108 PARTICULAR FRACTURES. 



be possible to do this without trephining or removing any sound 

 portion), the wound must be closed, and the most strict anti- 

 phlogistic treatment pursued, both to prevent inflammation and 

 to subdue it in case of its occurrence. 



4. Com'pcyiind or Open Fracture with Depression, is the most 

 common form met with in our patients ; a force strong enough 

 to break the bones being sufficient to drive in the soft parts also. 



There is a wide difference of opinion amongst surgical writers 

 as to the necessity of immediately elevating the depressed 

 bone in this form of fracture, — Sir Astley Cooper, Sir B. Brodie, 

 and others laying it down as a law that trephining must be 

 performed as soon as possible, it being useless to do so when 

 inflammation is once established. On the other hand. Professor 

 Samuel Cooper, Sir Philip Crampton, Dease, and Desault main- 

 tain that in fractures of the skull with depression, whether it be 

 compound or not, no attempt should be made to elevate the 

 depressed bone, unless very decided symptoms be present of 

 compression or irritation of the brain ; and that they have seen 

 Qiany cases terminate favourably without the use of the trephine. 



I think that in all such cases, whether there be symptoms of 

 compression or not, the veterinary surgeon should not hesitate 

 to elevate the depressed bone at once ; by not doing so, he runs 

 the risk of losing his patient by the inflammatory process setting 

 in, when all chance will be gone. This is imperative where the 

 depression is exposed in consequence of a wound in the soft 

 parts, whether there be any signs of mischief to the brain or 

 not ; but if there be depression without wound, and no signs of 

 compression, let him make no such wound by operation. 



In ponies that work in coal-pits this is a very frequent form of 

 fracture, arising from the tunnels being made so low that the 

 animals are continually striking their heads against the roof. The 

 force of the blows is here merely strong enough to break the skin 

 and the surface of the bony crest. It is my opinion that in some 

 cases the detached pieces of bone result from the continual blows 

 producing necrosis. It is lamentable to think that these poor ani- 

 mals are worked from week to week, and month to month, without 

 an effort being made to prevent or cure such injuries. I have 

 seen the skin of the forelock detached for several inches — easily 

 raised up as a flap — swollen, inflamed, with an ugly, unhealthy 

 wound underneath it, containing several pieces of necrosed bone, 



