S H O ULDYOU VACCINATEAG AI NSTM O O NBLI NDNESS ?

P A G E1 6

SEPTEMBER2OO5
ISSUE335

FIRST
UD
FOR
NGTUR
OUNDS
Here'swhatto do to prevent
a seeminglyminorinjury
your
fromendangering
horse'slife.
Byloy Sttha
he problemwith puncturewoundsis that
mostof them look innocuous.There'soften
a smallround hole and a minimal amount
of blood-certainlv sufficientevidenceof
injury but not the sort of signsthat triggeralarm.
Yetdependingon its locationand the extentof
damagebeneaththe skin, a puncturewoundcan
be lifs-threateningforyourhorse.
Severalcharacteristics makepuncturewounds
dangerousand difficult to treat:
O Theyareinflictedbyitems capableof carry-
ing dangerousbacteriadeepinto bodytissue.
O Deeperthan theyarewide,theydo not readi-
ly drain,creatingan environmentwhereinvading
bacteriacanflourish.
O Healingstartsfrom the skin inward,so
that the bacteriacanbecometrappedandproduce
localabscesses or deepseatedinfectionsthat may
spreadto other parts of the body.
O Any pieceof a puncturingitem that remains
in the woundthwartshealingand rehabilitation;
deadtissuehasno exit.

The worst places for punctures

Thereal menaceof a puncturewoundis not
somuchits causeas its location.Everypuncture
is a potentialRedAlert, so call yourveterinarian
immediatelywhen you detectthatyourhorsehas
sufferedone.Waitingcouldhavedisastrousconse-
quences,especiallyif a joint or bodycavityhas
beenbreached;withouttreatmentin the first few
hoursafterinjury completerecoveryisunlikely.
Puncturewoundsat the followinglocations
posethe greatestrisk for a horse:
Iotnts.An item that penetratesa joint andthe

S E P T E MB ER 2OO5 Eq u u s 33s 67
 synovial sacwithin it may causethe clearto deep-
yellow lubricating fluid to leak out.An infected
joint may developarthritis or osteomyelitis,a
destructivebone infection.Both conditions are
painful, difficult to treat and often result in perma-
nent lameness.
Tendon sheaths.A puncture to the thin tissue
that covers tendons and ligaments may introduce
bacteria;the resultant infection will be quite
painful and can lead to permanentlameness.par-
ticularlyvulnerableare the digital tendon sheath
and the carpal canal.The digital tendon sheath
runs from the navicularboneto the coronaryband,
over the pastern and fetlock to abovethe fetlock
joint. The carpal canal runs just aboveto just below
the backofthe knee (carpus).
The chest. A large puncture to the chest can
collapsethe lungs and causeasphyxiation.
The abdomen.An abdominal-cavitypuncture
and any subsequentinfection can be especially
serious,consideringthe vital organslocatedthere:
the liver, spleen,kidneys, large colon, stomach,
small intestine,duodenumand cecum.
Eyes.A punctured eye is extremely painful. The
iris protrudes and the eye may appear to be pop-
ping out. In actuality the inner contentsmay be
bulging through the wound. Surgeryis required,
and although the eye sometimes can be saved,a
horse'svision often is permanentlyaffected.
Feet. Punctures to the foot-which includes
the bones,joints, tendonsand ligamentsencased
within the hoofwall-are quite common,yet many
escapedetectionuntil a horse is in pain and lame.
Becauseof the particularly destructivenature of
an infection or abscessin any synovialspace,the
most seriousfoot punctures go through the frog to
the navicularboneand navicularbursa.the deep
digital flexor tendon and the coffin ioint.

Eyes
Puncture is
extremely
painful.
S ur gic al
r epartrs
required.

Chest
A punctured
lung
ma yc o l l a p s ec,a u s i n g
the horseto asphyxiate.
Potential for shock
is great.
Abdomen
Manyvitalorgansareat risk
Joints of life-threatening
damage.
Essentia
I Potential for shockis great.
lubricating
fluid
ma ye scapethrough Tendon
sheaths Feet
a puncture. lnfection Resultant
infectionis Themostserious
is likely;mayleadto quitepainful
andcan puncturesg0
p e rm a nent
l ameness. l eadto permanent throughthefrog
intotheinner
structures
of
I the hoof.

6 8 Eq uu s 33s SEPT E A 4 B E R 2OO5

l What to do
I Rule out shock As you wait foryourveteri-
narian to arrive,take stockofyourhorse'sphysical
condition as well as his behaviortogaugethe
severityand effectofhis wound. Seriouspunc-
tures can produce bodywide effects in a relatively
short time as normal organfunction slowsin an
attempt to deal with the trauma. Without immedi
ate and aggressivetreatment, a horse with a punc-
L
=

ture wound ofthe chest,bellyoreye can go into

shock.Signs include trembling, anxiety,clammy
ears and a weak, fast pulse. Do not attempt to move
a horsewho is in shock.Make him as comfortable
as possibleand informyourveterinarian ofthe
urgencyof your situation.
) ,4ssess behavior: If shock is not an immi-
nent threat,assessyour horse'sdemeanorfor clues
to the extent ofhis injury. Is he frantic, relatively
unconcernedorunusuallylethargic?Is he unable
or reluctant to move or is he lame for just a few
stepsthen willing to go on?Whateverthe case,
WOUl,lD
keep him calm and,if practicable,lead him to
IXYADERS:
an area where he'll be safe and unlikely to have
Tetanus is
reasonto becomeagitated.Unlesshe's flailing
causedby
violently and risking further injury, don't give
Clostridium
him sedativesor painkillers. They'll mask signs
tetanibacteria,
that provide important information for yourveteri-
whichlivein soil
narian.Theyalso may causeyour horse to overuse
andf eces.
his woundedpart.
) Examine the site: Now take a good look at A puncture woundis the perfectincubator
his injury. It's best not to touch it, particularly if for tetanusspores,so a veterinarian likely
the item responsibleis still lodgedin the wound. will administera tetanusbooster to an injured
At the very least,you're likely to causeyour horse horse.lf the horsehasn'tbeenimmunized
greaterpain and risklosing his cooperation.Han- againsttetanusin the last18months, the
dling the object might causeit to break off within veterinarian mayadminister tetanusantitoxin.
the wound. Manipulation-including cleaningor A rigidparalytic disease, tetanusis caused
flushing the injury in somecases-could drive the bv Clostridium tetani,an anaerobicbacterium
penetrant deeper,inflicting greater damageto presentin soilandfeces.Whenmultiplying
neryes,bloodvessels,organsorbone. Removal withina wound,the bacteriareleasea potent
may alsoworsen bleeding. toxinthattravelsthroughthe bloodstream to
) Prevent further injury: To avoid driving the the centralnervoussystem.
item deeper,generouslypad the area around the Theincubation periodrangesfromseveral
wound, then coverit with a clean piece of gauzeor daysto morethana month.Theinitialsignsare
cloth to protect it from further contamination and musclestiffness followedbytightening of the
control any persistent bleeding. If you're dealing jaw.As the diseaseprogresses, a horseexpe-
with a nail protruding from the sole,hold the foot riencesspasms, rigidlimbsandprotrusion of
up or duct tape a block ofwood to the bottom of the thethirdeyelid.Hisnostrils flareandhistail
hoofso the nail cannotbe pushed in deeper. andearsstiffen.Hemaylooklikea sawhorse
In most instances,it's best not to removethe andfallwith hislegsextended.
object from a puncture wound, even if it is pro- Tetanus is veryserious, with a low survival
truding from a horse'seye.Manyveterinarians rate.Horses that recoverrequirehugedoses
preferto seethe item in place so theycan trackits of antitoxinas well as constantnursingtreat-
path to determine the degree of damageand the mentfor a prol onged peri od.
potential for infection. Regardlessof location,

S E P T E MBER 2OO5 Eq u u s 33s 69

r We Know Horse People
(we're horse people too)
puncture wounds almost always devel-
op somedegreeof infection.Certain
materialsincreasethe possibility.
Woodis especiallydangerousbecause
of punctures
Sources
Ve know the boot it leavessplintersin tissue.Wire can . nai l s
you want and how break and shed rust or zinc fragments . splinters fromfenceposts
that become embedded.A sharp object andtrees
you want it. But
that was lying in manurecarries more . thorns
most of all we . smalstones
bacteria,increasingthe threat. l
know how to make ) Remove if you must: There . barbedandloosewire
it work for You. are rare instanceswhen it is advisable . fal l enbranches
to remove a penetrant beforeyour . cornstalks
See your local dealer . frozendirtclods
W'rite or FAX for veterinarian arrives:
Informaticn . It's causingthe horse to panic. . T-postfences
. Movementmight drive it deeper . barntools:rakes.pitchforks
into the wound. . latchesandhooksin the barn
. It's an item, such as rebar or a andtrai l er
metal fencepost,that is obviously . cafilewith horns

''ufL }eH n€R Companv. unbreakable.

n"..... . The wound is superficial-the
\/ t ) w-

36t4 ttnanhastreer trackofthe item is parallel to the skin.

omaha,Nebiaska68105 To removethe object,pull in the
U .S .A . direction oppositeof entry. Onceit's
Tel. 402-342-7788 FAX402-342-5444 out, examineit for missing piecesand
Internet address:http://www.dehner.com saveit foryourveterinarian to exam-
ine. Make a mark on the item to indi-
catehow deeplyitwas embedded.It is
also helpful to mark the wound site so
yourveterinarianwill be ableto locate
the puncturing item's track.
a
) Clean the site: Ifyour horse is
calm, clean the area around the wound =
by flushing it with physiologicsaline -
solution or plain water.Clip the hair if
possibleto provideyourveterinarian
with an unobstructedview of the
wound and to facilitatedrainase.

Veterinarytreatment
Whenyourveterinarianarrives,
he'll administeran antibiotic and
tetanusbooster(see"GuardAgainst
Tetanus,"page69). He'll clean the
wound if you haven'talreadyand look
for additionalpunctures.Then he'll
palpatethe area.If a metal item is be-
lievedto be in the puncture,he'll likely
x-ray the site to determine its path. At{ EYGTOWARDFItEYEXTlO}lt
Becausean X raywon't detecta Periodicallycheckyourhorse's
woodenor nonmetallicobject,yourvet- surroundings to eliminatepuncture
erinarian may anesthetizethe area and risks,suchasnailsor screws
inject contrastmaterialinto the track protrudingfromfences(top),Also
to outline the wound cavity and any avoidusingbarbed wire.
remnantsof foreien material.

70 E QU US 335 SEPT E MB E R 2OO5


Innovative
oxygentherapy
AttheAlamoPintado Equine
Medical Center in Los0livos,
California,horses withpuncture
wounds serious enough to require
surgerymayreceive follow-up
treatment inthefacility'shyperbaric April2000.
oxygen chamber. A cylinderlarge
enough to holdtwohorses, the
chamber isfilledwithoxygen at
approximately twotimesnormal
atmospheric pressure. Thisisthe
sametreatment usedto depressurizement,whichalsobolsters
scubadivers. A session takes
approximately 90minutes.
According to CarterJudy,DVM,
Dip.ACVS, a veterinarianatAlamo
Pintado,hyperharic oxygen therapy the siteof an infection-anadvantage
(HB0T)
hasbeenusedin human
The treatment regimen for a punc-
ture wound dependson the injury's
severity.In all cases,basic care in-
cludes cleaning the wound, removing
damagedand deadtissue (debride-
medi ci nefor morethana decade.
ment), and extracting any foreign
In horsesi t i s especi al useful
ly in
material that remains. Yourveterinar-
treatingclosedinfections in boththe
ian alsowill establishdrainage;.in
navi cul arj oi and
nt bursa.H B 0Thas
essence,he'll convertthe puncture to a
beenavai l ablat e A l amoP i ntadosi nce
less dangerouslacerationbywidening
the wound opening. With a foot punc-
H B 0Tdoesnotrepl aceanti bi oti cs
ture this means paring awaypart of
or anti-inflammatory medication.
the hoof.Forbodypunctures,it means
Rather, it enhances healing, says
openingthe wound until the outer sec-
Judy.Anaerobic bacteriacannor
tion is as wide as the inside.The injury
survivein the oxygen-rich environ-
alsowill be wrapped to protectit from
the white
further infection,but carewill be taken
bloodcells'abilityto defendthe body
not to inhibit drainage.
fromforeignorganisms.
A s up erfic ial p uncture may
Because oxygenpromotes blood
require no more than basic care.
floW HB0Tmayhelpantibiotics reach
Recoverynormally occurs within days.
A serious puncture-one where
whentreatingabscesses.
the item has penetrateddeeplyinto
a sensitivearea of the body-will
require surgery. Depending on the na-

7 2 Lq u us 335 SEPT E MB E R 2OO5

ture and extent of the injury as well as
the available surgical equipment, the
proceduremaybe conductedthrough
an endoscope,minimizing additional
trauma to the site. In caseswhere a
leg, joint or foot is involved, a surgeon
may aggressivelyflush fluids and anti-
biotics directlyinto the area;the proce-
dure is called perfusion. This provides
more protection than systemic admin-
istration of antibiotics. Aftercare may
involve steadying the wound edgesby
immobilizing the site in a cast,brace
or supportive bandage.Recoverymay
take as many as severalweeks.
In the aftermath
All puncture wounds-even those
that are relatively minor-need to be
monitored in the days and weeks after
injury. Be on the lookout for swelling
and tenderness in the area as well as
pus. All are indicative of uncontrolled
infection. Call your veterinarian imme-
diatelyifyou seeanyof these signs.
S E P T E MB ER 2OO5
To facilitate healing, yourveterinar-
ian may recommendstall confinement,
then, onceyourhorseis on the mend,
a few minutes of hand walking each
day.Keeping his surroundings as
clean as possiblewill minimize the
risk of his wound becomins infected
from the outside in.
Giventhe nature ofhorses,youcan
never eliminate all puncture wounds,
butyou can reducetheirincidence.
Regularly inspect the ground in areas
your horse frequents for nails, glass
shards,wood and metal splinters,loose
wire and other potentially trouble-
causing debris. Keep wood and wire
fencesin goodrepair; secureT posts
to avoid accidents.Consider sweeping
a magnet over the ground as you walk
your paddock or corral to pick up stray
bits of metal as well as nails after a
farrier's visit.
Whenyou are picking outyour
horse's hooves.take a few moments to
inspectthem foranytelltale signs ofa
puncture.And, ifyou spot one,make
every effort to find the object that
causedthe injury.
lthough a puncture wound may
I
benign, it rarely is. Without
-CLlook
prompt and proper treatment, a seem-
ingly innocent puncture can c.ause
permanent damageand even endan-
ger life. That's the problem with punc-
tures. But knowing the risks that
puncture wounds pose as well as what
to do when your horse suffers one will
help you and yourveterinarian bring
the situation quickly under control.U
EQUUSthanks Dean Hendrickson,
DVM, Dip. ACVS, of the CoIIegeof
Veteri.naryMedicine & Biomedical
Sciencesat Colorado State University
in Fort CoIIins, and CarterJudy, DVM,
Dip.ACVS, of theAlamo Pintado
Equine Medical Centerin Los Olivos,
California,for their technical assls-
tance in the preparation of this article.
Eq u u s 33s 73