Surgical Management of Septic Pedal Osteitis Katherine Miley 2022 Louisiana State University Signalment 9 year old quarter horse gelding History Presented on emergency with a fiveday history of acute ID: 931640
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2021 Student and New Graduate Case Study Competition
Surgical Management of Septic Pedal Osteitis
Katherine Miley, 2022 – Louisiana State University
Signalment
:
9 year old quarter horse geldingHistoryPresented on emergency with a five-day history of acute severe lameness of the right forelimb with no history of trauma. The right distal forelimb was soaked in Epsom salt and kept bandaged on the farm as a suspected abscess for four days with no improvement. The rDVM was consulted on day five. Radiographic findings indicated osteomyelitis of the right distal phalanx and the patient was referred for management. The rDVM performed regional analgesia of the medial and lateral palmar nerves in the right forelimb prior to transport. Additional pertinent history includes suspected subsolar abscessation 6 months prior to presentation with eruption and 2 months prior to presentation with no known eruption. The patient does not currently wear shoes. Presentation:Physical exam within normal limits and ambulation normal at the walk following regional analgesia by the rDVM.
Diagnostics:
Radiographs: (Figure 1) Focal area of osteolysis lateral to the solar notch of the distal phalanx with gas tracking to the solar margin of the right forelimb. Left forelimb distal phalanx unremarkable. Blood work: Creatinine (1.3mg/dL) PCV (30%) and TP (7g/dL) were evaluated and were within normal limits. Treatment: Antibiotics: Regional limb perfusion with 2g Amikacin diluted to 35mL in 0.9% sodium chloride q24h for 3d and 30mg/kg Trimethoprim sulfa PO q12h. Pain Management: 4.4mg/kg/d Phenylbutazone PO q12hr . Surgical: Debridement of the distal phalanx with curette under standing sedation and regional analgesia.Other: Clean bandaging changed daily with iodine gauze packing within solar defect once discharge resolved.Intraoperative findings:Mucopurulent pocket within draining tract, focal area of soft, necrotic bone.
Outcome: Intraoperative radiographs confirmed successful debridement of visible osteolytic lesion. 1 day post operatively the solar defect is clean with mild slightly malodorous discharge. Pain is being successfully managed with phenylbutazone. Ambulatory on all four limbs.Discharge Instructions:Keep foot clean and bandaged with stall rest for 4-6 weeks until defect is healed. Monitor for increased lameness or discomfort in other limbs. Follow up exam in two weeks with primary veterinarian.
Figure 1
Figure 2ab: Dr. Carrie Jacobs (right) guiding Katherine Miley (left) in performing (a) a regional limb perfusion and (b) surgical debridement.
Figure 3 [bottom right]: Mucopurulent discharge
(a)
(b)
Conclusion
:
Surgical debridement of septic pedal osteitis can be successfully performed under standing sedation with minimal equipment and may be useful for general practitioners in the field where referral is not available.
Client should be informed of husbandry requirements and duration of recovery.