Wood Splinter Foreing Body in a Horse

A young mare presented with a baseball-size swelling on the left side of her neck that was just below the jugular groove. Two weeks prior, the mare presented with a puncture wound in the same area and the referring veterinarian removed several splinters. The mare was treated with antibiotics and the wound healed slowly; however, purulent discharge developed recently and the mare was tender to manipulation of the swelling. An ultrasound exam was performed and several linear foreign bodies (yellow arrows) were noted (Figures 1-3).

Figure 1

The linear foreign bodies were approximately 1-2 cm deep in the tissue and ranged in length from 5mm to 20mm (yellow arrows). Most concerning was the close proximity of one linear foreign body with the carotid artery (red circle in Figure 1)!!

Figure 2

Figure 3

 A 6cm incision was made directly over the linear foreign bodies followed by careful dissection of the subcutaneous tissues (Figures 4 and 5). Although the ultrasound exam suggested that the foreign bodies were big and obvious, it was quite tedious to locate the wooden offenders. In this case, 2 weeks had passed since the mare had impaled herself and her body had begun the process of forming thick scar tissue around the splinters, like a cocoon. After what seemed hours, 5 wooden splinters (Figure 6) ranging in size were removed from the mare's neck!!

Figure 4

The wound was lavaged heavily and left open to heal by second intention. It is probable that some wood fragments remain within the wound however their size and the extensive surgical exposure should allow for adequate healing without complications.

Figure 5

Figure 6

Not All Splints Are Created Equal!!

The radiographs below are from the forelimbs of a lame horse. The horse had prominent "bumps" on the inside of both canon bones and only one was sensitive to direct pressure (right front). These bumps were consistent with osseous or bony callous formation over the splint bones which are also know as "splints". The  splints had been present for over 45 days and despite moderate rest, the horse remained lame. Specifically, the horse was lame in the right front limb when trotted in a circle to the left! Careful exam of these "splints" revealed that in addition to being painful to pressure over the callous, the horse was positive to pressure over the suspensory ligament at the level of the fractured splint.

Ultrasound exam of the soft tissue structures near the fractured splint revealed an inflamed suspensory ligament. The image below highlights the suspensory ligament (yellow arrow). The areas of black are consistent with edema/fluid accumulation within the ligament and are adjacent to the bony callous. In addition  to the presence of edema/fluid, the fiber pattern is irregular. These findings are consistent with moderate inflammation of the suspensory ligament, most likely due to physical interference via the bony callous. 

The ultrasound image below compares the left and right suspensory ligaments at the level of the corresponding "splints". A clear difference can be seen between the suspensory ligaments (area under the yellow curves) of the lame leg (RF) versus the non-lame leg.

The horse was scheduled for surgery and the offending splint bone was removed. At the time of surgery, moderate inflammation of the suspensory ligament was confirmed. The gelding underwent an extensive period of rehabilitation consisting of rest and controlled exercise. Three months post surgery the gelding is back to work and completely sound. Special thanks to Dr. Tim Lynch at Peterson and Smith Equine Hospital for his surgical expertise and great collaborative effort!

This case is not unique and reminds us that we should pay close attention to ANY "splint" development. Most often, splints resolve without the development of lameness or significant complications however if the appropriate care is not considered, the likelihood of complications does increase. Appropriate care includes forced rest, ice therapy, topical Surpass, and shockwave treatment.