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Discussion on Recognizing sequestrum

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PKB
Member
Username: Pkb540

Post Number: 3
Registered: 11-2004
Posted on Thursday, Jul 7, 2005 - 12:09 am:   Edit PostPrint Post

My four to five year-old horse had what a vet first diagnosed as minor injury from a kick to the inside of the horse's radius, about an inch above the knee, with what was a pinhead size puncture on the bottom. About five days later, the swelling went from below the knee all the way up. Antibiotics brought the swelling down some, but the area around the wound (about a four inch kick line) was still bigger than the other leg and there was a hard little bump that made me wonder. The vet did not x-ray. Anyway, I decided I needed a second opinion because even without any medical training, my instinct said that this could be much more serious than what the vet was telling me.
My second vet did blocks and flexions on every leg, and said the worst was that left front. She took radiographs and found that there was a reaction to the bone. She showed me the sort of white shadow around the bone. She said that I should watch for draining because there could be a "sequestrum," which I learned is dislodged pieces of dead bone. She said that if there is a sequestrum, the horse will have to have surgery.

The injury happened around four weeks ago. My horse is still sore when you touch his wounded leg (the left) although he puts weight on it. His hind end is off when I lunged him for the vet and ran him straight ahead. His hind end movement is uneven--the right leg and left leg move differently. He drags the R hind leg noticeably at a trot. The radiographs did not show any hock problem, and the stifle didn't appear to be a problem. I think he would probably be better with hind shoes. But his lameness is very subtle, unless you saw the horse before the injury. The vet says he is probably compensating for the pain in the left front.

She said to give one gram of bute a day, dsmo, and not to ride him for three weeks or until he is no longer sore to the touch on the wound area.

It has been a week since the second vet came. She is out of town for five days.

My horse is still sore, and maybe a slight difference in the leg's appearance. The bump is softer, I think. (I have spent so much time just gazing at that leg and comparing it with the other leg.) My question is what should I be looking for as signs of a sequestrum? Will it probably be obvious draining or some different feel on his leg? Do you recommend any other steps I should be taking? I would appreciate some guidance because I am of course very concerned.
I perused the articles and different questions, but did not see much discussion about recognizing or looking for signs of a "sequestrum" and hope I have put this inquiry in the right category.
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13295
Registered: 1-1997
Posted on Thursday, Jul 7, 2005 - 7:51 am:   Edit PostPrint Post

Well you can stop staring at it, sequestrums form over time and if it does occur the prognosis good to excellent once removed. If lameness remains after the wound has healed or if the wound experiences delayed healing that is the time to radiograph for the very typical appearance of the sequestrum: a radio-opaque (white area on the radiograph) detached piece from the body of the bone.
DrO
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PKB
Member
Username: Pkb540

Post Number: 4
Registered: 11-2004
Posted on Thursday, Jul 7, 2005 - 1:01 pm:   Edit PostPrint Post

Thanks. I'll stare at the computer instead. The wound has been heeled for a couple of weeks. The area near the wound just has one small hard bump, one soft raised bump, and very slight swelling. The kick happened a month ago. He has never seemed lame on the leg where the wound is, but he is still dragging the right hind.

I guess you are saying that probably only a radiograph will reveal that there is a sequestrum. The vet had said to look for drainage. She was here after the wound was obviously not draining anymore. Does a sequestrum sometimes cause the wound to reopen? By "some time" do you mean months, weeks? Sorry for my ignorance, but this is the first of this sort of injury. I am happy to hear that the prognosis is good to excellent. This is a great service you provide.
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Robert N. Oglesby DVM
Moderator
Username: Dro

Post Number: 13299
Registered: 1-1997
Posted on Thursday, Jul 7, 2005 - 6:12 pm:   Edit PostPrint Post

This is a very variable process of healing and sometimes does require months to develop. I have even seen one wound completely heal with no problem only to have 2 years later a abscess form and open and have to remove a small piece of bone. My guess is that the small dead piece did not cause a problem until it became infected.
DrO
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PKB
Member
Username: Pkb540

Post Number: 5
Registered: 11-2004
Posted on Thursday, Jul 7, 2005 - 6:44 pm:   Edit PostPrint Post

So, possibly sooner or later. Now I just have to figure out if his right hind is dragging because of this injury or what. My hunch is that the wound just got him out of sync elsewhere.

Thanks for responding so promptly.
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