title: Outcome of horses with synovial structure involvement following solar foot penetrations in four UK veterinary hospitals: 95 cases.
abstract: BACKGROUND
  The factors associated with outcome following solar foot penetration involving synovial structures treated using endoscopic lavage have not been described in the UK population.
  
  
  OBJECTIVE
  To provide descriptive data on horses with synovial contamination or sepsis following solar penetration in 4 UK equine referral hospitals and to identify specific factors associated with the outcome.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Data were collected from 4 veterinary hospitals. Follow-up data were obtained via a telephone questionnaire. Two multivariable logistic regression models were generated. Model 1 included all horses with synovial contamination following foot penetration undergoing surgical treatment, with the outcome variable being euthanasia during hospitalisation. Model 2 included all horses surviving anaesthesia, with the outcome variable being failure to return to pre-injury athletic function.
  
  
  RESULTS
  Ninety-five horses were included. Overall, 56% of horses survived to discharge and 36% of horses returned to pre-injury athletic function. Model 1 included penetration of the central frog sulcus (odds ratio [OR] 10, 95% confidence interval [CI] 1.9-51.8), concurrent distal phalanx involvement (OR 32, 95% CI 2.6-101.9), increasing days to presentation (OR 1.2, 95% CI 1.0-1.3) and hospital. Model 2 included increasing days to presentation (OR 1.1, 95% CI 1.1-1.6), breed (OR 32, 95% CI 2.2-135.4), more than one surgery (OR 5.6, 95% CI 1.0-32.7) and hospital.
  
  
  CONCLUSIONS
  Synovial involvement following solar foot penetration has a guarded prognosis for survival to discharge and a poor prognosis for return to pre-injury athletic function. Penetration of the central sulcus of the frog and distal phalanx involvement are associated with euthanasia during hospitalisation. Delayed referral and hospitalisation are associated with both euthanasia and failure to return to pre-injury athletic function. Breed and more than one surgery are associated with failure to return to pre-injury athletic function. These data may assist veterinary surgeons and owners to make evidence-based decisions when managing cases with synovial involvement following solar foot penetration.
authors.affiliation: Philip Leverhulme Equine Hospital, School of Veterinary Science, University of Liverpool, UK.
authors.forename: J A
authors.initials: JA
authors.lastname: Findley
authors.forename: G L
authors.initials: GL
authors.lastname: Pinchbeck
authors.forename: P I
authors.initials: PI
authors.lastname: Milner
authors.forename: B M
authors.initials: BM
authors.lastname: Bladon
authors.forename: J
authors.initials: J
authors.lastname: Boswell
authors.forename: T S
authors.initials: TS
authors.lastname: Mair
authors.forename: J M
authors.initials: JM
authors.lastname: Suthers
authors.forename: E R
authors.initials: ER
authors.lastname: Singer
mesh_terms: D000818:Animals; D005260:Female; D018409:Foot Injuries / Q000628:therapy / Q000662:veterinary*; D006736:Horses / Q000293:injuries*; D006762:Hospitals, Animal; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D013583:Synovial Membrane / Q000473:pathology*; D007507:Therapeutic Irrigation / Q000662:veterinary; D016896:Treatment Outcome; D006113:United Kingdom; D014950:Wounds, Penetrating / Q000628:therapy / Q000662:veterinary*
keywords: foot penetration; horse; navicular bursa; synovial sepsis