Complete ostectomy of middle phalanx and partial ostectomy of proximal phalanx in a Brown Swiss calf for treatment of purulent arthritis of the proximal interphalangeal joint and adjacent severe osteomyelitis.

A five month old Brown Swiss heifer calf (212 kg body mass) with severe left hind limb lameness, caused by a wound of the lateral digit was referred to the veterinary teaching hospital. The calf showed a score 4 of 5 lameness on the left hind limb. A scarified skin lesion with a fistula formation and purulent exudate was observed at the level of the proximal interphalangeal joint (PIJ) of the lateral digit of the left hind. The PIJ region and the lateral digit were severely swollen and painful. Ultrasonography showed a moderate anechoic effusion of the lateral digital flexor tendon sheet (DFTS) and a severe heterogeneous hypoechoic effusion with some small hyperechoic areas of the plantar and dorsal pouch of the PIJ. In addition, a highly irregular contour of the dorsal and abaxial surface of the phalanx media (P2) and the distal aspect of the proximal phalanx (P1) were imaged. Based on physical examination and ultrasonographic findings, the diagnosis was chronic purulent arthritis of the PIJ, osteitis of P2 and the distal end of P1 with suspected adjacent osteomyelitis. Complete ostectomy of P2 and ostectomy of the distal part of the P1 of the lateral digit was performed with an oscillating saw through the extended debrided wound. The lameness improved subsequently and 21 days post-surgery the calf was discharged from the clinic without lameness, and with a wooden block attached to the healthy claw. A year later the heifer was pregnant and still in the herd, during this period it did not exhibit lameness. The described surgical technique resulted in an excellent long-term outcome and may be considered in cases of severe purulent joint infection of the PIJ with osteolytic processes in adjacent bones, as a digit salvage procedure especially for young cattle.