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 to make the proper remuneration. There is but one circumstance that would justify the abandonment of a horse with fractured leg, and that is it being a compound fracture, i.e. the integument and muscular parts being lacerated; then, indeed the case is hopeless. The cure of a fracture of the pastern or the shank bone may be undertaken with a fair prospect of success. All that is to be done is to cut the hair closely from the parts; to bring, – and as gently as may be, – the divided edges of the bone in apposition; to retain them there by a pitch plaister; and then to bind on splints, which shall reach a considerable way above and below the injured part. This should be done in the box in which it is intended that the horse should remain. He should be bled, and a dose of physic should be given to keep down inflammation, and then he should be left to himself. He will take care of his broken leg; he will not press upon it for many a day; and not at all, until he can do so without much pain: and, in many more cases than some have imagined, the fractured bone will unite, and the horse will do well. A sling should rarely, I would say almost never, be used. The sad excoriations, and other inconveniences occasioned by the long use of a sling, have, more than anything else, brought the treatment of fractures into disrepute. The horse does not like pain, and will generally take all the care of his injured limb that we could wish him to take. Fractures of the hind extremities are more serious affairs, and should be undertaken with caution.’
Fitzwygram (1869) [20] described bone structure, as far as it was understood, and gave a rudimentary classification of fractures. The following paragraphs provide a summary that endured. ‘In the human subject, the treatment of broken bones is comparatively easy, because the patient can be placed without difficulty or opposition on his part on his back in bed, the position most favourable for relieving the broken limb of all weight and pressure. Whilst in this position splints and other restraints can be conveniently imposed, and the patient is blessed with sense enough to induce him to submit to such restraints and to remain quiet. In the horse, we have none of these advantages. We cannot without hurtful violence throw the animal on his back, nor can we by any persuasion induce him voluntarily to remain in that position. Hence fractures of important bones are generally incurable. In most cases therefore of such injuries it is better to have the animal destroyed at once. Again the horse is an animal, whose value as a general rule consists in his power of locomotion. In man on the other hand the surgeon, though he may not be able to make a perfect cure, is often well content, if he can produce such re‐union of the bones, as may enable the patient, in case of broken leg for instance, to walk about. A horse is of no value, unless he can walk, trot and gallop sound and level. An exception however to this general rule occurs in the case of valuable brood mares or stallions.’
Fitzwygram [20] also understood the concepts of monotonic and fatigue (cumulative stress/strain imbalance) fractures, and described fractures caused either by violence to the bone or from excessive strain. Diagnosis was entirely clinical. Treatment objectives were reported as ‘setting’, i.e. the bringing together of the broken ends and when the bones were ‘thus adjusted … to keep them in their place’, which was described as ‘a very difficult matter and needs expertise and ingenuity’ which is equally applicable today. Splints padded with tow (flax or hemp), bandages and strips of adhesive plaster were described. The starch bandage, which had been in human use since Roman times (reported by Celsus in 30 CE), was considered particularly useful and could be stiffened with an external wooden splint. It was also suggested that in some cases the horse may be slung with a view of taking the weight off the part affected.
In 1884, Smith [21] reported sling management of horse, which was non‐weight‐bearing on a hindlimb and which subsequently (at post‐mortem) was found to have an axial fracture of the lateral condyle of the femur. The first surgical repair of an equine fracture appears to be in 1891 when Prieur [cited in 22] referred to repair of an equine jaw fracture with a drilled wire suture in Cairo, Egypt.
Around 1800, William Eton [23] described the creation of a gypsum (calcium sulphate) plaster mould to immobilize fractured legs that he had observed in Turkey. First documented use in man is attributed to a Dutch surgeon Antonius Mathijsen in 1852 and it was adopted into military service in the 1850s during the Crimean War by a Russian surgeon Nikolai Pirogor (1810–1881). The earliest reference to attempted use of plaster of Paris in horses was in 1872 [24], although it was not recommended. However, in 1883 plaster of Paris splints were described as a successful method of fracture management [25].
Near the end of the century, one of the first identifiable movements to reduce the incidence of fractures in horses was the 1889 formation of the Horse Accident Prevention Society (Slippery Roads), which campaigned against asphalt road surfaces.
The Twentieth and Twenty‐first Centuries
