Abstract
SummaryBackgroundPrevious studies investigating factors associated with survival following endoscopic treatment of contamination/sepsis of the calcaneal bursa are limited.ObjectivesTo investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections.Study designRetrospective analysis of clinical records.MethodsMedical records from 128 horses with contamination/sepsis of the calcaneal bursae treated by endoscopic lavage at seven equine hospitals were reviewed. A follow‐up questionnaire was used to determine survival and return to athletic performance. Descriptive statistics and Cox proportional hazards survival models were used to determine factors associated with survival.ResultsHorses underwent one (n = 107), two (n = 19), or three (n = 2) surgeries. Survival to hospital discharge was 84.4%. Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (hazard ratio, [HR] 0.41, 95% CI 0.18–0.91, P = 0.03). Increased mortality was associated with bone fracture/osteomyelitis (HR 2.43, 95% CI 1.12–5.26, P = 0.03), tendon involvement (≥30% cross sectional area) (HR 3.78 95% CI 1.78–8.04, P = 0.001), duration of general anaesthesia (HR 1.01, 95% CI 1.00–1.02, P = 0.04), post‐operative synoviocentesis (HR 3.18, 95% CI 1.36–7.43, P = 0.006) and post‐operative wound dehiscence (HR 2.5, 95% CI 1.08–5.65, P = 0.04). Multivariable Cox proportional hazards model revealed reduced mortality after systemic antimicrobial administration prior to referral (HR 0.25, 95% CI 0.11–0.60, P = 0.002) and increased mortality with tendinous involvement (≥30% cross‐sectional area) (HR 7.92, 95% CI 3.31–19.92, P<0.001). At follow‐up (median 30 months, range 0.25–13 years, n = 70) 87.1% horses were alive, 7.1% had been euthanised due to the calcaneal injury and 5.7% had been euthanised for unrelated reasons. From 57 horses with athletic performance follow‐up, 91.2% returned to the same/higher level of exercise, 5.3% to a lower level and 3.5% were retired due to persistent lameness of the affected limb.Main limitationsRetrospective study and incomplete follow‐up.ConclusionEndoscopic treatment of contamination/sepsis of the calcaneal bursae has an 84% survival rate to hospital discharge. Tendinous involvement reduced survival whilst systemic antimicrobials administration prior to referral improved survival.
Highlights
Infection or contamination of the calcaneal bursae is a common sequela of wounds to the plantar aspect of the tarsus
To investigate the factors associated with survival in horses with contamination/sepsis of the calcaneal bursae treated endoscopically and to describe the bacterial isolates involved in the synovial infections
Univariable survival analysis revealed that administration of systemic antimicrobials prior to referral was associated with reduced mortality (Hazard Ratio, (HR) 0.41, 95% CI 0.18-0.91, P = 0.03)
Summary
Infection or contamination of the calcaneal bursae is a common sequela of wounds to the plantar aspect of the tarsus. Superficialis, situated between the SDFT and gastrocnemius tendon (GNT); and the bursa tendinis calcanei, which lies dorsal to the insertion of the GNT on the TC [1,2,3,4]. These latter two bursae are continuous [5], and an anatomical study using latex injections demonstrated 100% communication medially with 50% communicating on the lateral aspect [6], conflictingly the opposite anatomical communications have been reported endoscopically [7].
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