Bovine Septic Arthritis and Fractures

What is the difference in primary, secondary, and tertiary septic arthritis?

Primary: direct penetration of joint

Secondary: extension of infection from adjacent site

Tertiary: hematogenous infection of joint

What is the rarest type of septic arthritis?

Which is most common in adult cattle, especially the coffin joint?

Which is the most common cause in neonates (FPT + sepsis)?

Primary

Secondary

Tertiary

T/F: If bacteria is prolonged and left untreated, it can penetrate deeper and get into the structures of the coffin joint and adnexa.

True!

What are THREE major clinical signs of septic arthritis of the coffin joint and adnexa?

1. Swelling on ONE side of coronary band +/- draining tract if advanced

2. Fracture-like lame (unresponsive to abx)

3. Lateral toe abducted (DDFT rupture)

Septic arthritis can be a sequelae to what FIVE major conditions?

1. Septic interdigital fibroma

2. Penetrating sole wound

3. Subsolar abscess

4. Foot rot

5. Rusterholz ulcer

T/F: You might see severe subluxation or osteomyelitis in a radiograph with septic arthritis.

True!

What are the FIVE major treatment options for septic arthritis?

1. Nothing (cull that hoe)

2. Systemic abx alone (hardly work unless within 24 hours)

3. Lavage of joint (early cases)

4. Facilitated ankylosis/arthrodesis +/- abx

5. Digit amputation +/- abx

If performing facilitated ankylosis, it needs to be worthwhile and the animal must be valuable to justify time and expense. You should expect ——- weeks of care post-op.

8-12 weeks

T/F: Facilitated ankylosis involves using a 1/2 inch drill bit and curette joint cartilage followed by bandage and systemic antibiotics.

True!

T/F: The goal of facilitated ankylosis is to debride the infected synovial structures and bone and is considered a "salvage" of the infected digit to prolong life.

True!

What might be good to do to the contralateral limb in a facilitated ankylosis to relieve weight and pain?

Place a block

Facilitated ankylosis might be a good option for what animal?

Breeding bull

Septic arthritis usually involves the (medial/lateral) claw.

Lateral

What are the THREE major anesthesia options for a claw amputation?

1. Local infiltration

2. Regional nerves

3. Regional perfusion (Bier block)

Describe how to do a claw amputation like a first grader.

Pull skin flap proximally -> Gigli wire interdigital space -> transect distal P1 or mid P2 at 45 degree angle dorsally

T/F: Claw amputation aims to totally remove source of infection and serves as a long-term solution, although expensive.

False! Claw amputation aims to totally remove source of infection and is a SHORT-TERM SALVAGE OPTION.

Survival after claw amputation depends on what THREE things?

1. Claw affected

2. Animal weight

3. Amount of movement

Is septic or non-septic P3 fracture most common?

Non-septic (traumatic/acute)

Septic P3 fractures is usually a sequelae of what THREE things?

1. Sole ulcer

2. Puncture wound

3. Chronic foot infection (foot rot; less common cause)

How does treatment differ in non-septic vs septic P3 fractures? (THIS IS ON EXAM)

Non-septic: glue a block on other toe

Septic: amputate toe

What is the most common site for a P3 fracture with joint involvement?

Type II

What are THREE ways to diagnose a non-septic P3 fracture?

1. Mild-moderate coronary band swelling

2. Pain on hoof tester

3. Radiography

Claw amputation of a septic coffin bone fracture is NOT indicated is the infection involves what?

What other feature makes this contraindicated?

Fetlock joint

Affected contralateral claw

What should you do prior to amputation if the contralateral claw is also affected?

Apply block to other claw to ensure animal can walk on one claw before attempting amputation

T/F: For fracture management, an animal must be ambulatory on 3 legs.

True!

What kind of fractures have a poor to grave prognosis?

Open fracture (skin must be intact)

Lower limb fractures have a (good/poor/grave) prognosis.

Good

T/F: You should be able to immobilize a fracture both above and below the fracture for best success.

True!

The use of —- increases likelihood of treatment failure as animal more likely to use the injured limb excessively.

Analgesics

Name FOUR important principles for cast placement.

1. Do not clip hair -> protect skin

2. Appropriate amount of padding

3. Cover all bony prominences with felt

4. Write date on cast

T/F: As a general rule, you should always incorporate the foot into a cast.

True!

A half-limb or low-limb cast is best for immobilization of what TWO things?

1. Phalangeal fractures

2. Distal metacarpus or metatarsal physeal fractures

Name the FOUR major principles for half-limb or low-limb cast application

1. Immediately distal to carpus or hock

2. Extend to ground and encompass foot

3. Dewclaws and top of cast padded

4. Stockinette +/- padding

What is the most common fracture in calves?

Cannon bone fractures

Cannon bone fractures are usually —- in nature and the prognosis is ———-.

Closed

Very good

T/F: Metasplint, PVC splint, cast, or external fixator (rarely necessary) may be used in cannon bone fractures in calves.

True!

How long can a cast stay on a calf of the following ages: (ON EXAM)

Birth-4 weeks

1-3 months

3-6 months

>6 months

Birth-4 weeks: 2 weeks

1-3 months: 2-3 weeks

3-6 months: 4 weeks

>6 months: 6-8 weeks

In the forelimb of an adult with a cannon bone fracture, apply a full limb —- cast and remove it in —- weeks.

Then, —- weeks additional stall rest and —- months additional confinement to a small, flat paddock.

Fiberglass

6 weeks

2 weeks

3 months

Where should a cannon bone fracture in an adult be applied in a hindlimb?

Apply cast up to midtibia or stifle

A full-limb or high-limb cast involves the immobilization of what kind of fractures?

Distal to midradius or midtibia (still not always the best choice)

What are the FOUR major bony prominences you should cover in a full-limb or high-limb cast?

1. Accessory carpal

2. Styloid process of ulna

3. Calcaneus

4. Medial and lateral malleolus of tibia

Fractures distal to the elbow or stifle should be casted as (low/high) as possible.

Why?

High

May not provide sufficient stabilization (must stabilize above joint)

What splints are best in fractures distal to elbow/stifle in calves, adult cows, or adult bulls?

Calves: Thomas-Schroder Splint/Cast combo

Adult cows: Walker splint

Adult bulls: Walker splint

What precludes most fracture fixations in a fracture distal to the stifle in the adult cow?

Udder

The Walker splint is especially useful in —- fractures.

Tibial

T/F: Tibial fractures have a better prognosis than cannon bone fractures.

False! Tibial fractures do NOT have as good as prognosis as cannon bone fractures.

What THREE bones are most fractured in the upper limb?

1. Humerus

2. Scapula

3. Femur

T/F: The femur will heal, but it will not heal normally.

True!

What are the TWO non-surgical managements for a femur fracture?

1. Immediate slaughter

2. Stall rest 8-12 weeks -> 3 months additional confinement

Although surgical repair can be performed in upper limb fractures, why is it rarely seen?

Very expensive and high risk of infection