Sequestrum post-tibial plateau leveling osteotomy treated with debridement and vancomycin-impregnated calcium sulfate...

A 9-year-old neutered male German shepherd dog was presented because of a left pelvic-limb lameness and chronic draining tracts along the distomedial left stifle at 3 mo post-tibial plateau leveling osteotomy (TPLO) plate explantation. Tibial plateau leveling osteotomy was completed 9 mo before presentation. Bone imaging, surgical, and histopathologic evidence supported the development of a bone sequestrum at the surgical site. Culture and sensitivity assessment of the draining tracts indicated that the dog had developed a methicillin-resistant Staphylococcus pseudintermedius infection. The bone sequestrum was surgically debrided and vancomycin-impregnated calcium sulfate beads were packed into the resultant bony defect. At mid- and long-term follow-ups, the chronic infection and draining tracts had resolved. The dog recovered well with bony remodeling of the surgical site. Key clinical message: This case report describes the diagnosis and successful surgical management of an S. pseudintermedius-infected bone sequestrum at a TPLO site. Bone sequestrum and comprehensive antimicrobial management should be considered in the TPLO patient with chronically draining tracts post-implant removal. Increased awareness and appropriate treatment of bone sequestra and complicated infections can improve patient outcomes.