Group 13 "What Ifs"

1. History of penetrating wound. Signs/symptoms would include local pain, heat and swelling. Anorexia and depression would start 5 to 21 days after the traumatic incident. A purulent exudate may be seen in the wound. Specialty exams would show a leukocytosis with a degenerative left shift. Radiographs would show non-specific soft tissue changes. Active progression of changes will be seen in serial radiographs. After 10 to 14 days, radiographs may show bone destruction and remodeling.

2. The management plan would include the administration of local/systemic administration of antibiotics for 6 to 8 weeks based on culture and sensitivity; antibiotics should be rotated during that time. A few days after finishing the antibiotics, a second culture should be taken as well as radiographs. Removal of the dead bone fragment and drainage of the site may eventually be warranted. The prognosis is fair to good with treatment and no dead bone fragments.

3. This case is completely opposite from Case 3, in which the patient was a skeletally immature equine and did not have a penetrating wound. Young animals usually get osteomyelitis hematogenously, whereas older animals usually get it from a penetrating wound. The situation in young animals is based on the higher vascular content of their growing bones. The prognosis might be less favorable in a young animal because its bones are still growing, so inflammation around the physis may alter the growth plate's ability to develop normally. Formation of a bone sequestrum is likely in large animals. Also, a bone sequestrum due to lower leg wounds is more common in large animals. Lastly, surgical treatments would be riskier in younger animals for the same reason.