An Unusual Case of Iatrogenic Septic Synovitis?

An 18 month old Arabian mare was presented with a history of acquired flexural limb deformity of both metacarpophalangeal joints. Bilateral desmotomy of the accessory ligament of the superficial digital flexor tendon was performed tenoscopically.

At the end of the surgery an approximately 5mm long vertical wound within the sterile field was detected on the medial aspect of the distal antebrachial region of the right frontlimb. The wound was closed. During a violent recovery the bandage of the right frontlimb got dislodged and had to be reapplied.

Two days postoperatively the horse developed a fever (up to 40°C) but no clinical signs of infection at the surgery site. Viral infection was suspected. During the following days no abnormal findings were noticed upon bandage changes. 8 days postoperatively lameness and diffuse swelling with serous discharge from the medial wound on the right frontlimb was detected.

Cytology results from synoviocentesis indicated aseptic inflammation of the carpal sheath. Ultrasound examination of the carpal sheath showed increased filling with hypoechoic fluid. Cellulitis and aseptic tenosynovitis were suspected and systemic antimicrobial treatment was initiated.  [...]