Treatment.—­During acute inflammation, absolute quiet is, of course, of first consideration.  Cold packs are to be kept in contact with the parts until acute inflammatory symptoms subside.  The fetlock region is then enveloped with a poultice or an iodin and glycerin combination (iodin one part to seven parts of glycerin) is applied and a dressing of cotton is kept in contact with the inflamed region.  Following this, a vesicant is employed and the subject is allowed a month’s rest.

In sub-acute cases, the entire region surrounding the pastern is blistered or the actual cautery is used.  Line-firing is preferable.  The subject is given a month or six weeks rest and one may be guided by the presence or absence of lameness as to whether improvement or recovery is taking place.

Old chronic cases, and particularly those where there are considerable induration and fibrous organization of tissue surrounding the joint, are not to be benefited by treatment.

The chief consideration in handling sesamoiditis is checking inflammation as early as possible and preventing, if this can be done, the erosion of articular surfaces.  If destruction of any part of the articular surfaces can be prevented and the patient allowed ample time for complete resolution of the affected parts to occur, permanent relief is possible.

Fracture of the Proximal Sesamoids.

Etiology and Occurrence.—­Fracture of the proximal sesamoid bones is caused by violent strain when there exists fragilitas osseum, or by contusions.  The author treated a case where fracture of one sesamoid was occasioned by a horse receiving a puncture wound wherein the sharp end of a steel bar was protruding from the ground where it was firmly embedded.  The subject in this case was injured while being driven along a country road.  Frost[23] reports simultaneous fracture of all of the proximal sesamoids occurring in a sixteen-year-old pony.  The condition is of rather common occurrence in some countries because of the fragile condition of horses’ bones.

Symptomatology.—­If the parts can be examined before extravasation of blood and swelling mask the condition, crepitation may be detected.  In other instances, it is possible to note a displacement of parts of the sesamoid bones—­this in horizontal fracture.  There occurs more or less descent of the fetlock which must not be attributed to rupture of the superficial flexor tendon (perforatus).  By outlining the course of this tendon with the fingers, when it is passively tensed sufficiently to follow its course, one may exclude rupture of the superficial flexor.  Finding the suspensory ligament intact from its origin to the sesamoid attachments, one may also eliminate rupture of this structure as a cause of the trouble.  Needless to say, marked lameness and swelling of the fetlock soon take place.  The condition is painful, and ordinarily, recovery is impossible.

Treatment.—­Where treatment is attempted, immobilization as in luxation is in order.  The patient’s comfort is sought, and if the fractured parts can be kept in close proximity, their union may occur in time.  However, chances for partial recovery (which is the best to be hoped for) are so remote that early destruction of the subject is the humane and economical thing to do.