COSTAL SINUS. 475 



in the voice. Recovery occurred in six weeks. When the skin is 

 perforated the broken fragments can often be directly seen. Dogs 

 with multiple fractures of the ribs usually show more pronounced 

 disturbance, especially if many ribs are broken. The severity of 

 the symptoms increases with the number of ribs broken and the 

 degree of displacement. 



Treatment in simple and partial fractures consists in keeping 

 the animal quiet, and guarding it against work and movement. 

 Even in complicated fractures, with injury of the pleura and lungs, 

 nothing further may be necessary. Reduction in such cases is 

 difficult. If the skin be broken, fragments of bone dislocated inwardly 

 may be replaced by pushing a finger or hook under the anterior border 

 of the rib, thus avoiding the vessel and nerve which pass down the 

 posterior border. Antiseptic precautions should be observed, and 

 a dressing with roller bandage afterwards applied to guard the 

 wound against infection. Injury of the skin greatly increases danger, 

 and under no circumstances should a wound be artificially produced 

 for the object of reposition ; it is much better to adopt an expectant 

 treatment. Charpentier and Lafourcade, in 100 slaughtered swine 

 found 15 with united fracture of the ribs, 10 without further injury, 

 5 with adhesion of the lungs, and 3 with pleuritic thickening. Cases 

 of one broken rib were rare ; and two or three were usually affected. 

 The fracture occurred in the middle of the rib or in its lower portion. 

 According to Stockfleth, the first ribs seem specially prone to break 

 at their upper end. 



II.— COSTAL SINUS. 



Chronic inflammatory processes in the thoracic wall, with sinus 

 formation, are more frequent in horses than in other animals. They 

 result from necrosis of one or more ribs due to direct injuries or to 

 cellulitis, occasionally to extension of infection in fistulous withers, 

 or the formation of a strangles abscess. When depending on necrosis 

 of bone, the sequestrum, if allowed to remain, causes chronic in- 

 flammation, with pus formation and thickening of the ribs and of 

 their surroundings, which may persist for months and even years. 

 The condition seldom leads to pleurisy, the fascia endothoracica 

 and pleura becoming thickened, and preventing complication. 



The symptoms consist in a swelling more or less diffused, seldom 

 sharply defined, but hard and firm, without evidence of acute in- 

 flammation. A narrow opening exists in the centre of the swelling, 

 and a probe passed through this is arrested by the hard, rough surface 



