Exam 1: Management of Septic arthritis and cellulitis in the horse

goals of therapy for septic arthritis, cellulitis, myositis (all emergencies)

• eliminate infection

• limit inflammation and tissue degrading enzymes

• preserve structure and function of the tissue affected

• pain management

two major treatment aspects of saptic arthritis

• joint lavage 

• arthroscopy 

arthroscopy for septic arthritis 

• gold standard 

• removal of fibrin and debris 

• evaluation of joint surface 

• debridement of cartilage damage if present 

• improved lavage vs needle through and through 

irrigation solution for septic arthritis 

• balanced electrolyte solute 

• large volumes- foals 500-2000 mls, adults 1-5L 

• pressure using syringe, pressure bag, fluid pump 

• no disinfectants 

• number and frequency of lavage will be dictated by case progression 

abscess drainage and fenestration

• microabscesses can be difficult to drain and abscesses may need time to mature

• fenestration to increase oxygenation, therefore important when treating clostridial myositis

• streetnail procedure in horses with septic navicular bursititis from solar puncture

routs of abx for septic conditiosn

• systemic

• IV rehional limb perfusion

• intra-articular/synovial

• topical

systemic antibiotics for septic conditions 

• judicious use of systemics strongly recommended

• broad spectrum bactericidal are ideal- mild cases use local only 

• cultre wen possible

important information for picking a broad spectrum systemic abx 

• gentamicin may not penetrate abscesses very well, so if not improving consider alternative 

• excede does not get high enough 

• clostridial myositis= double dose penicillin 

• c. pseudotuberculosis = penicillin, TMPS or doxy if oral needed 

describe regional limb perfusion

• eshmar tourniquet

• 21g butterfly

• abs diluted in 60cc saline

• after administered leave tourniquet for 20 min

regional perfusion tips

• use wide rupper torniquet

• dont mix abx

• consider the use of carbocaine with amikacin

• consider 2g amikacin

• use large volumes of dilute

• tourinquite could be removed within 15-20min

• apply surpass to vein after RLP to minimize swelling

pain management for septic conditions 

• multimodal may be necessary 

• NSAIDs most common 

• acteaminophen 

• butorphanol, morphine 

• gabapentin 

dosages for caudal epidurals

• 0.2 mg/kg morphine

• 0.03 mg/kg detomidine

• 20ml saline

bandaging for septic arthritis

• typically indicated if one can be applied t decrease periartcular swelling and protect further introduction of bacteria

bandaging with cellulitis 

• pressure bandage 

• sweat wrap- nitrofurazone and or DMSA replace q24 

• stacking of bandage when entire limb is affected 

• remove bandage and let gravity allow swelling to settle 

Kerlix polyhexamethyene biguanide antimicrobial bandaging

• similar to chlorhexidine, more biocompatible

• wide antimicrobial range preventing penetration to wound and colonization within the dressing

• gauze 4×4 or roll

silver dressings

silver ions damage and disrupt bacterial cell walls and denaturng RNA and DNA

manuka honey dressings 

• antimicrobial effects via osmosis and non-peroxide properties of unique manuka factor 

• breakdown biofilms 

hyperbaric oxygen therapy

• facilitates killing oc anaerobic bacteria such as clostridium

• high oxyen concentrations under pressure forces more oxygen into tissues, encouraging new vascular formation

vascular therpies for septic conditions

• rheological agent, non specific phosphodiesterase inhibitior that increases RBC deformability, thereby improving capillary blood flow

• Clopidogrel- decreases platelet aggregation, potential use to inhibit thrombus formation

adjunctive therapies for septic conditions 

• laser therapy 

• hydrotherapy 

• pressure cold therapy 

• accupuncture 

• wound vacuum therapy 

• ozone therapy 

• medical maggots 

laminitis preventatives

• cryotherapy

• contralateral limb support

• heavy bedding

• support bandages

• sling

supportive therapy

• IV fluids

• anti-endotoxic therapies

• deep bedding

• wound management and fly control

• isolation if C. pseudotuberculosis

rest and rehab 

• allow time for healing, time to decrease swelling and inflammation 

• range of motion exercises- helpful for joints in particularly, decreased joint capsule thickening, decreased adhesion formation 

• gradual return to work in weeks to months

follow up therapy for septic arthritis

• hyalyronic acid IV then IA

• PSGAG IM,

• NO IA CORTS

• IRAP once infection clears

monitoring response to therapy

• improvement of lameness/swelling

• decrease in swelliing of affected tissues

• resolving drainage

• resolving fever

  • decrease in SAA or improvement of CBC

how long to treat septic conditions 

• systeic abx = 5 days IV, 2-4wks oral 

• regional abx = 1-4 avg treatments 

complications for septic MS conditions

• chronic lameness

• inability to perform

• antimicrobial or stress colitis

• laminitis

• infection of deeper structures

• thrombophlebitis

• colic

• gastric ulcers

• death

septic arthrits/tenosynovitis complications

• osteoarthritis

• adveshions within sheath or bursa

• angular limb deformities in doals

• support limb laminitis \

septic cellulitis complications

• skin sloughing 

• hoof sloughing 

• support limb laminitis 

• recurrence 

• chronic lymphodema 

septic arthritis prognosis

• foals= fair to guarded

• \adults good to fair if treated early ad aggressively

• septic tenosynovitis and bursitis= carries a more guarded prognosis

prognosis septic cellulitis and myositis

• cellulitis mild = good, severe = guarded

• clostridial myositis= guarded

• suppurative myositis = fair