╨╧рб▒с>■  )+■   (                                                                                                                                                                                                                                                                                                                                                                                                                                                ье┴ ┐┬jbjbjкjк ╚╚┬       ]╥╥╥╥╥╥╥ " ╒ъ::::::::ТФФФФФФ,┐Ї│|└╥:::::└J╥╥:::JJJ:╓╥:╥:Тц■╥╥╥╥:ТJHJТ╥╥Т. л∙╥╢:ТManagement plan Group 11 Case 3 In cases of acute osteomyelitis with potential secondary joint sepsis, prognosis is guarded at best. Foals usually respond better to treatment than adults, especially when there is single joint involvement. However, the fact that there is bony involvement already does not bode well for the patient. Although, economics and clinic capabilities are limited, aggressive and possibly costly therapy needs to be provided if the foal is to have a decent chance at survival. If client opts to circumvent initial treatment, the resultant problems will be far more expensive to deal with, assuming the foal even lives. The client needs to be made aware of the realities of the situation and may need to consider euthanasia, if even minimum treatments can not be afforded. Due to the hematogenous nature of the infectious organism and its presence in the joint, both systemic and local therapy should be initiated. Based on the culture and sensitivity, a combination of amikacin and potassium penicillin would be effective. The potassium penicillin should be given intravenously every six hours at a dose of 20,000 IU/kg. After 1-2 days medications can then be given orally. Treatment should continue over a course of six weeks. Locally, a simple regional perfusion of the affected joint can be done. A tourniquet is applied proximal to the fetlock and a local vein or artery can then be injected with antibiotic. Due to the bony involvement , careful mechanical curretage of any affected bone is indicated. These latter two procedures can be performed daily or every other day. Within a few days of ending antimicrobial treatment, a fine needle aspiration of the joint should be performed to supply a second sample for culture. Radiographs may be used to help pinpoint the optimal site for aspiration. If the follow-up culture is positive, the protocol should be modified to include different antimicrobials, and an exploration of the site should be done to remove the persistent infectious source. If the local inflammatory response has not improved within 2-3 days, drainage procedures should be employed. This involves making an incision over the area, exposing the underlying periosteum, and drilling 1/8 inch holes into the affected bone. Any dead bone should be removed, the cloaca curetted, and the area flushed profusely with sterile saline over the next few days. In order to allow persistent drainage and lavage, the wound will need to be left open with or without a drain depending on situation at that point. Due to the age of the animal, care should be taken avoid disruption of the growth plate. In addition, NSAIDS, like phenylbutazone, may be given to limit inflammation and provide analgesia. The foal should be stall rested to allow for proper bone remodeling and healing of articular structures. Passive motion exercises should be encouraged to maintain joint mobility. As mentioned the prognosis is guarded, especially without proper treatment. If the foal survives, potential complications may arise from septicemia and resultant bacterial colonization of the bony vasculature supplying the distal growth plate of the third metatarsal. The compromise in blood supply may cause bone sequestration. Bony proliferation then occurs around this area forming an involucrum. This area may serve as an additional source of infection and potential lameness. 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