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  Discussion on Infection surrounding hock after trauma
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New Member:
Hrbdn

Posted on Monday, May 10, 2004 - 7:07 am:

I have a gelding that somehow got himself hurt in the trailer. The trauma consisted of a cut just below the point of the hock and another one inch below one the outside/rear cannon. This though his did have shipping boots on at the time. It was late at night so when unloaded I cleansed both wounds by scrubing with an iodine cleanser then rinsing and wrapping until the vet could come out the next day.
Initially though sore he would walk flat on the injured leg however he became infected by the third day and by the end of the first 7 days could not walk flat but used his toe. The culture on the infection came back staph and e coli. My vet put him on Baytril IV, bute, and eventually took him to her farm to manage the wound. Xrays showed a small chip below the point of the hock which has since been absorbed according to the latest xrays. A tendon sheath had become infected but my vet was able to clear that area up; the infection busted through the skin beside the tendon.
The horse was getting worse and it came to the point that he would hobble on three legs. He lost a lot of weight and had atrophied terribly. Thinking it was the chip and that it may need removal I moved him to another of our vets who runs a clinic and is set up for minor surgeries. When we arrived the front of the hock was quite swollen and the lowest leision still had yellow pus. He pressed on the front of the hock and a red fluid came streaming from the lowest(cannon)leision. He immediately filled a test tube for lab processing. Immediately making the assessment that the hock was ruptured and infected he then tapped and flushed the hock every other day for a week and a half. The test results returned a simple skin strep. Meanwhile swelling on the inside of the hock joint resulted in a blowout of infection. He switched the medication to Naxel and the horse seemed to improve. He was sent home with enough Naxel for 5 days; 15cc in the catheter.
Since home the gelding has gained at least 50 pounds if not more and is eating well. I have turned him out with a filly and he does roll and occassionally lope. However, there is still swelling with some heat and infection has begun to ooze from the pores surrounding the lesion where it had blown out the second time and in addition from the cannon lesion. I have been hosing using pressure to keep the would cleaned out and he has tolerated this quite well. In addition I be sure to cleanse and use the water to remove and debride the initial wounds as well. I am concerned at this point with the swelling and breaking of infection. I don't understand what I and or my vet needs to do. She believed it is cellulitis and will take a long time to heal. She has instructed me to continue as I have and that's all. I don't know if she will leave him on an antibiotic or not as his naxcel is now finished. She believes the hock capsuel itself was never infected until tapped.
Confused and wanting this horse to heal. What do you make of all this.
Member:
Nathalie

Posted on Monday, May 10, 2004 - 7:41 am:

Dear Dawn, My mare had a puncture wound in her hock joint a couple of years ago which was infected with E-coli as well. It took 4 or 5 months before we finally had the infection beat! NC state university sent her home with the suggestion to put her down since they only gave her 4% chance of ever becoming pasture sound again. Eventually we managed to clear the infection and she can even be ridden. I need to look up which antibiotic eventually cleared the infection. But has this infection cleared yet? I have a whole file on all treatments used so I can give you some idea's maybe. Hope I can help!
Member:
Nathalie

Posted on Monday, May 10, 2004 - 4:46 pm:

I have my folder here and try to understand all my notes (from '98) I believe the plan was to put her for 30 days on Baytril IV 25cc first 4 days 35cc. (Baytril was only just on the market then) This together with 14 days Amikacin 4cc (and 4cc Legend once a week). After this a treatment of Chloramphenicol orally 4 times a day 46cc, I can't remember how strong it was (pharmasist mixed it into a paste) I did find a note 23.75 (per doses) if this means anything. This for 14 more days. This cleared the whole infection! Before this treatment she was on: Oxytetracycline 25cc, Naxel I am sure there were more but they didn't do the job. Let me know if you need more details!
Moderator:
DrO

Posted on Monday, May 10, 2004 - 7:03 pm:

Hello Dawn,
How lame is the horse right now and are there any painful areas when you put light pressure on it.
DrO
Member:
Hrbdn

Posted on Friday, May 14, 2004 - 10:41 am:

Good Morning
Since my first post my horse became very lame and would only walk on his toe overnight which really suprised me. He had been off the Naxcel 2 days going on three by then. Though his entire hock is swollen, the oldest of the original lesions which is below the hock on the back of the cannon again began to spray fluid when I pressed on the front of the hock where there seemed to be a, almost like a roll of fat, which was evidently fluid. Since then, my vet has put him on Tucuprim(?) and debrided the bottom lesion where proudflesh was inhibiting free drainage. She also when into the side of the hock near where he had blown out infection as well as debrided the open lesion where it blew. We were able to press a lot of pus and fluid from that as well. He is most touchy where it blew out on the inside of his hock. However, he is touchy around the hole not in it. He will let me water and scrub the hole where it blew out but seems tender around it. That is where there is the hair loss as well. The bottom lesion where the infection migrated out can be scrubed vigorously as well. My current vet is concerned with the use of Naxcell and its side effects. However, he seemed to respond to that better. He will only walk on his toe this AM though he no longer has a fever of 102 which he seemed to develop 3 days post Naxcel. So to answer your question, only really painfull around that blow out area inside the hock where there is currently no hair. But I can scrub quite hard everywhere else.
Thanks
Member:
Hrbdn

Posted on Friday, May 14, 2004 - 10:52 am:

Nathalie,
Thank you very much for your information, I will give that to my vet. He had been on Baytril originally due to a culture which returned Staph and E Coli. That cleared up his tendon sheath but the infection just moved around to a different area. However the last culture only returned a simple skin strep. I need to ask the other vet who did that for a copy of the lab results and sensitivites as well as the original location of the culture and get it back to my vet. I know he took a test tube and filled it from the drainage of the lower legion but do not know if he sent in fluid from a joint tap. He was convinced the joint had ruptured and my local vet did not agree believing it to be under the skin but on top of that capsule. Anyway, hope to find out more today. There was no original damage to the joint capsule so this is very frustrating.
Thanks again
Dawn Brewer
Moderator:
DrO

Posted on Saturday, May 15, 2004 - 11:52 am:

The walking on the toe suggest to me the infection is around the flexor tendons as they are stretched when the heel is put down.
DrO
Member:
Hrbdn

Posted on Saturday, May 15, 2004 - 1:49 pm:

DrO,
My local vet is still not convinced of infection of the joint capsule itself but suggested that it is now a possiblility since the other vet tapped it. She too is getting quite frustrated and commented that it is healing almost too fast, that there is no where for the infection to drain efficiently and continues to back up around the hock. She did in fact clear up a tendon sheath infection, that going from the cap of the hock up to the hindquarters. There seems to be no problem there however the hair loss and swelling as well as the rupture of infection is located over the top of long bone on the inside of the hock. My vet and her husband who is also a vet at our local track are coming today to open that area up as it just keeps abcessing in and around that area. I am concerned that he is not getting enough Tucuprim via oral paste that I am mixing as he is off feed and would be more comfortable with another catheter. I think we need another culture today to be sure what bacteria we are dealing with at this point in time. My concern is that he remain on something long enough to get the infection completely out. I am facing quite a vet bill already for a gelding that can no longer compete in reining. But this horse is a pet as well and would like to see him healed and comfortable. He is great with babies (foals) and would like to have him as a turnout buddy. My husband suggests we put him down but I am not sure at what point that decision should be made considering he was loping on his own prior to removing him from the Naxcel just last Sunday. Any suggestions or comments? It would be greatly appreciated.
Thanks
Dawn Brewer
Moderator:
DrO

Posted on Sunday, May 16, 2004 - 7:46 am:

If a wound cannot drain properly antibiotics are of limited use Dawn, I think continued exploration and enhanced drainage sound like a good idea.
DrO
Member:
Hrbdn

Posted on Sunday, May 16, 2004 - 10:07 am:

DrO

Thank you. I believe both myself and my local vet are in agreement with you. The plan is to open it up and maybe put a drain in if possible. We are not working in a clinic environment but I have a lot of faith in my local vet. She will also put a catheter in making certain my gelding will get the full benefit of his antibiotics. We will culture as well. But I do have a question, what symptoms would lead to a hock infection diagnoses and is this still something we should be looking at and treating for in addition to the tendon area? I apologize for all the questions but I have been training reining horses for years now and have managed and worked a some very large barns. I not only have a very inquisitive nature (things need to make sense to me)but want to learn what I can to assure that proper care is administered as soon as possible in future events. You and I both know that there are good, not so good and excellent vets out there as in any other profession. I take great personal responsibility for making the proper decisions for both my animals and personnel.
Thanks
Dawn Brewer
Member:
Hrbdn

Posted on Sunday, May 16, 2004 - 5:34 pm:

DrO
My vet was just out and lanced the area that was beginning to break through. Not much pus in that. The vet then went in through the front of the hock and when flushed the fluid came out the hole that was lanced though it was fairly clear. My vet is now convinced that the hock capsule is infected and has burst. The vet said they had never seen one recover from one this bad and suggested putting him down. She said some tissues recover and others don't do so well due to blood flow. I am having a hard time with this and would be happy just to have him pasture sound. Can you advise?
Dawn
New Member:
Schorses

Posted on Sunday, May 16, 2004 - 6:08 pm:

Hi Dawn, I'm so sorry about your horse. Your situation sounds very close to what I went through with my newly purchased TB, 3 1/2 years ago. We came literally minutes away from putting him down. My horse had been on chloramphenicol (sp), antibiotic for several months and bute, to clear up a horrendous hock infection. He held his RH leg up for months and was nearly always 3-legged lame. Sometimes the bute helped and sometimes not. He was left with an atrophied right side and ulcers. Now, I am able to ride him, doing 1st and 2nd level dressage movements. He is an amazing horse! I was told by 2 vets to put him down and by 4 vets that he would only be a pasture ornament. The infection did affect the joint and by the looks of his x-rays, he shouldn't even be walking. It has been an emotional roller coaster and the vet bills were enormous. Thankfully, I have an understanding husband. Please e-mail me if you'd like. Maybe some of the experience I went through can help you and your horse. Scshiell@peoplepc.com
Moderator:
DrO

Posted on Monday, May 17, 2004 - 6:51 am:

Dawn, I continue to have a hard time picturing exactly what is going on because of the lack of specificity of exactly where the infection is and how much permanant damage has been done. The hock is a large complicated area made up of 4 joints and many soft tissue structures. Some of these joints can receive a large amount of trauma yet the horse will still come sound, others (tibiotarsal joint) are very sensitive. It is not clear from your posts what is infected where and how much permanant damage has been done.

If you want to pursure this further I think a referral to a equine hospital is in order but this should be done quickly.
DrO
Member:
Hrbdn

Posted on Monday, May 17, 2004 - 1:54 pm:

DrO
The xrays taken yesterday showed damage to the smaller joints of the hock. My vet said the tibiotarsal joint looked fine. It is the indside, not front of the hock that is swollen and broken open. The outside of the hock though somewhat distorted is not very swollen at all. In addition it is the inside where the hair is missing and swollen that is tender. I can press quite hard everywhere on the hock itself as well as above and below with not problem. Some of the posts have given me hope but would like your professional opinion as to antibiotic treatment and likelyhood of outcome. My vet has him on 15cc Baytril 1x day and 2gr bute 2x daily. I have been hosing and cleaning 2x daily trying to debride what I can with the water and keep it draining up until last friday. Friday I washed and hosed once then bandaged until the vet came on Sunday. She was supposed to be there Saturday and he seemed to be walking on it better. I think taking off the antibiotic was the worst we could do as he went from walking flat and loping on occasion on his own to walking on his toe with fever in two days. I also think that debriding is what will keep the natural drainage path it has taken open but needs to be a combination of water and surgical that has worked best so far.
Thanks
Dawn
Moderator:
DrO

Posted on Tuesday, May 18, 2004 - 7:41 am:

As long as it is the distal 2 joints and not the proximal 2, I would not give up unless your goals and resources dictate it. I have treated infected tarso-metatarsal joints that took months to get healed but the infection finally resolved and the joint fused and that mare is now sound. You need to find an antibiotic regimen that can be continued for a long time, perhaps doxycycline would be a good choice? See the antibiotic section for more.
DrO
Member:
Hrbdn

Posted on Wednesday, May 19, 2004 - 7:01 am:

DrO
It is the distal joints affected. A change back to Nacxel and a lot of hosing, massaging the infection out and walking and washing just one day brought a three legged horse out on all fours and walking flat on good ground. He seems to have plenty of appetite. Two questions- how to keep the drainage holes open and my local vet wants him on chloramphenecol but cannot get her to take another culture. Is chloramphenecol for long term use? Could not find it in the medication list.
Thanks
Dawn
Moderator:
DrO

Posted on Thursday, May 20, 2004 - 6:37 am:

Chloramphenicol has both a wide spectrum of activity and good bone absorption.
DrO
Member:
Hrbdn

Posted on Friday, May 21, 2004 - 7:16 pm:

DrO
Thank you very much for all your input. I spoke with my clinic vet and I believe things are under control as far as a regime goes. He decided 10 days on 20cc Naxcel which worked for him before and had him loping in the pasture. We are then going with a longer term use of the chloramphenicol. He agrees that it is much better at penetrating tissue and bone. My horse though still not walking sound of course seems to be healing and can now see some some of the normal bone structure through the distortion of swelling. He is eating ...pardon my pun...like a horse. In addition my vet and I discussed side effects and decided Fast Track Probiotic was a good idea while on all this med.. So with God willing and all the help from my vet and the good and timely advice, my gelding will be ok. I do have one question that I forgot to ask my vet while there and that has to do with joint fusion. He does have changes to his distal joints. Was wondering about this as I have no idea what to expect during that phase and how it should be handled. Will talk with my vet in 10 days but am very curious and want to prepare my mindset, if you know what I mean.
Thanks again sooooo much!!
Dawn Brewer
Moderator:
DrO

Posted on Saturday, May 22, 2004 - 12:37 pm:

Here again Dawn you are asking about things I cannot see. In general distal intertarsal and tibiotarasal joints fuse quickly following such an episode. By the time the infection is cleared up and closed or shortly thereafter.
DrO
Member:
Hrbdn

Posted on Tuesday, Jun 15, 2004 - 7:27 pm:

Dr O
Went through 14 days of chloramphenicol 15mg 2x day. Now on SMZ for another ten. My horse experienced a bout of bad diahrea and is skin and bones at this point. He tires very easily but seems ravaged and will eat. His injured hock is now almost normal size with little or no heat. However he is still walking on his toe and I can hear a loud creaking noise when he uses it. He is very anxious to get to pasture and feed and is drinking well. I hate to trailer him at this point and am wondering if you have any ideas as to what the noise is from. I am not sure how much I should increase his feed at this point either.
Thanks
Dawn
Moderator:
DrO

Posted on Thursday, Jun 17, 2004 - 7:41 am:

I am uncertain what the noise might be Dawn, has your vet heard it and what does he say?
DrO
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