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Median neurectomy is of service in many instances where lameness is not completely relieved by the use of the actual cautery and no bad results attend the performance of this operation even though no benefit is derived thereby. Plantar neurectomy is contraindicated in all cases where there exists much lameness.
If lameness is due to acute inflammation bad results such as sloughing and loss of the hoof may follow; and if large exostoses mechanically interfere with function of the joint, or where articular erosions exist, no possible good can come from neurectomy.
In cases where no acute inflammatory condition exists, neurectomy is beneficial. One must discriminate, however, between favorable and unfavorable subjects. This is not a last resort expedient to be employed in cases where extensive lesions of the navicular structures exists.
In some cases median neurectomy is advisable. This is recommended by Breton as being productive of good results even where contraction of tendons exists and tenotomy is done. By shoeing with high heel-calks considerable strain is taken from the inflamed tendons because of the changed position of the foot which alters the distribution of weight on different parts of the leg.
Operative Treatment. This consists in the removal of the affected nerve or nerves, either by resection neurectomy; or by a combination of resection with twisting or tearing of the nerve from its central connections avulsion. To prevent the regeneration of the nerve after these operations, the canal of exit through the bone should be obliterated; this is best accomplished by a silver screw-nail driven home by an ordinary screw-driver (Charles H.
Neurectomy is not indicated even though there is a recurrence of lameness, unless the lameness is not pronounced and inflammation is periarticular and no osseous enlargements mechanically interfere with function of the joint. There are few cases then, where neurectomy is materially helpful. Ossification of the Cartilages of the Third Phalanx. Anatomy and Function of the Cartilages.
Nerve-grafting, as a supplementary operation to neurectomy, has been practiced, and Gersung has transplanted the nerves of lower animals to the nerve stumps of man. Bone-grafting is quite frequently practiced, portions from a recently amputated limb, or portions removed from living animals, or bone-chips, may be used. Senn proposed decalcified bone-plates to be used to fill in the gaps.
Careful discrimination should be employed in selecting cases for neurectomy for this operation; otherwise, it is very likely to prove disappointing. Open Sheath of the Flexors of the Phalanges.
In cases when slight and persistent lameness interferes sufficiently to prevent using an animal at any sort of work on hard roads, median neurectomy will relieve all lameness in most instances. This is a safe operation, moreover, in that no bad after effects are to be feared, even though lameness were to continue. Calk Wounds. Etiology and Occurrence.
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