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Discussion on Fetlock Joint Infection/severed tendon
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New Member:
alij
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Posted on Tuesday, Aug 18, 2015 - 7:59 am:
Hi, I am new here but I am hoping you can give me some advice on my horse’s injury. I have pictures but don’t look if you are squeamish.
Went to pick up a horse that was given to me, owners ill health meant she could no longer look after her. She is a thoroughbred ex-racehorse 11 years old. On the journey home she put her leg through the trailer floor. Apparently, the trailer company knew there were problems with the floor design on this model and did a recall in France but not in the UK!
Horse had cut the front of her fetlock through to the bone, severed tendon as well. Vet came immediately and gave two options; a) take her to hospital to be flushed but chance of success not guaranteed or, b) treat as best we could at home. The cost of option a, was £4,000 with no guarantee plus we had no transport to get her to hospital, drive was over an hour and she had a miniature horse companion that she has been inseparable from for the past 6 years, so she would have to go. Time was of the essence to start treatment and I really thought the stress of going back into a trailer would not be good so I told the vet to do what she could. Her advice was to pts because she did not think the horse would come through this type of injury and I was informed the cost of treating at home was going to be high and the horse would only ever be a companion at best.
Vet gave tetanus and injected antibiotic (Noradine) she tried stitching some skin and tendon but it came apart. Wound was flushed as best she could and bandaged. We put her in a stall with her companion and waited the next 24-48hrs being crucial. She was also given bute maximum dose. Vet called next morning amazed the horse was still alive, she’d expected a call during the night as she’d told me if she got feverish I must call her and have her pts. Horse was weight bearing but the vet said she had an infection and leaking joint fluid. She could feel the bone and did not think there was any damage to the bone as it felt smooth with no pitting. She was very worried about the leaking fluid. Vet came out three more days with the same routine inject antibiotics, clean wound, bandage. I was giving her bute 2gms am and 2gms pm. On the fourth day I had to take over dressing the wound as I had already spent over £1,000 and vet was costing me £100 per day. My routine was bute 2x daily, 1 sachet Noradine in her feed, was wound daily to remove pus apply sterile melolin dressing with penicillin 4ml applied to dressing, orthopaedic dressing over wound and up to hock/ down to hoof, knitted bandage over that and vetwrap on top. Vet called following week to check progress and felt we had a long way to go but main concern was the open wound and infection. Vet advised using Manuka Honey surgical grade to replace the penicillin on the dressing. Also after two weeks I was told to reduce the bute to 2gms a day.
Vet had to leave practice to return home to Ireland. By week three proud flesh had developed and dressing was a little smelly, leg swelling more than usual so I called the vet out as I felt we were going backwards. This vet said it was unlikely to heal, worried about leaking joint fluid, joint infection, open wound, might be better to pts. The horse is really well in herself though and I check her temperature daily it is normal, she eats, she is bright, she lays down for a rest at least three times a day. She’s not suffering so I am not going to pts. So vet changed the plan and ordered some aggressive antibiotics. She is on 30ml Baytril once a day and 2gms bute. I have a product called vulketan for the proud flesh and it has reduced it. The wound to the exposed bone has got smaller. I will upload pics later. We are at 5 weeks and three days since the accident happened. Still leaking fluid but I think it is improving. It is two weeks since she has been on Baytril. What are your thoughts please on this type of injury because I need some hope. The horse is so alert, she’s in a haybarn with about 30’ x 20’ area for her and her companion. She can watch what’s going on all day whilst I am working other horses and she seems very happy. She does rest her leg but can put weight on it. Is there anything else after Baytril because I think she is just on that for three weeks then I don’t know what?
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New Member:
alij
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Posted on Tuesday, Aug 18, 2015 - 8:15 am:
 This pic taken four days after accident. The hole goes straight through to the bone.
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New Member:
alij
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Posted on Tuesday, Aug 18, 2015 - 8:23 am:
 Proud Flesh 22 days after accident
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New Member:
alij
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Posted on Tuesday, Aug 18, 2015 - 8:29 am:
This is current 5 weeks and one day after accident. Although you can’t see in the picture the hole through to bone feels like it is covered with tissue. When I wash and flush I can no longer get right through.
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Member:
dres
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Posted on Tuesday, Aug 18, 2015 - 9:05 am:
for your reading interest , here is the tale of my horses severed DDFT , and Bow tendon ..
and part 2 https://www.horseadvice.com/horse/messages/4/256847.html
On the first day God created horses , on the second day he painted them with spots .
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Member:
moxshi
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Posted on Tuesday, Aug 18, 2015 - 9:15 am:
Hi, Alison J (and, hey, Ann  )
Was cold water hosing therapy ever mentioned by your vet? It would help keep the wound clean and help it heal.
It looks like it's filling in, well. Has the vet given you any idea about when you might hand-walk her?
Bless your heart for taking such amazing care of her. It's so unfortunate that as she was heading to a forever home, she had such an awful accident. They plus of this is that you and she have been able to get to know one another pretty well, and if she recovers from this injury, you may have a new best friend.
Is the trailering company responsible for any of the expenses? I would check to see if you can be compensated for the vet bills.
To know what's really going on inside her leg, I think you'd have to have an MRI or, at least, an xray, right? Another of our members had a mare with a cut tendon, and she became pasture sound, I believe. If you get a chance after reading Ann's adventures, look for other discussions on severed tendons or tendon injuries.
Hope to hear that she has a miraculous recovery. She doesn't seem ready to leave Earth, yet.
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New Member:
alij
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Posted on Tuesday, Aug 18, 2015 - 10:03 am:
Hi Ann and Holly Wood,
Thanks for replies. Ann I read your story and you have been on a real rollercoaster ride my goodness but at least the outcome was worth it! Holly Wood, no, neither vet suggested water hosing therapy. I have only been told to clean it using hibiscrub (Chlorhexidine gluconate) firstly wiping over the wound with cotton wool soaked in that and then squirting into the cavity with a syringe filled with the hibiscrub.
The trailer company are unlikely to do anything about it. The trailer belongs to a friend so she is doing all she can but I doubt anything will happen.
I am reading as much as I can about other people’s experiences of this type of injury but it seems like everyone else got their horse to hospital! So I am hoping I have not ruined any chance of success by not doing so.
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Member:
mrose
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Posted on Tuesday, Aug 18, 2015 - 1:17 pm:
Hi Alison. If you haven't already done so, do a search on here for Libby and her tendon injury. Some of the posts are under Libby and Sara. Libby is mare we had who severed both her DDFT and DFT. She did recover and would have been rideable except for the severe laminitis she developed on her other front foot. She was pasture sound for over 12 yrs and led a pretty happy life with her buddies. Hopefully, her story might be of help. Ann and I were going through similar things close to the same time and compared notes often. If she is lame on that injured leg and won't put much weight on it, I would recommend putting a support wrap on her other front leg, and maybe on all her legs as a preventative.
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Member:
alij
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Posted on Tuesday, Aug 18, 2015 - 3:49 pm:
  
Thanks Sara I read about Libby and it gives me hope, what a special horse.
This is how it looks today and a picture to show how much leakage comes from the wound. After I take the vetwrap off this is the bandage and underneath that two layers cotton wool, orthopaedic dressing and the sterile pad over the wound. So seems like a lot of leaking fluid still. The other pics show the wound before and after cleaning. My vets haven’t offered anything other than the aggressive antibiotics, bute and daily dressing. I read your stories and it seems like there are so many more options.
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Member:
rtrotter
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Posted on Tuesday, Aug 18, 2015 - 4:16 pm:
Alison, as awful as this looks, it will heal. I had a horse I rehabbed whose leg looked basically the same. He was a race horse, who hit his knee, the knee got infected but they did not keep the horse on antibiotics long enough. So although the knee wound healed, the infection stayed in his leg and eventually burst out the back of his tendon. I got him after it burst and after they called the original owner to tell her that if she did not come and pick up the horse, they were going to euthanize him. At the time the horse was being leased. It took a lot of months of rehab and constant care and long term( SMZ tabs) but the wound did heal, and the horse made it back to the races. He never took a lame step on the leg and he was turned out with his buddy in a large field. The turn out kept the fill out of the leg. A lot of cold water hosing and a lot of care( sort of the same scenario you are going through). But it was gratifying to watch the wound close up and finally heal. So yes, there is hope so keep going the way you are. Good Luck!
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Member:
rtrotter
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Posted on Tuesday, Aug 18, 2015 - 4:20 pm:
And a post note: to the above. when he retired from racing. He was broken to ride( I used to ride him) He was donated to the Mounted campus Patrol at Cook college at Rutgers University and remained there until he once again retired at the age of 24. As far as I know he is still there.
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Member:
mrose
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Posted on Tuesday, Aug 18, 2015 - 4:35 pm:
As Rachel said, these wounds look awful and drainage is normal. In fact, I would be concerned if it dried out to soon. Anytime a wound goes into a joint, it is dangerous. The best thing you can do is to keep it really clean, keep the horse on antibiotics and let it heal up. The reason Libby's leg got so bad wasn't the initial injury; it was the fact she had a secondary infection that no one picked up on. Anerobic bacteria had flowed down into her sesimoid bones and that infection combined with the laminitis in her "good foot" almost killed her. I'd keep on the antibiotics until she is healed up totally. If she is sore, then bute is good. Libby lived on bute for a long time. It might be a good idea to put her on probiotics to help her digestive system cope with the antibiotics and pain meds. Remember, bute is not just for pain but an anti-inflamatory also. Has anyone mentioned Nolvasan ointment to you? It's excellent for a wet dressing to prevent infection and prevent a wound from drying out on the surface before it is healed up on the inside.
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Moderator:
DrO
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Posted on Tuesday, Aug 18, 2015 - 7:11 pm:
Welcome Alison,
This wound will heal, but if the wound is as you present above, the chances of chronic arthritis in the fetlock is very high. Unfortunately arthritis in the fetlock will be permanently debilitating and pasture sound the best you can expect. As to antibiotics, until the wound has completely granulated in they should be continued.
For more on wound care check out HorseAdvice.com » Diseases of Horses » Skin Diseases, Wounds, and Swellings » Wounds / Burns » Long Term Deep Wound Care. However the open joint capsule requires special consideration with non-irritating (with respect to the synovium and cartilage) wound treatments to be considered of paramount importance. Be sure to run any changes you contemplate by your vets. A wound like this will heal faster and with less granulation tissue with stall or small paddock rest.
DrO
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Member:
alij
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Posted on Monday, Aug 24, 2015 - 4:37 pm:
Thank you everybody for all of your words of advice and taking the time to reassure me! It is very promising to read your stories and know that horses have recovered from worse injuries than this.
Thank you Dr.O for your input. I have read the articles which are a great source of information.
The vet is coming out Friday but meanwhile she is continuing to heal and the hole has almost filled in. There is some leakage still and now some bright red blood which comes out of the hole after I have cleaned it. Is this just granulation tissue bleeding due to being disturbed when cleaning? Or something to worry about??
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Moderator:
DrO
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Posted on Monday, Aug 24, 2015 - 6:30 pm:
Hello Allison,
Without examination at this ourselves we cannot know. If it is just blood then this is the product of granulation tissue. You continue to give the wound good care and perhaps your veterinarian following a good exam can answer the question.
DrO
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Member:
alij
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Posted on Saturday, Aug 29, 2015 - 5:25 am:
Hi Everybody, It is not good news from the vet’s visit this morning. He said the wound is healing well but the joint infection has not gone and the horse is on full dose Baytril which hasn’t got rid of the infection. She is still very lame and he said the infection is not likely to go away. She is the best she can be and the joint will never heal so he has recommended she is pts. I have Baytril supply until Wednesday and he will call out again but wants me to have her euthanased on Wednesday. Does anybody have any suggestions what else I can do please.
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Member:
rtrotter
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Posted on Saturday, Aug 29, 2015 - 8:27 am:
The only thing I can suggest is flushing the joint with antibiotics and getting a culture on the drainage prior to the antibiotic flush. I had a horse( bought from a sale) that had a knee infection the bacteria was a really nasty one, that is very hard to clear up. We flushed it several times, and he was put on Chloramphenicol, I finally did get the infection cleared but the horse had bone on bone( no cartilage left in his knee) and was quite lame without meds. So, the final decision was made to euthanize him. It was the kindest thing I could do for him.
I am so sorry you and your horse are going through this. It is not an easy decision to have to make.
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Member:
moxshi
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Posted on Saturday, Aug 29, 2015 - 9:33 am:
I am so sorry to hear that the mare's infection hasn't healed. Do you have another vet you can ask? Maybe a different vet would have another suggestion for treatment. Do you have a vet hospital close-by? Sometimes, solutions come from discussion with others, and a group of vets might have more creative ideas?
We can only do what we can do in the best way we know how to do or are able to afford. I pray that if there is a solution to this infection and lameness that it will come to light between now and Wednesday . . . You are giving her the best chance at life that you can.
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Moderator:
DrO
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Posted on Saturday, Aug 29, 2015 - 9:40 am:
Hello Alison,
I am sorry to hear about your horse, horses with severe trauma to the fetlock joint resulting in infection do not have a good prognosis for return to soundness. If you are uncertain about your vets evaluation or recommendation you should get a second opinion so that you can be sure you are doing the right thing.
DrO
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Member:
alij
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Posted on Saturday, Aug 29, 2015 - 5:23 pm:
I’m totally gutted because I thought as the wound was healing, that was the main concern and I suppose I didn’t fully understand the implications of damage to the joint capsule. There aren’t any hospitals within easy distance and to be honest I don’t think the travel would do her any good but I have found a vet who works at the hospital and does surgery there, so I am hoping to get him out for a second opinion. I have a sinking feeling now that this isn’t going to heal. Thanks for all the suggestions and it is all sound advice. Have any horses ever recovered from this type of trauma to the joint does anyone know. I have read and read and read and now I don’t even know what I’ve read or if there was the slimmest chance of recovery. My vet thinks not in fact he said he’s never known a horse last 7 weeks with this type of injury.
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Member:
moxshi
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Posted on Sunday, Aug 30, 2015 - 5:37 pm:
Hope you can get the second opinion, Alison. At least then, if you have to make the decision to put her down, you will know that you are doing so at the advice of two different vets. On the other hand, if you have any doubt, don't do it.
The fact that she's lasted 7 weeks says that she's not ready to go, yet . . . and who knows what tomorrow will bring? She is blessed to have you caring for her at this time of her life. I hope that she will make a turn around and the infection will disappear and her joint will be healed.
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Member:
alij
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Posted on Friday, Sep 11, 2015 - 7:17 am:
Hello again. The second vet has just been out to see my horse and it is bad news. I had asked him to look at her with a view to operating, fusing the bones and plating but he said on a fetlock joint it would be less than 5% chance of success. He said there is nothing else to be done and so sadly she will be euthanased when my local vet returns from holiday around Sept.22nd. Meanwhile she is still on the baytril and bute to get her by, but with no hope of recovery. So sad because even the vet agreed she is not suffering unduly, still eating, bright as a button and quite happy munching hay looking at the mini’s. Thank you for all your comments and advice, it was really helpful. I do not regret keeping her going because she will have had 9/10 weeks of a happy life. So now I will make the remaining time as best I can for her, she will be spoilt rotten until the day comes.
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Member:
moxshi
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Posted on Saturday, Sep 12, 2015 - 10:57 am:
Oh, Alison, I am so sorry to hear this, but you are looking at the situation in the best possible way. You were right to rescue her, and you have done the very best you can so for her. She is happy and has known kindness . . . and her end will be respectful and peaceful and loving. God bless you. We don't know why things happen this way, but there is a reason, and you have certainly have come away from this more knowledgeable and larger in your heart.
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Moderator:
DrO
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Posted on Sunday, Sep 13, 2015 - 6:49 pm:
My condolences Alison, but I think you have made the right decision.
DrO
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