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Discussion on Sequestrum - coffin bone
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New Member:
Fabi0
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Posted on Tuesday, Aug 8, 2006 - 5:55 am:
Hi, I'm new on this board and have been thrilled to find all the articles to read. I haven't however been able to find any information on Sequestrum as it applies to my pony.
I have a 6 YO haflinger gelding. He spent the first 4 years of his life in pasture with his herd and moma. He was ground trained but not ridden or really worked until the age of 4. He spent one summer(last) at a kids camp. I bought him a year ago straight from the kids camp.
He has been barefoot his entire life.
About a month ago he got a stone bruise which developed into an abscess. He wasn't getting better, in fact he seemed to be going down hill fast so we took him in for x rays to make sure the abscess hadn't invaded his bone.
the x rays reveled that part of his coffin bone was dead. He had surgery 3 weeks ago and is now on the road to recovery.
My question lies in the area of how long could he have had this? what could have caused it? How soon can I even look at shoes to help him be more comfortable? Does my farrier need to worry about where the bone was taken out where nails are concerned.
What is the long term prognosis for him developing ringbone?
The surgeon went in thro the bottom of his hoof in order to remove the dead area. That hole was about the size of a cherry when he first came home.
He is bandage free now, after 3 weeks, but is still tender tho walking pretty well.
I'm finding very hard to find any information about recovery time or what to expect during recovery.
Any information you could give me would be appreciated.
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Member:
Scooter
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Posted on Tuesday, Aug 8, 2006 - 8:17 am:
Hi Robin and welcome to the board. It sounds as if your pony may have Pedal osteitis. I really could be wrong, but if you search that term you would come up with more info on debriding the coffin bone. I'm sure Dr.O. will chime in and help you soon. Good Luck with your pony.
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New Member:
Fabi0
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Posted on Tuesday, Aug 8, 2006 - 1:12 pm:
Hey Diane. thanks for the information....
I'm off to find out more about Pedal Osteitis!
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New Member:
Fabi0
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Posted on Tuesday, Aug 8, 2006 - 1:18 pm:
I think with just the small amount of reading I just did I can rule that out. Also the diagnosis is totally different.
Follows is the diagnosis word for word.
Right front Abcess with osteomyelitis of coffin bone.
Physical exam: With in normal limits except for lameness right front. Radiographs: small area of boney lysis with sequestrum of coffin bone on lateral aspect.
Treatment: Curettage of coffin bone, bute.
Prognosis: Good
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Member:
Scooter
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Posted on Tuesday, Aug 8, 2006 - 3:25 pm:
Hi, Robin I am wondering if osteomyelitis of coffin bone, isn't in fact Pedal Osteitis. If in fact it is or isn't. that shoes with a pad for that foot would indeed protect it. Just my line of thinking. I believe, if my memory isn't failing me, that a subsolar abcess can induce septic Pedal Osteitis, I think. DrO. will know
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Member:
Scooter
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Posted on Tuesday, Aug 8, 2006 - 3:38 pm:
Septic Pedal Osteitis
Septic pedal osteitis is caused by a pathogen that infects the soft tissue of the foot and extends into the coffin bone. Causes of septic pedal osteitis include a penetrating injury to the soft tissue, subsolar abscess, untreated white line disease, laminitis, infected corns or any long standing soft tissue infection of the hoof. The infection can involve the coffin bone, sole structure, laminae and the hoof wall. Symptoms include drainage from the foot - often in the form of a tract leading directly to and from the coffin bone.
X-ray changes that are specific to the septic form of pedal osteitis show isolated areas of avascular bone that have become necrotic and have separated from the coffin, bone known as sequestrums. These necrotic pieces can be designated as primary sequestra (if the piece is entirely detached), secondary (if it's still loosely attached) and tertiary (if still attached but remaining in place). X-rays will also reveal bone density loss at the laminar attachments. MRI scans can be used to detect adjacent soft tissue infection.
Treatment for septic pedal osteitis often involves surgical debridement under neural block or general anesthesia to drain purulent exudate, remove sequestra and curettage of infected or necrotic bone and tissue. Up to a fourth of the coffin bone can be removed without permanent long-term effects. The wound is initially treated with antibiotic soaked gauze, waterproof bandages and daily wound cleansing with antibiotic irrigation. Often oral antibiotics and anti-inflationary agents are prescribed. Areas of white line disease may be resected concurrently. After granulation tissue covers the coffin bone (usually in 7-10 days) the farrier can make a hospital plate to cover the area, provide relieve from any sole pressure and allow observation and treatment of the foot. Selection of the type of plate depends on the size of the area needing to be treated and the skill of the farrier. Sole hardening agents can be applied once granulation tissue is level with the sole as directed by the veterinarian. Recovery from septic pedal osteitis may require a lengthy convalescence but the prognosis is excellent unless the underlying caused is laminitis.
With proper diagnosis, early detection and a combination of medical and farrier techniques, pedal osteitis can be resolved and most horses returned to athletic function. Quite often these horses have other substantial underlying causes that must be resolved making the treatment plan specific to the individual horse and a challenge to the skills of the farrier.
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New Member:
Fabi0
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Posted on Tuesday, Aug 8, 2006 - 3:54 pm:
I guess I'm really confused because what I was reading about Pedal Osteitis is that it's a general term meaning many things. It is caused by heavy work over a long period of time. Like driving.
My pony hasn't ever been driven and his work load didn't start until he was 4. Then it was a kids camp for the summer and me riding him beginning once a week last year and building up to every day by this summer.
The treatment and prognosis is not the same.
My understanding from the surgeon was that he probably sustained a fracture(probably over a year ago) that chipped the bone, causing the piece to die.
When I look up the word osteomyelitis, it's defined as an infection that causes the bone to die. The treatment is to remove the dead/infected bone, followed by anitbotics. the prognosis is good.
I have to tell you how great it is to find a place to try and figure this out. It's a puzzle and I really want to know what happened, if possible.
I so appreciate the challange that makes me think!
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Member:
Scooter
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Posted on Tuesday, Aug 8, 2006 - 4:04 pm:
Robin, did you read the entire SEPTIC pedal osteitis article I posted? The prognosis is good it says. It certainly sounds like what you said your pony had (second paragraph). but ya never know with horses!
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New Member:
Fabi0
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Posted on Tuesday, Aug 8, 2006 - 10:07 pm:
Gosh Diane.........Your post at 3:38 wasn't there when I posted.........at least I didn't see it. 
That sure sounds like what we have been dealing with.
I still wish I knew what caused it. He showed no lameness before the stone bruise.
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Moderator:
DrO
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Posted on Wednesday, Aug 9, 2006 - 7:46 am:
Welcome Robin,
Yes pedal osteitis means inflammation of the pedal (coffin) bone. There can be many causes, infection being one so this could be termed infections or septic pedal osteitis or osteomyelitis. It really is just a definition game here.
Many of the questions you have about treatment and prognosis will depend on the specifics of your case so are best answered by the surgeon, who could actually see the problem. But I can help with how the infection got there. There are only two ways: as an extension of local infection like a solar access that formed from a defect in the sole or from hematogenous origin: the bacteria circulated there through the blood and lodged in this part of the foot. The location and condition of the surrounding tissue will give clues as to which happened, so here again your surgeon should have an opinion on this.
DrO
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Member:
Scooter
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Posted on Wednesday, Aug 9, 2006 - 11:38 am:
Hi Robin, sorry that post of mine did seem a little snippy. I didn't mean for it to. I know sometimes I graze over articles and miss the pertinent stuff. Anyway it seems that MAYBE the stone bruise started all your problems and as Dr.O. said only your surgeon may know. (or not). The good news is the prognosis is excellent. Hopefully you have a good farrier, they seem hard to come by. Good Luck with your pony, I hope he recovers fully
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Member:
Fabi0
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Posted on Wednesday, Aug 9, 2006 - 4:11 pm:
My surgeon couldn't give me a good handle on the why. This is why I started looking for more information.
If it was something that could be prevented, well it would be good to know for the future.
I expect my Pony to be 100% when he's all healed up.
I also have found a really good farrier who knows what he's doing and is sensitive and patient with both my pony and me!
Thanks for the help Diane!
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