title: Osteomyelitis and osteonecrosis after intraosseous perfusion with gentamicin.
abstract: OBJECTIVE
  To describe and discuss previously unreported complications associated with intraosseous perfusion with gentamicin in horses.
  
  
  METHODS
  Case report.
  
  
  METHODS
  Ten-year-old Warmblood gelding.
  
  
  METHODS
  Intraosseous perfusion with gentamicin into the proximal phalanx (P1) was used as part of the treatment regimen for distal interphalangeal joint and navicular bursa synovial sepsis. Although the sepsis responded favorably complications developed at the perfusion site, including persistent osteomyelitis, progressive osteonecrosis, and ultimately pathologic fracture of P1.
  
  
  RESULTS
  The progression of the clinical signs and findings at necropsy are suggestive of a toxic osteonecrosis secondary to intraosseous perfusion.
  
  
  CONCLUSIONS
  Further work is needed to investigate the effects of high dose gentamicin on equine mesenchymal cells that may be achieved during intraosseous perfusion.
  
  
  CONCLUSIONS
  Lower doses of perfusate within the medullary canal of P1 or alternative perfusion sites should be considered.
authors.affiliation: Department of Veterinary Clinical Studies, Easter Bush Veterinary Centre, University of Edinburgh, Large Animal Hospital, Midlothian EH25 9RG, UK. russell.parker@ed.ac.uk
authors.forename: Russell A
authors.initials: RA
authors.lastname: Parker
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Bladon
authors.forename: Kate
authors.initials: K
authors.lastname: McGovern
authors.forename: Ken C
authors.initials: KC
authors.lastname: Smith
mesh_terms: D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005839:Gentamicins / Q000008:administration & dosage / Q000009:adverse effects*; D006734:Horse Diseases / Q000139:chemically induced* / Q000188:drug therapy; D006736:Horses / Q000293:injuries / Q000601:surgery; D006801:Humans; D017148:Infusions, Intraosseous / Q000009:adverse effects / Q000662:veterinary*; D007794:Lameness, Animal / Q000209:etiology / Q000601:surgery; D008297:Male; D050279:Metacarpal Bones / Q000293:injuries / Q000382:microbiology; D010019:Osteomyelitis / Q000139:chemically induced / Q000662:veterinary*; D010020:Osteonecrosis / Q000139:chemically induced / Q000662:veterinary*; D011512:Proteus Infections / Q000188:drug therapy / Q000662:veterinary
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins