Intra-articular Injection of a Dextran Polymer Combined with Antibiotic Medications for Bacterial Infective Arthritis in Dogs: 14 Cases

Objectives The aim of this study was to describe the use of an intra-articular delivery of a dextran polymer (IADP) for bacterial infective arthritis in dogs. Materials and Methods Cases of bacterial infective arthritis treated with IADP were reviewed. Resolution of infection was based on joint fluid cytology. Lameness scores, total nucleated cell counts, and per cent neutrophils were monitored throughout treatment. Results There were 14 dogs included in the study. The stifle was the most commonly affected joint. The median number of injections per dog was 3 with a median of 2 weeks between injections. Amikacin was combined with the dextran polymer in 13 cases and imipenem was used in 1 case. Concurrent oral antimicrobials were used in 12/14 cases, and surgery for infection was performed in 10/14 cases. Cytological evidence of infection resolved in 11/14 cases. Median lameness scores throughout treatment decreased from severe (grade ¾) at initial presentation to mild (grade ¼) at the final recheck. Median total nucleated cell counts and per cent neutrophils decreased from 40,000 white blood cell/µL and 91% to 2,200 white blood cell/µL and 4% respectively. A transient worsening of lameness was the main side effect documented in 5/14 cases. Conclusion Intra-articular dextran polymer combined with antimicrobials was generally well tolerated; however, the efficacy of IADP was unknown in this population since most dogs received concurrent oral antimicrobials and/or surgery.

Musculoskeletal and orthopaedic emergencies

A knowledge of bone and soft tissue injuries is required for an emergency medicine trainee. This chapter provides information on the classification and management of different types of fractures and dislocation which may commonly appear in the short-answer question (SAQ) paper. It also covers common rheumatological problems such as gout or infective arthritis and their associated diagnosis and management. The Royal College of Emergency Medicine (RCEM) curriculum includes both traumatic and atraumatic limb problems, which this chapter reflects. This chapter also covers the diagnosis and management of specific hand injuries and wound infections, which may appear as any aspect of the Intermediate FRCEM examination.

Bacterial infective arthritis of the coxofemoral joint in dogs with hip dysplasia

SummaryThe objective of this study was to describe seven cases of unilateral bacterial infective coxarthritis from a total of 19 cases of bacterial infective arthritis (BIA), presenting over a two year period. We recorded the history, clinical signs, diagnostic process, treatment and clinical outcome in these cases. The data were obtained from medical records, review of the radiographs, and telephone follow-up with the owners. All of the dogs in this study had severe chronic osteoarthritis secondary to hip dysplasia, which caused periodic hind limb lameness. They were all admitted with severe acute hind-limb lameness. Pelvic radiographs were performed under general anaesthesia shortly after presentation, followed immediately by arthrocentesis of the affected joint. The synovial fluid was evaluated microscopically by direct smear and a sample was sent for culture and sensitivity. An attempt was not made to drain or lavage the affected joint during the course of treatment. The initial choice of antibiotics was empiric and subsequently modified, as required, based on the sensitivity results. Four of the dogs showed a rapid return to weight-bearing after the initiation of antibiotic treatment, and all of the patients returned to their pre-BIA level of function. Neither recurrent infections nor any adverse sequela requiring further intervention were reported by the owners on telephone follow-up.