Clinical Case Review

The Case of a “Street Nail”

The contrast material fills the navicular bursa.

Nagel, a four year old Quarter Horse gelding, presented to the Tufts Hospital for Large Animals at the Cummings School of Veterinary Medicine after stepping on a nail, which entered the outer aspect of his right hind sole. Initial home treatments included daily foot soaks, phenylbutazone (an anti-inflammatory) and a course of antibiotics. Unfortunately, Nagel’s lameness returned despite his owner’s supportive and diligent home care. Radiographs taken by the referring veterinarian showed a penetrating wound that was tracking to the navicular bursa, with a small volume of gas observed within the bursa. Contrast injection into the site of nail puncture confirmed a communication of the wound with the navicular bursa. At that time, Nagel was referred to Tufts for exploratory arthroscopy.At the time of presentation, Nagel was quite lame (4 out of 5) on the right hind leg. Based on the available diagnostic findings, Nagel was placed under general anesthesia for an arthroscopic examination of the right hind navicular bursa. At the time, a moderate amount of fibrinous material was removed. The wound tract was then thoroughly lavaged with saline using a high pressure system and debrided. In addition, regional limb perfusion (RLP) was performed using the antibiotic Amikacin.

Nagel was hospitalized after surgery for continued broad spectrum intravenous antibiotic and anti-inflammatory therapy. Regional limb perfusion was performed at several time points following surgery with alternating antibiotic use. To further support Nagel during the healing process and to prevent further contamination of the wound, a foot cast was placed on the right hind limb. Following placement of the cast, Nagel ambulated comfortably at the walk. Due to the care and support of Nagel’s owners, referring veterinarian and clinical staff at Tufts Hosptial for Large Animals, Nagel  healed thoroughly  returning to athletic performance.

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