Subchondral bone sequestrum formation in the proximal intra-articular and osteochondral region of the third metatarsal bone of an Appaloosa mare treated for septic arthritis

Abstract

Abstract OBJECTIVE To raise awareness of the potential for intra-articular subchondral bone sequestrum formation secondary to a traumatic or septic process to enable more rapid identification of this uncommon but possible outcome in future cases. ANIMAL A client-owned 12-year-old Appaloosa mare. CLINICAL PRESENTATION, PROGRESSION, AND PROCEDURES The mare had a wound to the lateral aspect of the fourth metatarsal bone (MT4) that communicated with the distal tarsal joints. Radiographs revealed a displaced, comminuted fracture of MT4. TREATMENT AND OUTCOME The horse underwent aggressive debridement of the wound and MT4 as well as, on 2 occasions, needle joint lavage. Systemic, regional, and IA antibiotic therapy was also performed together with a bone graft from the tuber coxae. The horse’s comfort improved, and the wound appeared to be healing. Five weeks following discharge, the horse re-presented with a non–weight-bearing lameness and radiographs revealed marked osteomyelitis of the tarsometatarsal and distal intertarsal joints. Postmortem examination of the limb identified a sequestrum within the proximal articular surface of the third metatarsal bone. CLINICAL RELEVANCE The present report highlights the importance of arthroscopic lavage to visualize the cartilage surface and the benefits of advanced imaging to detect associated changes within the bone earlier than conventional radiographs. To our knowledge, no reports exist of intra-articular subchondral bone sequestra in the tarsometatarsal joint in horses.