Page 144 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Musculoskeletal system: 1.3 The foot 119

VetBooks.ir 1.206 1.207

Figs. 1.206, 1.207 Palmaroproximal/palmarodistal oblique (1.206) and close-up lateral (1.207) radiographs
demonstrating erosion of the palmar cortex of the navicular bone (arrows).

perfusion with antibiotics, and carefully monitored 1.208
for clinical improvement. Many horses improve
initially only to suffer a relapse with recurrence of
severe lameness and drainage from the penetrating
tract around 4–5 days after bursoscopy.
The ‘streetnail’ procedure, also referred to as a
bursotomy, which involves fenestrating the frog, dig-
ital cushion and DDFT, is less commonly performed
following the development of bursoscopy. This
approach permits direct lavage, limited debridement
and ventral drainage (Fig. 1.208). Although effec-
tive in some horses, this procedure is not benign
and adhesions may develop between the surgically
created DDFT wound and the navicular bone, plus Fig. 1.208 Solar view of the foot a few days after a
the larger solar wound increases the opportunity ‘streetnail’ procedure has been performed.
for ascending infection and the length of aftercare
postoperatively. This procedure is still used where through-and-through lavage, medical therapy and
bursoscopy is either difficult or not available, and a shoeing; however, this should be performed in a refer-
recent study suggests that the results may be compa- ral hospital where surgery can be performed at short
rable to those obtained with bursoscopy. notice should the animal fail to improve or deteriorate.
Occasionally, horses present with recent docu-
mented penetration injury of the bursa, typically of Prognosis
less than 36 hours’ duration, that are able to put their The prognosis for survival and return to work is
heels down at a walk. These have been managed suc- heavily influenced by the time interval between the
cessfully with debridement of the external wound, injury and surgical treatment and whether there