How to Place an Orthopedic Drain in a Joint or Tendon Sheath to Treat Intrasynovial Sepsis

1. Introduction

The placement of drains into joints and tendon sheaths has frequently been used to treat intrasynovial sepsis^.1,2,3 Sepsis of joints and tendon sheaths can be difficult, costly, and time-consuming to treat. Studies of various techniques to treat joint/tendon sheath sepsis report that intrasynovial lavage and arthrotomy resulted in an improved outcome when compared to horses that were treated only with systemic antibiotics.³ Described methods of drain placement^1,2 can be difficult in certain joints. Our technique of drain placement can be utilized with or without arthroscopic guidance, requires minimal instrument manipulation, and can be done with the horse standing.

2. Materials and Methods

The materials we use include a fenestrated 0.125- inch wound tubing,a an egress cannula with a sharp trocar,b a 60-ml syringe, a no. 15 scalpel blade on a blade handle, no. 1 nonabsorbable suture material, a 14-gauge needle, glue and an injection cap. The joint or tendon sheath, as well as any wounds present, should be clipped and aseptically prepared. The most important aspect of adequately performing this technique is to obtain distention of the joint or tendon sheath. If a wound is present that allows free flow of synovial fluid, we attempt to temporarily block the exit of fluid by placing large, simple, interrupted sutures through the skin and synovial sheath. We then insert an 18-gauge needle into the joint/sheath. A 60-ml syringe filled with lactated ringers solution is attached to the needle, and the synovial capsule is infused until obvious distention is noted or resistance is encountered. An area is chosen on the joint or tendon sheath that is proximal, furthest from any wounds, and away from neurovascular structures. A no. 15 blade is used to make a stab through skin and synovial capsule. The egress cannula with sharp trocar is placed through the stab incision, carefully avoiding damage to underlying structures such as cartilage or tendons. The trocar is then removed and fluid within the capsule will flow through the cannula. The wound tubing is cut so the fenestrations will be within the capsule. The tubing is fed through the egress cannula until 2 to 3 cm of tubing are within the capsule. […]