Septisk tenosynovit i kotsenskidan hos häst : en retrospektiv studie av 21 hästar

Abstract: Septic tenosynovitis involving the digital sheath is a relatively common problem in the horse and the prognosis has been considered as poor. However, there are only few studies confirming this. The purpose of this study is to increase the knowledge about the prognosis for septic tenosynovitis in the digital sheath. The literature indicates that half or a bit more than half of the treated horses will return to previous use. The recommended treatment is debridement of the wound, lavage and sometimes application of drains and broadspectrum antibiotics. The prognosis is considered as worse when the infection is established. The most common complication is adhesions between the tendons and the digital sheath wall. Journals from 21 horses diagnosed with septic tenosynovitis or a wound penetrating the digital sheath, treated at the horse clinic at SLU, during a period of almost seven years, has been studied. 71 % of the horses had a good outcome i.e. returned to previous use or were able to be used for the intended purpose. Three horses were not able to be used to the same extent as earlier because of remaining lameness and three were destroyed. The survival rate was 86 %. The median age was 4 years (3 months to 19 years). The aetiology was a perforating wound in 19 (90 %) of the horses. All of the horses had both surgical and medical treatment. Depending on the long-time treatment outcome the horses were divided into two groups with good or bad outcome. The groups were compared regarding age, breed gender, aetiology, clinical signs, the cytological and bacteriological features of the synovia, time to surgical treatment, postoperative drainage of the digital sheath, response to surgical treatment, length of hospitalisation, medical treatment and treatment during recovery period. The treatment outcome tended to be worse the longer time that had passed since the first signs of infection until surgical treatment and also the lamer the horse was preoperatively. The percentage of horses that had postoperative drainage was higher in the group that had a good outcome than in the group that had a bad outcome. On the fifth day postoperatively, five of the total group of 21 horses were still more than 1° lame and of these 80 % belonged to the group with bad outcome. Owing to these results and the literature rapid surgical and medical treatment including tenoscopically guided lavage and debridement of the digital sheath is recommended. Exsudate from the digital sheath should be able to drain through the wound or through an intrathecal drain. Antibiotic treatment should be given both intrathecally and intravenously with broadspectrum antibiotics in addition to anti-inflammatory drugs.