Puncture Wounds
Puncture wounds to the equine limb can be deceiving and may not initially appear serious. The visible skin wound might be innocuous, however, the underlying injury may be more severe and may involve structures such as joints/tendons/tendon sheaths/ligaments/bursa/cartilage and bone. Injury and/or infection to these structures can have very serious, sometimes fatal, implications for the horse if not treated promptly.
What do I look out for?
Common culprits of puncture wounds are pieces of wood, nails, wire and thorns. Objects are commonly contaminated with dirt or rust, and this material is driven deep into the wound to set up a seed of infection.
Puncture wounds of the foot that occur in the clefts of the frog or in the middle third of the frog or near joints or tendons require prompt attention. If a wound involves a synovial structure, such as a joint or tendon sheath, then joint fluid, which appear as an oily, clear to yellow fluid may be present.
What to do if I find a puncture wound on my horse?
If you find your horse with the offending object still in place then it can be helpful for your vet to see the object in place. However the object should only be left in place if you are 100% sure that it will not be driven deeper into the foot when the horse bears weight. If you are in any doubt then remove the object noting carefully how far and in what direction it has penetrated, keeping the object for your vet to see.
What Happens Next?
Further procedures such as X-rays, ultrasound and/or evaluation of joint fluid may be required to confirm which, if any, structures have been affected. Treatment taken may include: antibiotics, surgical debridement of the wound tract, high volume flush of the synovial structure (with or without endoscopic assistance/evaluation), and anti-inflammatories.
Other Precautions?
It is also essential to ensure that your horse's tetanus vaccinations are up to date when a puncture wound occurs. If not, your vet will be need to administer tetanus anti-toxin to provide immediate cover as well as a tetanus toxoid vaccine to provide longer term protection.
Because deep wounds have an increased risk for serious consequences, the need for early identification and treatment cannot be overemphasized. Assuming that the wound is superficial may delay the most appropriate treatment being given, and may be the difference between humane destruction and return to soundness.
In the picture a Nail foreign body has penetrated the frog of this horse. A complete radiographic study of the foot with the nail in place is critical to determine depth and direction of penetration and give an indication as to what structures might be involved.
