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.

Age retards the process of osseous regeneration, but in one instance at the Kansas City Veterinary College, a very aged mare suffering from a multiple fracture of the first phalanx was treated and at the end of sixty days was able to walk into an ambulance.  Large exostoses had developed and the subject remained lame, but union of the broken bone took place in a surprisingly prompt and effective manner, when age of the subject and nature of the fracture are considered.