Surgical site infection associated with equine orthopedic internal fixation: 155 cases (2008-2016).
Authors: Curtiss Alexandra L, Stefanovski Darko, Richardson Dean W
Journal: Veterinary surgery : VS
Summary
# Surgical Site Infection Following Equine Orthopedic Internal Fixation Between 2008 and 2016, researchers at a single equine hospital retrospectively analysed 155 cases of internal fixation for long bone fractures and arthrodesis procedures, examining perioperative variables to identify risk factors for surgical site infection (SSI) and mortality. SSI occurred in 22 horses (14.2%), a significantly lower prevalence than previously reported in the literature; however, SSI proved catastrophic for prognosis, with affected horses being 12 times less likely to survive to discharge. Fetlock and carpal arthrodesis procedures, along with radial, humeral, and femoral fractures, carried substantially elevated risk for both SSI development and nonsurvival, whilst surprisingly, local prophylactic antimicrobial therapy was associated with increased SSI incidence rather than providing protection. Notably, factors commonly considered high-risk—open fractures, open reduction techniques, and prolonged surgical time—showed no association with SSI development in this cohort. For practitioners, these findings underscore the critical importance of recognising at-risk fracture and arthrodesis types, optimising surgical management and postoperative protocols accordingly, and maintaining heightened vigilance for early SSI signs in these populations, whilst the unexpected relationship between local antimicrobials and infection warrants further investigation before modifying current prophylactic strategies.
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Practical Takeaways
- •SSI remains a major complication affecting survival after internal fixation—horses developing SSI have a 12-fold higher mortality risk, so vigilant postoperative monitoring and early intervention are critical
- •Certain procedures carry higher SSI risk: fetlock/carpal arthrodesis and radial/humeral/femoral fractures warrant enhanced aseptic technique and management protocols
- •Local antimicrobial therapy did not reduce SSI in this population; reconsider current prophylaxis protocols and focus on surgical technique optimization and strict sterile handling instead
Key Findings
- •Surgical site infection occurred in 22/155 horses (14.2%), lower than previously reported rates (P=0.003)
- •Horses with SSI were 12 times less likely to survive to discharge than those without SSI (P<0.0001)
- •Fetlock arthrodesis and ulnar fractures were significant risk factors for SSI development
- •Local prophylactic antimicrobial therapy was unexpectedly associated with increased SSI risk, with no protective benefit demonstrated