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Septic osteitis of the distal phalanx in foals: 22 cases (1995–2002)

Kirsten M. Neil BVSc, MS, DACVIM1, Jane E. Axon BVSc, DACVIM2, Paddy G. Todhunter BVSc, MS, DACVS3, Paul L. Adams BVSc4, John P. Caron DVM, MVSc, DACVS5, and Angus R. Adkins BVSc6
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  • 1 Scone Veterinary Hospital, 106 Liverpool St, Scone, NSW 2337, Australia
  • | 2 Scone Veterinary Hospital, 106 Liverpool St, Scone, NSW 2337, Australia
  • | 3 Scone Veterinary Hospital, 106 Liverpool St, Scone, NSW 2337, Australia
  • | 4 Scone Veterinary Hospital, 106 Liverpool St, Scone, NSW 2337, Australia
  • | 5 Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI 48824-1314
  • | 6 Scone Veterinary Hospital, 106 Liverpool St, Scone, NSW 2337, Australia

Abstract

Objective—To determine the clinical characteristics and outcome of foals with septic osteitis of the distal phalanx.

Design—Retrospective case series.

Animals—22 foals.

Procedures—Information obtained from medical records included signalment; clinical, laboratory, and radiographic findings; treatment method; and outcome. Foals included in the study had lameness referable to the foot, radiographic evidence of localized lysis or focal loss of bone density of the distal phalanx, and suppurative discharge or necrosis of the affected bone evident at surgery. Foals with a history or evidence of penetrating wounds or subsolar abscessation were excluded.

Results—Mean age of foals at initial evaluation was 40.8 days (range, 3 to 122 days). Twenty-one (95%) foals had lameness as the primary complaint. Lesions consistent with septic osteitis of the distal phalanx localized to specific areas of the bone on the basis of radiographic and surgical findings were located on the solar margin or toe (14/22 [64%]), extensor process (5/22 [23%]), and palmar or plantar process (3/22 [13%]). Hind limbs (18/26 [69%] affected limbs) were more frequently affected. Two foals had > 1 affected limb, 2 had additional sites of osteomyelitis, and 4 had concurrent septic arthritis. Surgical debridement and regional antimicrobial perfusion were performed during general anesthesia. Extensor process lesions were not debrided. Nineteen of 22 (86%) foals survived to be discharged from hospital, and 16 horses reached racing age. Eleven of 16 had race starts, of which 8 had official race starts and 3 had unofficial race starts.

Conclusions and Clinical Relevance—Septic osteitis of the distal phalanx should be considered as a source of lameness in foals with signs referable to the foot and does not necessarily preclude a career in racing. Although infection may occur secondary to bacterial penetration of the hoof or sole, the distal phalanx should also be considered as a potential site for hematogenous septic arthritis or osteomyelitis in foals.

Abstract

Objective—To determine the clinical characteristics and outcome of foals with septic osteitis of the distal phalanx.

Design—Retrospective case series.

Animals—22 foals.

Procedures—Information obtained from medical records included signalment; clinical, laboratory, and radiographic findings; treatment method; and outcome. Foals included in the study had lameness referable to the foot, radiographic evidence of localized lysis or focal loss of bone density of the distal phalanx, and suppurative discharge or necrosis of the affected bone evident at surgery. Foals with a history or evidence of penetrating wounds or subsolar abscessation were excluded.

Results—Mean age of foals at initial evaluation was 40.8 days (range, 3 to 122 days). Twenty-one (95%) foals had lameness as the primary complaint. Lesions consistent with septic osteitis of the distal phalanx localized to specific areas of the bone on the basis of radiographic and surgical findings were located on the solar margin or toe (14/22 [64%]), extensor process (5/22 [23%]), and palmar or plantar process (3/22 [13%]). Hind limbs (18/26 [69%] affected limbs) were more frequently affected. Two foals had > 1 affected limb, 2 had additional sites of osteomyelitis, and 4 had concurrent septic arthritis. Surgical debridement and regional antimicrobial perfusion were performed during general anesthesia. Extensor process lesions were not debrided. Nineteen of 22 (86%) foals survived to be discharged from hospital, and 16 horses reached racing age. Eleven of 16 had race starts, of which 8 had official race starts and 3 had unofficial race starts.

Conclusions and Clinical Relevance—Septic osteitis of the distal phalanx should be considered as a source of lameness in foals with signs referable to the foot and does not necessarily preclude a career in racing. Although infection may occur secondary to bacterial penetration of the hoof or sole, the distal phalanx should also be considered as a potential site for hematogenous septic arthritis or osteomyelitis in foals.

Contributor Notes

Dr. Neil's present address is Goulburn Valley Equine Hospital, 905 Goulburn Valley Hwy, Congupna, VIC 3632, Australia.

Dr. Todhunter's present address is Newcastle Equine Center, Broadmeadow Racecourse, Darling St, Broadmeadow, NSW 2292, Australia.

Presented at the 13th Annual American College of Veterinary Surgeon Symposium, Washington, DC, October 2003.

The authors thank Dr. Lori Bidwell for artistic assistance.

Address correspondence to Dr. Neil.