates a support round the pastern. It can, however, be secured in the following way:

The seat of operation is covered with small antiseptic pads, which are also applied round the pastern and in the interdigital space. A bandage is then passed twice round the pastern and over the posterior two-thirds of the claw, as in fixing the dressing used after removal of the lateral cartilage in the horse. The bandage is then passed repeatedly round the pastern in an upward direction and tied above the interdigital space.

AMPUTATION OF THE CLAW OR OF THE TWO LAST PHALANGES.

It sometimes happens that certain grave diseases in the foot or pastern (stabs or picked-up nails, panaritium of the interdigital space, necrosis of the ends of the flexor tendons, etc.) are accompanied by necrosis of the bones, suppurative synovitis, and even suppurative arthritis of the second and first inter-phalangeal joints.

If carefully treated these forms of arthritis may disappear, leaving the joints anchylosed, but unfortunately the application of the necessary antiseptic injections (free injection with warm boiled water, injection of 10 per cent. iodised glycerine, 3 per cent. carbolic glycerine or ·1 per cent. sublimate) is difficult and costly.

It is better, in such cases, to remove the claw or the two last phalanges. With antiseptic precautions the stump heals, and recovery takes place without the interminable suppuration and pain which otherwise cause such grave loss of condition.

(1.) =Disarticulation of the Claw and Third Phalanx.=—The patient is cast and suitably fixed. The horn-secreting coronary band of the claw must be preserved.

=First stage.= The horny wall immediately beneath the coronary band is thoroughly thinned and the tissues are divided as far as the bone.

=Second stage.= Disarticulation: The tendon of the extensor pedis is divided and the joint opened. The claw is pressed backwards, and first the external and internal ligaments, then the flexor tendons of the phalanges, are divided.

This operation is of no great use, because, on account of the position of the joint and the arrangement of the articular surfaces, the end of the second phalanx extends beyond the line of section. To avoid complications, therefore, it is better to remove the lower extremity of the second phalanx, which, moreover, is always injured to a greater or less extent in cases of pedal arthritis. To effect this it is only necessary to draw back the flap of skin a little and rapidly divide the second phalange at its upper third with a fine saw. The points of section of the tendons and ligaments must be carefully examined, and if they exhibit necrosis should be further shortened.

The stump is enveloped in a surgical dressing fixed to the pastern.

=Amputation of the two First Phalanges.=—When necrosis is very serious and has extended a long way upwards, it is often better immediately to resort to amputation of the two last phalanges.

The region is first shaved and thoroughly cleansed. The coronary band of the claw is also preserved in this case.

=First stage.= The horn below the coronary band is thoroughly thinned and the tissues are divided as far as the bone.

=Second stage.= The skin covering the front of the limb is vertically incised from the lower third of the first phalanx (Fig. 298) to the coronary band; the skin is separated and external and internal flaps are formed.

=Third stage.= The extensor pedis tendon is divided, the first inter-phalangeal joint opened, the internal and external lateral ligaments are divided, the claw is pressed backwards, and the flexor tendons are also divided.

To facilitate disarticulation, and particularly to facilitate section of the lateral ligaments, the claw is rotated successively outwards and inwards.

According to circumstances, the lower extremity of the first phalange is either scraped or divided and the stumps of the tendons are carefully trimmed to a regular shape.

A surgical antiseptic dressing is applied over the whole of the seat of operation.

Several other methods of performing this operation will be found in Möller and Dollar’s “Regional Surgery,” pp. 831–835.