1. BJ Newcomer Annual Conference April 7, 2011 Septic arthritis in a Red Holstein dairy heifer

2. “Reba” “2081” – 6 mo old Red Holstein heifer 3 week history of lameness/foot swelling On presentation: TPR elevated from trailer ride Nearly “3-legged” lame on left forelimb Soft tissue swelling proximal to hoof capsule Medial claw Muscle atrophy of left forelimb

3. Initial Rads Severe soft tissue swelling Gas opacities in soft tissue Increased joint space Proximal IP joint No draining tract noted Lateral claw appeared unaffected

4. Initial Treatments Hoof block placed on lateral claw Following Day (under sedation): Arthrotomy – copious purulent discharge Lavage and curettage Regional antibiotic perfusion 1 gram Naxcel ® 2 days later – Naxcel ® impregnated beads

5. Continued treatments Over next 12 days: Regional perfusion 10 mL lidocaine Daily flushing and curettage Maintenance of Abx beads Bandage changes Splints

6. 2 week rads Decreased swelling No evidence of gas opacities Periosteal proliferation Widened joint space Proximal IP joint Coffin joint Abx beads No evidence of sepsis L LTF

7. Continued treatments Cast application for additional support Large IA defect a concern Bone graft to fill defect Rib resected from mid thorax Right 10 th rib Rib crushed and placed in defect 6 Naxcel ® beads IA Hard cast applied

8. Post-cast Non-weight bearing 2 days Hoof block on lateral claw Improved lameness Dropping of right fetlock Support wrap Daily physical therapy Increased weight-bearing Able to go home

9. Post-cast Continued physical therapy BID Support wrap removed after 1 week Mild valgus of fetlock remained Muscular atrophy improvement 3 weeks later cast removed

10. 3 weeks post-cast Significant callus formation Small defect remains No evidence of sepsis Wound lavaged Significant granulation tissue Cast-reapplied

11. 3 weeks later… 2 nd cast removed Clean healing wound No discharge or odor Moderate laxity of the pastern joint Splint and stall rest over weekend Physical therapy to strengthen tendons

12. Summary Valuable heifer w/ septic arthritis Resolve infection Regional perfusion Abx beads Joint healing Bone graft Hard cast Phyical therapy

13. Questions?