ISSN 2398-2977      

Foot: street-nail procedure

pequis

Introduction

  • The Street-nail procedure consists of draining an infected navicular bursa via the frog, digital cushion and deep digital flexor tendon.
  • The procedure developed its name from the common cause, historically, of the penetrating injuries which frequently resulted in the septic bursitis.
  • The technique is now largely obsolete, superseded by the less invasive technique of endoscopy   Navicular bursa: bursoscopy  , which provides for better visualization and appraisal of the navicular bursa, navicular bone and deep digital flexor tendon (DDFT); has fewer complications; shorter and less painful convalescence; and better outcome/prognosis.
  • The key to successful surgery is early (<7 days) intervention as soon as the penetrating injury is diagnosed or suspected, especially in cases where the frog, DDFT, navicular bursa, navicular bone or distal interphalangeal (DIP) joint are involved.

Uses

  • Infection of the navicular bursa   Navicular bursa: puncture  .
  • Salvage procedure following unsuccessful endoscopic surgery.
  • In cases where tissue damage is severe, or infection widespread or uncontrollable, particularly in the DDFT, digital cushion or frog.

Advantages

  • Removal of damaged and infected tissue.
  • Allows long-term drainage of infected bursa.
  • Instillation of post-operative medication.

Disadvantages

  • Painful in initial convalescent period.
  • Long convalescent period.
  • Daily attention required for several weeks post-operatively.
  • Relatively poor prognosis compared with bursoscopy   Navicular bursa: bursoscopy  .

Requirements

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Preparation

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Procedure

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Aftercare

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Outcomes

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Prognosis

  • The prognosis for septic navicular bursitis is always guarded to poor.
  • Hindlimb injuries have a better prognosis than forelimb.

Further Reading

Publications

Refereed papers

Other sources of information

  • M R Ross & S J Dyson (2011) Eds. Diagnosis and Management of Lameness in the Horse. 2nd edn. Saunders/Elsevier. ISBN: 97810416060697. 
  • McIlwraith C W, Robertson J T & Turner A S (1998) Equine Surgery - Advanced techniques. 2nd edn. Wiley-Blackwell. ISBN: 9780683057706.

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