June 1 my horse lacerated his front left front pastern on barbed wire. He was immediately brought in, the tendon sheath was tapped and determined to have been compromised. They did a standing lavage, IV antibiotics, and limb profusion. We were sent home with SMZ and bute. He was sound initially. We did another prophylactic profusion a week later. The next week, he went lame and developed a fever, and leg was clearly infected, more obvious now that the wound started to close. My vet recommended surgery which was not an option for us, other than that he said just to continue what we were doing. He did not think culturing for a stronger antibiotic or doing another RLP would make much difference.
So I kept on with SMZ. Signs of infection started to clear up, no fever now for several weeks, the wound looks great, but he is still lame (walks just toe touching on his left front) and there is still swelling. I had a different vet out from the same office to look at him on Monday. She was more on board with tapping for a culture and doing RLP if warranted.
She wanted to US before tapping the tendon and saw thickening of the sheath, but not much fluid. Then they ran an SAA and the number was 3 which made her believe the infection resolved, and now we were dealing with soft tissue. So she did not do the tendon tap, She pulled blood to do a CBC at the clinic which also came back all normal. On US however, she saw something strange around the sesamoids, so we did an xray. She still thought they looked strange but wasn’t sure what it was. Her advice was to get him on appropriate pain meds and start aggressive PT to improve the range and get him using that leg. However, she called me back after she got back to the clinic an said one of the other vet suspects this is osteomyelitis of his sesamoid.
What are your thoughts? Spot in question is marked with an unlabeled arrow.
How is all his blood work normal if there is an infection in the bone? Is there a chance that the tendon sheath is still infected? Kind of frustrated being I asked her to come out for a tendon tap and culture for stronger antibiotics and a RLP, she did neither of those and another $1000 later I am left with more questions.
