Post-operative care
After surgery, a protective bandage was placed and changed every three
to five days. The horse received procaine benzylpenicilline (22.000 u/kg
bwt, i.v., q. 8 h) for five days and acepromazine (0.02 mg/kg bwt, per
os, q. 6 h) during the first ten days after surgery. Sixteen days after
surgery, skin sutures were removed and post-operative radiographs were
taken (Fig 3 ). The limb was kept bandaged until full
wound healing was obtained. Three weeks later, the horse became painful
at manipulation of the scar and a small exudative wound appeared. After
radiographic and ultrasonographic evaluation, two bone sequestra were
identified at the level of the fistula. The sequesters were followed up
radiographically and the fistula was rinsed daily and kept under
bandage. Six weeks later, the sequesters were still visible on
radiographs but because of the clinical improvement and decreased
drainage from the fistula, they were left in place to resorb. The first
chemotherapy was planned four weeks later and was administered standing,
while the horse was sedated with detomidine (15 µg/kg bwt, i.v.) and
morphine (0.01 mg/kg bwt, i.v.). Regional anaesthesia consisted of
subcutaneous infiltration of wound edges with 20 ml of lidocaine.
Afterwards, 5 ml of a 10% carboplatin solution in an equal volume of
sesame oil was injected at the level of the bone defect. A protective
bandage was placed for another three days and no further medical
treatment was needed. After bandage removal, training was gradually
built up. Initially, the horse was hand walked for short periods each
day. Once the fistula had closed, additional rehab included aqua
training twice a week. Eventually the aqua training was reduced to once
a week and replaced by regular training until the horse reached its
normal level of work. Control radiographs were taken every six months.
The periosteal reaction of the second and third metacarpal bone remained
stable and the radiolucent zones became more delineated
(Fig 4) . Additionally, some trabecular sclerosis could
be observed. The horse was sound for the next three years and was used
for recreative riding.