Disease Du Jour: Lacerations Over Joints in Field Settings

Some lacerations and wounds obviously involve synovial structures, but sometimes it is hard to tell without veterinary investigation.
equine hock injury
Some lacerations and wounds obviously involve synovial structures, but sometimes it is hard to tell without veterinary investigation. Photo courtesy Dr. Ed Gaughn

Most veterinarians will be called to the farm to treat a horse that has a laceration or wound near a synovial structure. In this podcast, we speak with Philip van Harreveld, DVM, MS, DACVS (Large Animal), a Senior Equine Professional Services Veterinarian for Merck Animal Health.

“Early and aggressive intervention will dictate the prognosis in these cases,” he said.

Watch for Lacerations

In the podcast, van Harreveld said lacerations are very common in horses. “They are very thin-skinned,” he noted.

“I think every time a horse gets a cut or laceration it is important to see where that location is,” he continued. “And if it is close to a synovial structure—either a joint, a tendon sheath or a bursa—I think special attention has to be given to evaluating those areas.”

He said veterinarians should train their owners to take photos of wounds or lacerations if they are close to a synovial structure. “Sometimes a tiny cut can be in a strategic location and be disastrous,” he said. “Horses are prone to joint infections,” and these can be life-threatening if not handled promptly.

Protocols for Lacerations

When van Harreveld is asked to examine a horse with a laceration or injury with potential synovial structure involvement, he first does a thorough physical exam of the horse. Then he sedates and gives the horse pain medication. This is followed by clipping the edges and disinfecting the injury site.

One of the best ways to evaluate if a joint structure is involved is to put a needle in the joint and pressurize that joint with fluid. Then you can see if the fluid comes out of the laceration.

“I think every time you treat a fresh wound, you want to be as gentle as you can,” said van Harreveld.

He likes to use physiological saline—which is very mild—to flush an injury. Van Harreveld likes to use iodine scrub to clean the area. He reminded the audience that iodine scrub is a mild medical soapy solution. It is not the same as iodine solution, which is very caustic.

If there is synovial structure involvement, he said the key to success is to be aggressive up front.

“We hear a lot about horses having a poor prognosis if they have a joint infection,” he noted. “But the thing to remember is if you have a fairly fresh laceration, you don’t have an established infection. What you have is a breach of the joint and a contamination of the joint.

“But if you get aggressive in treating these cases with strong antibiotics right away, and especially lavaging the joint and cleaning it out best you can, that way you can prevent establishment of those infections,” he explained.

Take-Home Points for Lacerations

In the podcast, van Harreveld went on to discuss many different aspects of successfully treating lacerations over synovial structures. He said with early, aggressive treatment of lacerations over joints or other synovial structures, there is an 85% positive case outcome prognosis.

Other take-home points were:

  • Early and aggressive intervention will dictate the prognosis in these cases.
  • Wound preparation, debridement and lavage are key to maximizing healing and prevent suture failure.
  • Determining if the joint or tendon sheath is involved is key in these cases. That usually determines outcome in these cases.
  • Aggressive antibiotic therapy early on is critical.
  • Serum Amyloid A or SAA is a very powerful tool in determining sepsis.
  • Veterinarians need to be careful not handing out a doom and gloom prognosis up front. Up to 85% of horses can survive with adequate early treatment.

About Dr. Philip van Harreveld

Van Harreveld, DVM, MD, DACVS (large animal), is a Senior Equine Professional Services Veterinarian for Merck Animal Health. He received his Doctor of Veterinary Medicine from North Carolina State University in 1996. In 1997, he completed a one-year internship in equine medicine and surgery at Kansas State University. After developing a strong interest in equine surgery, Dr. van Harreveld completed an equine surgery residency, as well as a Master’s degree in clinical sciences at Kansas State University. In 2001, Dr. van Harreveld was certified by the American College of Veterinary Surgeons in equine surgery. Prior to joining Merck Animal Health, Dr. van Harreveld founded and operated Vermont Large Animal Clinic, an equine field service and referral hospital in the Burlington, Vermont, area for more than 20 years.

His areas of Interest in equine medicine include lameness examination, soft tissue surgery, reproductive surgery, and management of medical and surgical equine colic.

Outside of his passion for equine health, Dr. van Harreveld enjoys traveling with his family, fishing, pickleball and volleyball.

Publications

  • van Harreveld, P.D.; Lillich, J.D.; Kawcak, C.E.; Turner, A.S.; Norrdin, R.W. Effects of immobilization followed by remobilization on mineral density, histomorphometric features, and formation of the bones of the metacarpophalangeal joint in horses. Am J Vet Res. 2002;63(2):276-281.
  • van Harreveld, P.D.; Lillich, J.D.; Kawcak, C.E.; Gaughan, E.M.; McLaughlin, R.M.; DeBowes, R.M. The effects of immobilization and re-mobilization on the function of the equine metacarpophalangeal joint. Am J Vet Res; 2002;63(2):282-288. 
  • van Harreveld, P.D.; Gaughan, E.M.; Valentino, L.W. A retrospective analysis of left dorsal displacement of the large colon treated with phenylephrine hydrochloride and exercise in 12 horses. N Z Vet J. 1999;47(3):109-111. 
  • van Harreveld, P.D.; Gaughan, E.M.. Physical examination of a horse with colic. In: Divers TJ, Ducharme NG, eds. Manual of Equine Gastroenterology. W.B. Saunders; 2002:109-112.
  • Ludwig, E.K.; van Harreveld, P.D. Equine wounds over synovial structures. Vet Clin North Am Equine Pract. 2018;34(3):575-590.
  • van Harreveld, P.D.; Cox, J.H.; Biller, D.S. Phenylephrine HCl as a treatment of nephrosplenic entrapment in a horse. Equine Vet Educ. 1999;11(6):282-284.
  • van Harreveld, P.D.; Gaughan, E.M.; Biller, D.S. Diagnosis and treatment of septic navicular bursitis in horses. Eq Pract. 2000;22(4):10-13.
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