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  • The danger of small wounds

    Posted on by Abii Dowdy

    As a horse owner it is incredibly important to realise how serious small wounds can be, especially if located over a joint. A recent case treated at our clinic highlights this perfectly.

    A high-level competition horse had jumped well and was sound on leaving the showground, however by the time he was unloaded at home he was non-weight bearing on his left foreleg. On inspection there was a tiny wound less than half a centimetre in diameter over the front of his carpus (knee) with almost no blood present.

    His owner called us and within an hour we had assessed the wound by flushing it and probing for depth and radiographed the area to check for any bone pathology. The location of the wound over the carpal joints and the level of discomfort of the horse meant the vet was highly suspicious of involvement of the joint, therefore making the wound a lot more serious than it outwardly appeared. Joint involvement was assessed in two ways: by taking a sample of the fluid from each of the two carpal joints to be analysed for signs of infection, and instilling sterile saline into the joints to see if any fluid came out of the wound which would confirm communication between the wound and the joint. In this case, the joint fluid collected was more watery and blood contaminated than usual, suggesting a possible infection. No saline was noted coming from the wound when instilled into the joint, however if something has penetrated the joint and then been quickly removed e.g. a thorn, this can seal quickly and the communication is therefore no longer obvious. Antibiotics were instilled into both joints after the joint samples were obtained.

     

    One of the two joints that makes up the carpus had a very high white blood cell count, confirming that an infection was present within the joint. A joint infection is very painful as well as being potentially damaging to all the structures within the joint; if left untreated arthritis can occur secondary to joint damage or infection can extend to the surrounding bones causing an osteomyelitis (bone infection).

    Image from: A Guide to Equine Joint Injection and Regional Anesthesia .ook by James Schumacher, Jim Schumacher, John Schumacher, and William Moyer

    The sooner a joint infection is diagnosed and appropriate treatment started, the better the prognosis for return to full work. With this in mind, the horse was taken immediately to surgery at our Plum Park Clinic. Under general anaesthesia, 20 litres of sterile saline was flushed through the joint and an arthroscopic camera was used to assess any damage to the cartilage within the joint.

    By the next morning the horse was sound and comfortable with only three sutures present in his knee; one from the original wound and two where the keyhole instruments were placed during surgery. He remained hospitalised for 5 days post-operatively to receive injectable antibiotics, dressing changes and be closely monitored by our inpatient team. Intravenous regional perfusion of antibiotics was performed, which involves placing a tourniquet on the limb before injecting antibiotics into the cephalic vein, the main vein of the foreleg. This allows delivery of a high concentration of antibiotic to the affected region. This horse made an amazing recovery and was back in full work within 6 weeks.

    Please remember small wounds can be much more serious than they first appear and so if your horse sustains a full skin thickness wound, we recommend it being seen by a vet to check there is no association with any important underlying structures and to ensure the horse receives the best care possible.