equis - Articles
Navicular bursa: puncture
Synonym(s): Septic bursitis
Introduction
- Cause: traumatic penetration of navicular bursa usually via a solar penetration → infection within bursa → direct damage to navicular bone, deep digital flexor tendon.
- Signs: severe lameness Musculoskeletal: gait evaluation , puncture wound evident on frog or sole, draining wound above the heel.
- Diagnosis: foot paring Foot / shoe: examination , plain and positive contrast radiography Forelimb: radiography , centesis of the navicular bursa with cytology and culture/sensitivity of samples, intrasynovial anesthesia Forelimb: joint anesthesia of the navicular and/or distal interphalangeal joint may result in gait improvement, post mortem
.
- Differential:
- Septic P3 osteitis Distal phalanx: pedal osteitis - septic .
- Distal phalanx fracture Distal phalanx: fractures .
- Subsolar abscesses Foot: subsolar abscess / infection .
- Solar bruising Foot: sole bruising .
- Acute laminitis Foot: laminitis .
- Navicular bone fracture Navicular bone: syndrome .
- Severe soft tissue damage in the foot.
- Treatment: surgical drainage and removal of infected and necrotic debris.
- Prognosis: depends on extent of infection and duration before effective treatment:
- Fair if confined to bursa.
- Guarded if navicular bone and deep digital flexor tendon involved.
Presenting signs
- Single limb lameness.
Acute presentation
- Severe unilateral lameness in fore or hindlimb associated with penetration of sole of foot by sharp object usually in the middle third of the frog region.
Cost considerations
- Considerable costs involved in treatment, including one or more surgeries, long-term antibiotic treatment and loss of use of horse.
Special risks
- General risks of anesthesia.
Pathogenesis
Etiology
- Trauma: penetrating injury to the sole of the foot in an area centered on the middle third of the frog.
- Less commonly, hoof lacerations or avulsions may penetrate deep enough to involve the bursa.
Predisposing factors
General- Poor foot care.
- Wet, muddy conditions.
Specific
- Presence of sharp, hard foreign bodies, such as nails, in environment of horse.
Pathophysiology
- Penetrating injury to the sole → puncture wound to the navicular bursa → introduction of bacteria and foreign bodies → damage to palmar/plantar fibrocartilage of the navicular bone +/- puncture of the deep digital flexor tendon → septic arthritis of the distal interphalangeal joint +/- septic tenosynovitis Joint: septic arthritis - adult may occur at the time of penetration or, more rarely, by subsequent spread.
- The frog tissue being elastic in nature, usually seals over the puncture wound, preventing natural drainage and → infection build-up.
Timecourse
- Inflammation and pain within 24 h of injury.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Garcia E B et al (2014) Navicular bone osteomyelitis and navicular bursitis with associated fistula diagnosed with magnetic resonance fistulography in the horse. Equine Vet Educ 26 (1), 10-14 VetMedResource.
- Smith M R W (2013) Penetrating injuries of the foot. Equine Vet Educ 25 (9), 422-431 VetMedResource.
- Wright I M, Phillips T J and Walmsley J P (1999) Endoscopy of the navicular bursa. A new technique for the treatment of contaminated and septic burse. Equine Vet J 31 (1), 5-11 (detailed description of arthroscopic technique and outcomes in 16 cases) PubMed.
- Honnas C M et al (1995) Use of autogenous cancellous bone grafting in the treatment of septic navicular bursitis and distal sesamoid osteomyelitis in horses. JAVMA 206 (8), 1191-1194 PubMed.
- Whitehair K J et al (1992) Regional limb perfusion for antibiotic treatment of experimentally induced septic arthritis. Vet Surg 21 (5), 367-373 PubMed.
- Whitehair K J et al (1992) Regional limb perfusion with antibiotics in three horses. Vet Surg 21 (4), 286-292 PubMed.
- Markel M D et al (1985) Use of cancellous bone graft in treatment of navicular osteomyelitis in a foal. JAVMA 187, 278-280 PubMed.