“Dear Prudence won’t you come
out to play” (Beatles circa 1968 The White Album)
The owner of Prudence contacted the practice at about 11am requesting a
visit the same day as the young mare had been unwilling to leave her
stable that morning. When
cajoled she stumbled badly and was then seen to be lame on her left
foreleg.
When
I examined the mare approximately 3 hours later she was in obvious
discomfort with an increased pulse rate and a raised temperature
(101.8). Closer inspection revealed a noticeable swelling on the front
of the knee and Prudence resented flexion of the knee. I clipped up the
relevant area and searched for any evidence of external trauma (direct
blow e.g. kick injury) or penetrating wound (barbed wire or foreign body
i.e. a blackthorn). The search being unfruitful meant that my suspicions
of a penetrated joint were by no means confirmed so I suggested that
X-rays should be obtained to establish the presence of a fracture or any
other bony damage.
Prudence, who was a model patient, was X-rayed in her stable and
thankfully all was normal. Despite the absence of any detectable “break
in the skin” and taking into account the aforementioned symptoms
(combined with the fact that the hedges bordering Prudence’s paddock had
recently been cut) I made a provisional diagnosis of a septic carpal
joint secondary to an undetected penetration. Sepsis involving any
structure that contains synovial fluid should always be regarded as a
serious emergency particularly if that structure is a joint. Obtaining a
sample of joint fluid and submitting it to the laboratory for analysis
would usually be the next important step but in this instance that
procedure would have led to an unwanted delay. The decision to refer the
pony to Rossdales Equine Hospital (Newmarket)
for arthroscopic evaluation (Keyhole surgery) and joint flushing was
made, and transport hurriedly arranged (always a bonus when good, caring
friends are on hand!).
Once at Rossdale’s Equine Hospital the relevant joint sample confirmed
the presence of infection and Prudence was taken to surgery. There in
the depths of the middle carpal joint was the “unwanted guest”, a nasty
blackthorn. Following prolonged flushing and installation of antibiotic
the small skin “holes” were stapled, the knee was bandaged and the mare
was placed in the Recovery Box for a safe awakening.
Within 72 hours of this procedure Prudence was feeling a lot better and
was almost completely sound. A follow up synovial sample taken from the
affected joint suggested that a favourable outcome was likely without
the need for further intervention. Prudence is now begrudgingly confined
to her box for about a month (feeling her normal self she doesn’t
understand why she can’t go out to play!) and wearing a rather fetching
“stocking” as a knee bandage. Hopefully it won’t be long before she’s
running “oup and doown Dale”.
P.S. Routine vaccination to include cover against Tetanus removed the
very real risk of this pony succumbing to the latter following possible
“unseen” introduction of the organism.
Fig. 1: Prudence wearing her “stocking” after surgery.
Fig. 2:
Skin staples on Prudence`s
knee after keyhole surgery.
C.B.
