Barbaro ~ America's Horse

Just rec’d this from a good friend at SYNTHES N.A. headquartered in West Chester, PA, Thought I’d pass it on to this thread…

Subject: Barbaro gets the best possible care

As many of you have heard, the most heartbreaking story of the weekend was the breakdown of Kentucky Derby winner Barbaro in the Preakness horse race on Saturday. Fortunately due to the incredible care Barbaro has received since the injury, he has a chance to survive his devastating injury. And Synthes has played a role in this story.

The treating veterinary surgeon, Dr. Dean Richardson is a longtime AO Faculty member, Synthes friend and strong proponent of LCP plating for horses. His experience with LCP over the past year has shown his horse patients to be more comfortable after surgery with LCP. Consequently he now routinely plates with LCP and Barbaro is no exception.

Barbaro underwent a 5 hour procedure last night repair many severe fractures to his hind ankle. Dr. Richardson elected to fuse Barbaro’s ankle joints using a 4.5mm Broad LCP using predominantly locking screws. It is still very earlier in the long road to recovery for Barbaro but it is reassuring to know he has the best care in the world at New Bolton Center and Synthes implants.

I have a question about his rehab. IF he survives the initial days, weeks and months, and his leg stabilizes, would they potentially use water therapy for controlled exercise? I don’t know anything about this, but have seen several photos recently showing horses working out in water. Just curious whether this might be an option?

Prayers continue.

I would certainly think so. It worked great for mine.

All the equine surgeons at N.B. are on faculty staff in the vet div. of SYNTHES and teach at the annual Columbus Ohio AO North America Large and Small Animal Vet courses. So they are quite familar with the materials & hardware used. Hopefully he will heal quickly before the implants are stressed to their limits though. The implants are load sharing devices, not weight bearing devices. But you can’t necessarily give instructions to the horse not to fully weight bear, as you can with humans. I’m sure they are doing all that can be done to protect the construction, but….

In yesterday’s press conference, somone asked about rehab/physical therapy, and Dr. Richardson made the very good point that the outcome of this surgery was not to return the leg to any range of motion/normalcy, but to fuse/decrease range of motion.

I don’t have a clue of what or how they will handle rehab, but its probably worth remembering the end goal of this surgery is radically different from most surgeries…

Would this mean that the majority of the screws would not have to be removed? If so why not use all locking screws?

I am curious as another non racing stallion I know of with a similar injury developed an infection when the screws were removed. The infection could not be healed and he had to be put down after 5 month of recovery. I would love for this possibility to have been removed for Barbaro.

implants

A mare of mine broke her P2 into 3 pieces, repaired w. plates and fusion of P1 & P2 (a minimal-motion joint anyway). Was at Davis. After 3+ mo. she developed an infection and the plates were taken out and she was treated w. antibiotics. 10 yrs later she has a bigger and slightly stiff pastern but looks totally sound and can run with the rest of them. She chooses to drop out sooner than the uninjured tho. Broodmare only.
This was a 3 yr old big-boned Arabian who had spent her first 3 yrs confined in a small pen. I attribute the accident (freak step) to that lack of normal conditioning that produces bone density.

Apologies if this has already been posted…

I hope this isn’t a duplicate. The latest excerpted from bloodhorse.com:

“He got through the night very well, day one and into day two is going as well as expected,” Dr. Corinne Sweeney, a veterinarian and the hospital’s executive director, said Monday. “He is standing on the leg, and with the appropriate amount of weight on it. He also showed appropriate interest in the mares, which means he’s acting like a young colt should.”

Sweeney said there are two major concerns in the first days of recovery, the possibility of infection from the surgery and laminitis, a potentially fatal disease sometimes brought on by uneven weight balance.

“He’s doing exactly what the doctor wants, but he’s got a long road ahead,” Sweeney added. “A lot of possible problems that could occur have not.”

See the full article at www.bloodhorse.com - and accompanying slide show.

The arthrodesis plate was made and sterilized ahead of time, and then bent to fit him during surgery. (They come in difference lengths to fit a variety of horses.) It is designed to never come out, unless there is a problem with infection. The locking nails in the athrodesis plate are also permanent. I haven’t looked at the films since last night but I don’t recall seeing any hardware that looked like it would be removed.

The plate will have to removed after time due to a condition called stress shielding. Bone must have a load to grow and maintain itself. The plate changes the load path in the bone thus causing a shift in how the bones will “remodel.” This is similar to why some hip implants fail in humans. Right now the plate is taking the entire load and it will fail around 2-3 million flexions (it is stainless steel as that is what Synthes makes). This comes out to about 1 year of walking around if the fractures fail to heal (non-union fracture). If the plate is left in, the surrounding bone will become weaker over time.

Also, the plate will fail on its own due to fatigue in its current position and its current configuration. The curve is a “stress concentrator” that will cause fatigue and micro fracturing in the plate over time. Hopefully the bones will be healed sufficiently to take the load when the plate goes.

The screws and plate will all go. Since the plate is held in place by the screws. In humans we do the same thing with intremedually nails when a person shatters their femur or tibia.

Reed

Removing screws is no indicator of if an infection can or can not take hold. We face all sorts of possible infection inducing problems with implant materials because bateria are RAINING down from the air all of the time during surgery and it takes only a few in the surface pores (less than 1/100 the width of a human hair) of a screw to carry bateria into a wound. This is called a latent infection and can occur even with sterilized materials.

Locking bone screws are NOT like those we use in everyday life. They are meant to lock to the plate. They can only “lock” to the bone for a few weeks since bone itself will grow away from the surface of the the screws due to remodeling (the continuous reshaping of bone to adjust for loading environments and repair micro fractures). We usually see around 2% of bony contact lost annually in bone implants due to this. Thus there is no such thing as a “locking” screw. Clinicians use this term inappropriately.

Reed

Thanks Reed!

Some of this is repetitive but there’s a couple new items in it. It’s from www.philly.com:

Trainer Michael Matz won’t ever forget how he last saw his horse at Pimlico Race Course. He expressed genuine wonder at how he saw his horse last night: Barbaro walking to his stall on four legs, then eating some hay.

“I felt a lot more relief when I saw him walk in the stall than I did when I loaded him in the ambulance [in Baltimore] to come up here,” Matz said.

Dean Richardson, chief of surgery at the University of Pennsylvania’s school of veterinary medicine at the New Bolton Center in Kennett Square, performed yesterday’s five-hour, 10-minute surgery on Barbaro’s right hind leg. Richardson made it clear that the Kentucky Derby winner’s chances for survival still are not better than 50-50.

“No one’s going to want to hear this,” Richardson said. “He’s still a coin toss, even after everything went well.”

But Richardson also said: “He practically jogged back to his stall.”

Barbaro suffered the devastating injuries Saturday in the first furlong of the Preakness Stakes. “Most horses who receive this severe an injury are typically put down on the racetrack,” Richardson had said before the surgery. “It’s about as bad as it could be.”

Barbaro had three fractures in his right hind leg, above and below the ankle. He also dislocated the ankle joint, doctors said. The pastern bone was in “probably 20-plus pieces,” Richardson said afterward.

“Oh, my God,” a Penn veterinary student said from the back of the room.

A metal plate was put in, 23 screws were inserted, and the ankle joint was fused, meaning it will not be a joint anymore if the fusion is successful. The process will take weeks.

“It is very unusual to have these three catastrophic injuries all piled into one,” Richardson said before the surgery at the Chester County facility. “I’ve never tackled one exactly like this.”

Barbaro, who will be at the facility for at least several weeks and possibly much longer, did pass another hurdle: Richardson found that the blood supply in the colt’s leg remained good.

The blood was “almost oozing through the skin,” Richardson said, but the skin had not broken.

As with other horses going into surgery at the New Bolton Center for Large Animals early yesterday afternoon, Barbaro was moved on a sling from intensive care, via a monorail, to the surgery table.

After the surgery, with the colt still in the sling, the monorail took him to a pool - “a fairly unique system,” Richardson said.

The facility’s pool recovery system allows horses to awaken from general anesthesia in a raft of sorts in the pool, still in the sling.

Richardson said he could tell he was dealing with an athlete. The horse tried to get out of the sling after being lifted from the pool, which was warmed to 97 degrees.

Speaking to about 75 members of the media at a 9:15 p.m. news conference, Matz said he had just spoken with owners Roy and Gretchen Jackson, who expressed their appreciation.

Richardson did not rule out Barbaro’s having a future as a stallion, which certainly is an issue. The Kentucky Derby winner has an impressive pedigree and a proven ability to win on different surfaces at varied distances. His value could have been more than $30 million.

But Richardson explained all the complications that could still set in, such as infection or problems with the opposite foot.

“It is the first step, but not the last step by any means,” the surgeon said, also talking about having to “manage his comfort.”

Jockey Edgar Prado, who was credited by doctors for his quick action in pulling up the horse, said after the race that “he took a bad step and I can’t really tell you what happened.”

The jockey said he heard a noise and began pulling him up. Barbaro wobbled for an additional 100 yards on three legs, with the right rear hind leg up in the air, the ankle hanging at an unnatural angle.

Richardson estimated the medical costs would run into the tens of thousands of dollars. The Jacksons, who live just down the road from the front entrance to the clinic, have been major donors to New Bolton.

Gretchen Jackson is on the board of overseers of Penn’s school of veterinary medicine. The Scott Equine Sports Medicine Clinic was dedicated June 29, 2002. It is named for Almira and Hardie Scott, Roy Jackson’s mother and stepfather.

New Bolton, in the midst of a $60 million expansion and refurbishment, considers its seven-day-a-week, 24-hour critical care service the first of its kind in the nation. There are four hospital wards for 150 horses, with an isolation facility for infectious cases and a climate-controlled neonatal intensive care unit for sick foals.

Barbara Dallap, the critical-care specialist who first examined Barbaro on Saturday night when he was rushed from Pimlico, also described the colt’s first hours at the facility: “He’s been extremely… brave and well-behaved… . He’s been comfortable all night.”

The outpouring of public emotion was immediate. A number of well-wishers were allowed to stop in with gifts of support.

John Farrell said he drove from Lancaster with his 31/2-year-old son, Hank, and 2-year-old daughter, Jane Elizabeth.

“They wanted to bring Barbaro some apples and carrots,” Farrell said. “Make him feel a little better.”

heehee. Just watched Comcast Sports on TV and they were talking about Barbaro. They were impressed with Dr. Richardson and one guy said, “There are guys who are players and guys who can be players AND coaches, which is rare. This guy is definitely a player who could also be a coach.” They loved that he’s a fantastic surgeon and that he also explains things so directly, honestly and well.

They also were amazed at the honesty of the reports-- they guessed because it was a horse. They got a kick out of the comment about the mares, and were imagining reports on injured ballplayers where the doctor would be happy with a patient’s progress because ‘he’s taken an interest in the nurses and is chasing them around the room.’

Sedation Questions: How do they keep him from acting up too much and for how long can they use sedation as a means to control his activity? How long can you keep a horse calm so that they don’t injure themselves? Eventually, they will have to move him so how do they and for how long can they use sedation medication?

Supposedly an update on CBS momentarily. Anyone watching??

Caught both ABC and CBS’s coverage

I love having DVR :D. When I saw your post War Admiral I was able to rewind both coverages. Unfortunately nothing new.

The surgeon is doing a great job communicating with the media. He said that Barbaro was still nickering at the mares. The ABC correspondent asked if that meant he was flirting and the Doc said exactly.

CBS showed a horse that suffered a broken foreleg a few weeks ago that would allow the vet to pick up the opposing one. It was the vet that first saw Barbaro on the track.

Barbaro in everyone’s prayers

I hope everyone out there will join me. Today, I wore two ribbons looped together in Barbaro’s racing colors. It shows everyone I come in contact with that I am supporting this great horse and his recovery. Said prayers as I hugged all the ex-racers on me farm.

Hey, that’s a great idea TBlvr!

And thanks for the update Laurel & Holly! No news is good news!!

Show your support ribbons for Barbaro

…and since I have a whole spool of this ribbon, if anyone out there would like a loop, email me @ treasurendoodle@aol.com and I will pop one in the mail for you!

Jingles for the big guy!