Case Study: equine osteomyelitis of the navicular bone, septic navicular bursitis and septic tenosynovitis following a puncture wound

Submitted by:  Christine Bridges D.V.M., May 10, 2018

Clinical History:

Penny is a 20 year old Quarter Horse mare who developed osteomyelitis of the navicular bone, septic navicular bursitis and septic tenosynovitis following a puncture wound entering the navicular bursa through the sole of her left hind foot. The hoof was separating from the foot at both heel bulbs and there was a large open wound at the caudal aspect of the pastern involving the flexor tendons.   After a surgical consultation, the surgeon did not recommend surgery due to the grave prognosis and less than a 25 percent chance of a successful outcome. Despite the odds, the owner opted to pursue surgery.  Penny received multiple surgeries during the last week of January which included intra-articular lavages under general anesthesia and regional perfusions. At the time of discharge, Penny was still reluctant to bear weight on the limb and was sent home on oral enrofloxacin. 

Penny began CO2 treatments on February 13th.  At that time, she still was significantly lame, had obvious swelling of the pastern and the open wound on the caudal aspect of the pastern was discolored with focal areas of necrotic tissue.  She received 15 transdermal CO2 treatments from February 13th to March 7th.  Following a few treatments, a healthy pink bed of granulation tissue was present and the inflammation was reduced.  The wound then began to contract at a faster rate than I would have expected for that size and location. Penny began to bear more weight on the foot and after 2 weeks of CO2 treatments, she began to bear significant weight on that limb.  

On March 10th, Penny was reevaluated. 

Radiograph Findings:

The radiographs showed no signs of infection in the navicular bone, the wound over the flexor tendons had almost completely healed and she was bearing full weight on the limb. 

Conclusions:

It is my conclusion that the CO2  treatments had a direct effect on the shortened healing time of the tendon sheath wound and reduction of infection.  Through enhanced blood supply, the transdermal CO2 treatments had a remarkable effect on both infection and soft tissue healing

Penny, January 20, 2018

Penny, January 18, 2018

Penny, February 12 and 23, 2018

Penny, February 12 and 23, 2018