Immediate referral to a clinic is essential if it is suspected that the puncture wound has penetrated bony, tendinous or synovial tissues. This type of injury should be treated as an emergency!

Preoperative procedure

• The entire distal part of the leg needs to be clipped and washed from coronary band to fetlock.

• The hoof is trimmed, cleaned and the horn around the entry site pared and/or filed away to a thickness that enable it to be cut easily with a scalpel during the subsequent surgical procedure.

• Surgical preparation of the entire area of operation area and application of a protective dressing.

• Anti-inflammatory and antibiotic medication and tetanus prophylaxis (see Treatment strategies).

Operation under general anaesthetic

• The procedure is performed with the horse placed in lateral recumbency and with a tourniquet in place.

• All the injured and contaminated tissue along the puncture channel must be removed in full.

• Subsequent generous irrigation of the affected synovial structures (see Treatment strategies) and the wound cavity is a key factor in reducing the number of bacteria.

• The defect is then covered with a sterile swab soaked in disinfectant and a compression bandage applied. If the structures of the navicular region (navicular bursa, navicular bone and/or deep flexor tendon) are affected, a wedge pad will also need to be applied to relieve pressure in this region.

Surgical techniques

Different surgical techniques will need to be used depending on the structures involved:

• Deep flexor tendon: resection of the affected tendon as required.

• Navicular bone/pedal bone: possible curettage 

• Puncture channel through the distal sesamoidean ligament into the coffin joint: resection of the ligament and irrigation of the joint 

• DFTS: irrigation of the tendon sheath

Postoperative management

• The irrigation of the synovial structures and the wound needs to be repeated until the follow-up bacteriology tests are negative, the wound begins to close and weight-bearing on the leg is largely normal.

• The sterile dressing needs to be changed every 2-3 days with the horse standing but sedated, until dense granulation tissue lines the wound cavity.