╨╧рб▒с>■  (*■   '                                                                                                                                                                                                                                                                                                                                                                                                                                                ье┴ ┐%jbjbjкjк ╚╚%       ]ввввввв╥╥╥╥╥ ▐ ╥ГъЎЎЎЎЎЎЎЎ@BBBBBB,mЇavnвЎЎЎЎЎnтввЎЎЎтттЎ▓вЎвЎ@╢─ввввЎ@т^т@вв@ъ ╕╠°╢╥╥и:@Hypothesis 3 Malunion of iatrogenic metacarpal fracture complicated by infection The jack used to pull the calf caused an iatrogenic fracture of the metacarpus. This in and of itself created a potential source for the hematogenous spread of bacteria to this area. If the fracture was of a fragmented or comminuted nature, the bony fragments have the potential to die, due to avascularity, and become depots for infection. If this were to occur a sequestrum or abscess may have developed. Direct penetration is not necessary in these cases in that any tissue destruction /cellulitis from the fracture and subsequent tissue destruction would be sufficient to open the area up to infectious agents. These areas may also have sluggish blood flow resulting in local blood pooling which additionally serves as a suitable site for infection. These internalized sources of infection would have eventually worked their way to the superficial tissue and broken through the skin, thus explaining the draining tracts. Another portal of entry for infectious organisms would have been through the lacerations caused by the obtestrical chains. The fact that the exudate was purulent indicates a chronic infection which complies with the history. In any case what started out as a local infection has spread systemically causing a febrile state with increased pulse and respiration. The metacarpal fracture was not reduced correctly resulting in a malunion of the leg. This initial malalignment of the bone in combination with any resulting pathologic medial pressure would have caused it to heal incorrectly. The overall result would be the obvious valgus deformity seen on removal of the cast. In addition to not aligning the bone properly, the joints distal to and including the fetlock should have been placed in a flexed position. Contracture of the extensor digital ligaments would account for the presence of tight prominent bands running along the dorsum of the foot and connecting to a raised toe. Failure to fix the digital joints in flexion resulted explains these findings. Furthermore, sufficient cast padding may not have been used. This in conjunction with a misshapen cast relative to the calfТs leg would have placed abnormal pressures on focal areas of the leg. The wounds seen on removal of the cast were a direct result of this. Once again the potential for infection becomes a concern . 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