Osteomyelitis and osteonecrosis after intraosseous perfusion with gentamicin.
Authors: Parker Russell A, Bladon Bruce M, McGovern Kate, Smith Ken C
Journal: Veterinary surgery : VS
Summary
# Editorial Summary This 2010 case report from the Royal Veterinary College describes a serious complication arising from intraosseous gentamicin perfusion in a ten-year-old Warmblood gelding treated for septic arthritis of the distal interphalangeal joint and navicular bursa. Although the initial infection responded well to treatment, the horse developed progressive osteomyelitis and osteonecrosis at the perfusion site in the proximal phalanx, eventually resulting in pathological fracture. Necropsy findings suggested the bone damage was toxic in nature, directly caused by high-dose gentamicin exposure to the medullary canal rather than residual infection. The authors highlight a previously undocumented risk: whilst intraosseous perfusion effectively delivers antibiotics to infected joints, the therapeutic concentration may prove cytotoxic to equine bone-forming cells and marrow tissues. For practitioners considering this technique, the implications are significant—dose reduction within the medullary canal, alternative perfusion sites, or modified protocols warrant serious consideration to preserve skeletal integrity, particularly given that the underlying sepsis may already be controlled by the time osteonecrosis develops.
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Practical Takeaways
- •Intraosseous gentamicin perfusion into P1 carries significant risk of bone necrosis and fracture even when joint infection appears controlled—weigh benefits against this serious complication
- •If using intraosseous perfusion for distal limb sepsis, consider reduced gentamicin doses or alternative perfusion sites to minimize osteotoxicity
- •Monitor treated cases closely for delayed lameness, swelling, or instability that may indicate developing osteonecrosis or fracture risk
Key Findings
- •Intraosseous gentamicin perfusion into P1 resulted in toxic osteonecrosis and progressive bone destruction despite initial control of joint sepsis
- •Necropsy findings demonstrated osteomyelitis and osteonecrosis at the perfusion site with eventual pathologic fracture
- •High-dose gentamicin exposure via intraosseous perfusion may cause direct cytotoxic damage to equine mesenchymal and bone cells
- •Alternative perfusion strategies including lower doses or different anatomical sites should be considered to avoid this complication