46TH
ANNUAL
CONGRESS
OF
THE
SAEVA
SKUKUZA
16-‐20
FEBRUARY
2014
39
How to manage septic arthritis
caused by distal limb lacerations
Mahne A1*
1
Section Equine Surgery, Department of Companion Animal Clinical Studies, Faculty of Veterinary
Science, University of Pretoria, Onderstepoort 0110.
Distal limb lacerations are a common cause of septic arthritis (or septic
tenosynovitis) in the horse. This is a life threatening condition and necessitates
prompt diagnosis and early and aggressive treatment.
The following can aid in the diagnosis of synovial structure involvement in a distal
limb laceration:
•
•
•
•
•
•
Severe lameness (unless the joint is open causing leaking of synovial fluids)
Digital exploration of the wound, performed aseptically
Pressurising the wound from an arthrocentesis site as far away from the wound
as possible
Radiographs/Ultrasound/Scintigraphy
Synovial fluid analysis, evaluating colour, viscosity and cytology:
Normal joint fluid
Septic joint fluid
Nucleated Cell Count
(NCC)
% Neutrophils
< 1 x 109 cells/L
> 30 x 109 cells/L
< 10 % of nucleated
cells
> 80 % of nucleated
cells
Total protein
< 25 g/L
> 40 g/L
Bacterial culture (this takes too long to wait for the results before initiation of
therapy. Also, ~ 50 % of case with a septic joint will have a negative culture).
Treatment for cases of septic arthritis includes arthroscopic flush and debridement,
arthrotomy, through-and-through needle lavage (usuall y not very effective due to
fibrin in joint) and systemic and local antimicrobial therapy. Local antimicrobial
therapy includes regional limb perfusion, intra-articular antimicrobial injection and
intra-articular antimicrobial constant rate infusion.
Adult horses treated for septic arthritis has a fair prognosis for survival and a
guarded prognosis for return to an athletic career. Factors associated with a negative
outcome are involvement of tendon or bone, involvement of multiple synovial
structures, osteomyelitis and increased duration of clinical signs before initiation of
treatment.
39