Haematogenous septic arthritis, physitis and osteomyelitis in foals: A tutorial review on pathogenesis, diagnosis, treatment and prognosis. Part 2

Abstract

Summary Haematogenous septic arthritis, physitis and osteomyelitis are manifestations of a potentially debilitating or even life‐threatening disease entity encountered in all types of foals from neonates to approximately 7 months of age. Correct and complete diagnosis and successful treatment requires collaboration across specialties; medicine, anaesthesia, diagnostic imaging, surgery, and rehabilitation. However, in order to succeed it is important that all specialties have an overall knowledge of all aspects of the disease complex. Therefore, the aim of this review is to give an overview of aetiology, presenting complaints, clinical findings, diagnostic imaging, treatment, rehabilitation and prognosis.

Current treatment and prevention of orthopaedic infections in the horse

“…Foals exhibit a greater susceptibility to haematogenous spread to synovial structures and bones, in part due to the presence of tortuous transphyseal vessels that can become seeded with bacteria or transport bacteria into joints (Firth, 1983;Lindegaard et al, 2022).…”

“…Gram negative bacteria, including Escherichia coli , Salmonella , Pseudomonas , Enterobacter and Klebsiella spp., appear to be overrepresented in foals; however, gram positive bacteria, including Staphylococcus and Streptococcus are not uncommon (Hepworth‐Warren et al, 2015; Marsh & Palmer, 2001; Neil et al, 2010; Vos & Ducharme, 2008). Foals exhibit a greater susceptibility to haematogenous spread to synovial structures and bones, in part due to the presence of tortuous transphyseal vessels that can become seeded with bacteria or transport bacteria into joints (Firth, 1983; Lindegaard et al, 2022). While orthopaedic infections caused by hematogenous spread of bacteria in adult horses are much less common, they can occur and should be considered when other causes have been ruled out (Bertone, 1996).…”

Diagnosing and treating septic arthritis, physitis and osteomyelitis in foals

“…Given the bacterial aetiology, antibiotics are crucial in eliminating infection but, due to their limited penetration into necrotic material and bacterial defence mechanisms, they are unlikely to be effective on their own. Removal of infected and necrotic tissue to reduce the load of bacteria, catabolic enzymes and inflammatory mediators is usually indicated to minimise the required workload of the immune system and antibiotics in eliminating infection (Lindegaard and others 2022). Therefore, treatment of foals with SAPO is likely to be intensive and expensive.…”

“…Short‐term survival is between 42 to 84 per cent and is known to be lower in foals that are less than 30 days old at diagnosis, systemically critically ill or if affected in multiple joints/bones. Prognosis is improved if treatment begins within 24 hours of the onset of clinical signs, hence early intervention is imperative (Lindegaard and others 2022).…”

Good outcome of newborn septic arthritis with holistic treatment: a case report

“…Septic arthritis is a clinical emergency, and prevention of significant long-term morbidity depends on timely diagnosis and relief of pressure; either by ultrasoundguided joint aspiration or more invasive surgical techniques. 20 Irrigation and debridement must be urgently performed to clear the joints of bacteria, associated enzymes, and degradation materials that can destroy the articular cartilage, reduce intraarticular pressure, and decrease epiphyseal ischemia. This can be done openly via an anterior approach, providing direct access to the joint and avoiding the ascending branch of the medial circumflex artery.…”