Special considerations for large animals:
This problem occurs most often around the growth plates in large animal neonates: see 
osteomyelitis of the growth plate and the animal is septic

Clinical signs:
Local heat, pain and swelling often associated with lameness
Anorexia, depression starting 5-21 days after the insult
May be a purulent exudate and a leukocytosis w/ a degenerative left shift
Radiographs 10-14 days after the incident may reveal bone destruction and bone 
remodeling, non-specific soft tissue changes; can see changes on serial radiographs
May get a positive culture from bone, but not always from the blood

Management plan:
Perform aerobic and anaerobic cultures and sensitivities should be performed to 
determine which antibiotic would be most effective
Treat aggressively, both locally and systemically: re-open puncture wound and flush area 
with saline, may place a drain
Systemic antibiotics and curettage to remove infected bone if necessary
Regional perfusion or intramedullary perfusion with antibiotics may be done daily or 
every other day in addition to systemic treatment

Prognosis: 
An acute case has a fair to good prognosis with treatment as long as there are no dead 
bone fragments