Open Menu Close Menu Open Search Close Search Open Directory Close Directory
Equine Clinical Case Challenge: A Nail in the Road
History A four-year-old Quarter Horse gelding stepped on a nail, which entered the outer aspect of his right hind sole. Initial home treatments included daily ...
October 19, 2016

History
A four-year-old Quarter Horse gelding stepped on a nail, which entered the outer aspect of his right hind sole. Initial home treatments included daily foot soaks, phenylbutazone and a course of antibiotics. Unfortunately, the horse’s lameness returned despite his owner’s supportive and diligent home care.

What Would Be Your Differential Diagnosis?

Radiographs taken by the referring veterinarian showed a penetrating wound that was tracking to the navicular bursa, with a small volume of gas observed within the bursa. Contrast injection into the site of nail puncture confirmed a

The contrast material fills the navicular bursa.

The contrast material fills the navicular bursa.

communication of the wound with the navicular bursa. At that time, the gelding was referred to the Hospital for Large Animals at Cummings Veterinary  Medical Center. At the time of presentation, the horse was quite lame (4 out of 5) on the right hind leg.

What Would Be Your Next Steps?

Based on the available diagnostic findings, the patient was placed under general anesthesia for an arthroscopic examination of the right hind navicular bursa. At the time, a moderate amount of fibrinous material was removed. The wound tract was then thoroughly lavaged with saline using a high-pressure system and debrided. In addition, regional limb perfusion (RLP) was performed using the antibiotic Amikacin.

Treatment and Outcome
The gelding was hospitalized after surgery for continued broad spectrum intravenous antibiotic and anti-inflammatory therapy. Regional limb perfusion was performed at several time points following surgery with alternating antibiotic use. To further support the Quarter Horse during the healing process and to prevent further contamination of the wound, a foot cast was placed on the right hind limb. Following placement of the cast, he ambulated comfortably at the walk. Due to the care and support of the owners, referring veterinarian and clinical staff at the Hospital for Large Animals, the horse healed thoroughly, returning to athletic performance. [/accordion_panel] [/accordion]

Posted in: Uncategorized
Download as: