Equis ISSN 2398-2977

Navicular bursa: puncture

Synonym(s): Septic bursitis

Contributor(s): Steve Adair, Graham Munroe, Vetstream Ltd

Introduction

  • Cause: traumatic penetration of navicular bursa usually via a solar penetration    →   infection within bursa   →   direct damage to navicular bone, deep digital flexor tendon.
  • Signs: severe lameness   Musculoskeletal: gait evaluation  , puncture wound evident on frog or sole, draining wound above the heel.
  • Diagnosis: foot paring   Foot / shoe: examination  , plain and positive contrast radiography   Forelimb: radiography  , centesis of the navicular bursa with cytology and culture/sensitivity of samples, intrasynovial anesthesia   Forelimb: joint anesthesia  of the navicular and/or distal interphalangeal joint may result in gait improvement, post mortem   Navicular bursa: puncture 01 - pathology  .
  • Differential:
  • Treatment: surgical drainage and removal of infected and necrotic debris.
  • Prognosis: depends on extent of infection and duration before effective treatment:
    • Fair if confined to bursa.
    • Guarded if navicular bone and deep digital flexor tendon involved.
Print off the Owner factsheets on Caring for your horse's feet, Navicular bursitisNavicular disease and Penetrating foot injuries to give to your clients.

Pathogenesis

Etiology

  • Trauma: penetrating injury to the sole of the foot in an area centered on the middle third of the frog.
  • Less commonly, hoof lacerations or avulsions may penetrate deep enough to involve the bursa.

Predisposing factors

General
  • Poor foot care.
  • Wet, muddy conditions.

Specific

  • Presence of sharp, hard foreign bodies, such as nails, in environment of horse.

Pathophysiology

  • Penetrating injury to the sole   →   puncture wound to the navicular bursa   →   introduction of bacteria and foreign bodies   →   damage to palmar/plantar fibrocartilage of the navicular bone +/- puncture of the deep digital flexor tendon   →   septic arthritis of the distal interphalangeal joint +/- septic tenosynovitis   Tarsus: tarsal sheath tenosynovitis   may occur at the time of penetration or, more rarely, by subsequent spread.
  • The frog tissue being elastic in nature, usually seals over the puncture wound, preventing natural drainage and   →    infection build-up.

Timecourse

  • Inflammation and pain within 24 h of injury.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Garcia E Bet al(2014)Navicular bone osteomyelitis and navicular bursitis with associated fistula diagnosed with magnetic resonance fistulography in the horse.Equine Vet Educ26(1), 10-14 VetMedResource.
  • Smith M R W (2013)Penetrating injuries of the foot.Equine Vet Educ25(9), 422-431 VetMedResource.
  • Wright I M, Phillips T J and Walmsley J P (1999)Endoscopy of the navicular bursa. A new technique for the treatment of contaminated and septic burse.Equine Vet J31(1), 5-11 (detailed description of arthroscopic technique and outcomes in 16 cases) PubMed.
  • Honnas C Met al(1995)Use of autogenous cancellous bone grafting in the treatment of septic navicular bursitis and distal sesamoid osteomyelitis in horses.JAVMA206(8), 1191-1194 PubMed.
  • Whitehair K Jet al(1992)Regional limb perfusion for antibiotic treatment of experimentally induced septic arthritis.Vet Surg21(5), 367-373 PubMed.
  • Whitehair K Jet al(1992)Regional limb perfusion with antibiotics in three horses.Vet Surg21(4), 286-292 PubMed.
  • Markel M Det al(1985)Use of cancellous bone graft in treatment of navicular osteomyelitis in a foal.JAVMA187, 278-280 PubMed.


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