Fractures in the Horse. Группа авторов

in ‘The History of Animals’ introduced the concept of gaits. An ancient Greek treatise called the Mulomedicina Chironis has been ascribed to a healer Chiron. There is evidence that this was a real person circa 700 BCE, but confusion is produced by later elevation to the mythologic status of centaur.

      In paleopathologic investigations, three healed metacarpal bone fractures dating from the Iron Age (800 BCE–43 CE) have been found in different parts of Europe [3]. These included a compound fracture of what was considered most likely a working mare buried in a human cemetery of the fourth to seventh century BCE at Sindos, Greek Macedonia. The bone was markedly distorted but the animal is thought to have survived for at least three to four years after the injury, and it was suggested that this lame mare may have pulled her ‘loving owner's’ cart to the grave before being sacrificed and laid next to him [4]. A rib fracture in a horse from the Roman Imperial period (27 BCE–284 CE) was found at a site near Seinstedt, Germany [5]. The same group reported a ‘neatly healed’ fractured third metatarsal bone in a horse from the Iron Age sacrificial site of Skeddemosse, Sweden [6], and a fractured metacarpus from a similar period was found in a horse at Tiel‐Passewaaij, the Netherlands [7].

According to Harcourt [cited in 8], an archeologic study of the Roman site of Tripontium, England, found a healed fractured humerus in a horse although there was no evidence to indicate intervention. The paucity of healed fractures in large animals was considered direct evidence of the associated bad prognoses [3]. No archeologic evidence of therapeutic intervention during this period has been found [7, 9]. The possibility had been suggested in a healed metacarpal of an Iron Age horse from Manching [10]. However, the specimen had a complicated fracture that healed with ‘distortion of the bone and development of an enormous callus’, which appears to make this tenuous.

      The writings of Hippocrates (considered the father of medicine) in the fourth to fifth century BCE included a text ‘De Fracturis’, which is the first known treatise devoted to the subject. The Hippiatrika, a text compiled in the fifth or sixth century CE, was a compilation of extracts of Greek technical literature on the care and healing of horses. This included a contribution from Apsyrtus, a ‘well‐known horse specialist’ from the fourth century CE [10], who was of the opinion that ‘all fractures below the knee have a good chance of healing’. Later manuscripts published as Hippiatria (1531) or Hippiatrica (1543) also cite Apsyrtus treating fractures below the knee with splints and bandages with cures expected in about 40 days (which must question the diagnosis), while fractures above the knee were considered incurable [11].

      The Romans appeared to document little in veterinary medicine until the end of their Western empire when the Byzantine Publius Vegetius (circa 450–500 CE) recognized that diseases of the horse were similar to those suffered by men. Vegetius is often considered the first to have documented hippiatric beliefs and practices. These were almost certainly preceded but records are lacking.

      Middle Ages/Mediaeval Period

      Throughout the Middle Ages (circa 500–1500 CE), horses continued to play a major role in warfare with increasing numbers employed in agriculture and transport. In the early Middle Ages, Western medicine in general was dominated by religious (Christian) doctrine; science in the currently accepted sense was neither considered nor applied. Further discussion on fractures is found in republications of the ancient works of Chiron the Centaur (circa 400 CE) and Vegetius Ranatus (450–500 CE). The latter was translated from Latin to English in 1748 as ‘Distempers of Horses’ and includes a chapter (two pages) on fractures. Open limb fractures were recognized as ‘almost incurable’. For closed fractures, bandages, splints and slings were recommended. The latter fitted so that the horse ‘may not touch the ground with his foot, lest the fracture should move to and fro in a lamentable manner’. Vengetius Ranatus instructed that the horse must not be allowed to stand on the fractured limb for 40 days ‘for that is the time when things that are broken, or torn asunder, or disjoined, are consolidated’ [11].

      The Mamluks, who ruled Egypt and Syria between 1250 and 1517, are thought to have used orthopaedic bandages containing resins from Boswellia plants and pitch from cedar and tannűb trees to heal broken bones in horses [12]. There is also iconographic evidence of care of horses with fractures: binding a fractured metacarpus in a horse suspended in a sling is illustrated in Mending the fractured metacarpal of the horse (1390) from Libro de menescalcia e de albeyteria et fisica de las bestias (a Spanish text from the Middle Ages) and in the fifteenth‐century work of Johan Alvares de salami Ella's. A fractured pelvis from the fourteenth to sixteenth century was recovered from the Cumanian settlement of Karcag‐Organdaszentmiklós, Hungary. The fracture involved the ilial shaft and was displaced, but there was sufficient adjacent new bone to suggest that this was of multiple months’ duration during which period the horse was considered to have been ‘immobilized’ [13].

      The Renaissance/Reformation

      From a medical/scientific perspective, the Middle Ages may be considered to have ended with the introduction of mechanical printing at the end of the fifteenth century. ‘Proprytes and medicynes of hors’ was thought to be first printed in 1497 or 1498. This was followed by ‘Medicines for Horses’ somewhere between 1510 and 1560. There are no ascribed authors to either. However, such texts made little comment on traumatology, concentrating on remedies, topical applications, bloodletting and similar (now considered illogical) insults [1].

      Equine fractures were mentioned by a French author Rusius in 1559 and Thomas Blundeville, an English mathematician (who invented the protractor), in The fower chiefyst offices belonging to Horsemanshippe published in 1565 described fractures as a form of ‘evil’ that, in common with wounds and ulcers, causes a ‘loosening or division of the unity’ [14]. Gervase Markham made comment on veterinary matters in books commencing with ‘A Discourse of Horsemanshippe’ in 1593. This was followed by Thomas De Grey's ‘The Compleat Horse‐man and Expert Farrier’ in 1639 and ‘The Anatomy of a Horse’ by A. Snape in 1674.

      The Enlightenment and Industrial Revolution

      Reference to anaesthesia and analgesia (albeit not in such terms) occurs in a series of experiments in the 1650s and 1660s when animals were injected with a solution of opium [A H Machle 1998 cited in 1].

The concept of musculoskeletal biomechanics appears in print in the mid‐seventeenth century when individuals like the physician Giovanni Alfonso Benelli (1608–1679) applied the concepts of physics and mechanics, thus viewing bones and joints as levers. Further reference is made in ‘The Compleat Horseman’ [15], a 1702 translation by Sir William Hope of ‘Le Parfait Marschal’ by Jacques de Solleysel. Of note is the absence, to this time, of veterinarians. Solleysel is said to have combined riding school training with veterinary practice (largely performed by farriers). It was not until 1762 that Claude Bourgelat founded the first veterinary college in Lyon. W. Gibson in ‘The Farriers New Guide’ published in London in 1722 noted that although broken bones might be corrected, a horse that had a fracture ‘with a large wound in the flesh’ was unlikely to recover satisfactorily. In 1766, von Suid described a sling system designed to prevent horses from lying down and reported healing of 10 horses with fractures of distal bones.

      Youatt (1843) in the ‘Fractures’ chapter of ‘The Horse’ [16] stated that ‘Accidents of this description are not of frequent occurrence but when they do happen it is not always that the mischief can be repaired: occasionally, however and much more frequently than is generally imagined, the life of a valuable animal might be saved if the owner, or the veterinary surgeon would take a little trouble’ [17]. This concept was reinforced by Williams (1893) [18] who noted that ‘a ridiculous idea has prevailed amongst horsemen that fractured bones never unite. This is incorrect … provided that fractured ends can be kept at rest.’ Both authors placed great emphasis on the use of slings, but splints of green wood [16] and leather [18] are also described.

      Clater's ‘Every Man His Own Farrier’ (1853) [19] suggested that ‘a horse is often condemned without cause, on account of fracture of the bones of the fore‐legs: either the practitioner dislikes the trouble of the case, or the proprietor is loath