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Friday, August 02, 2013

Vet Video: Fractured Pastern Surgically Repaired on Champion St Nicholas Abbey; Details on Work by Irish-American Surgical/Medical Team




A report on the injury, surgery, illness and recovery of Breeders Cup winner St Nicholas Abbey has been provided by Coolmore Stud, ten days after the initial injury, which happened at the training center in Ireland.



On July 23rd St Nicholas Abbey presented to Fethard Equine Hospital for evaluation and surgical correction of a complex fracture to the right fore pastern which occurred while exercising at Ballydoyle.

The limb had been promptly and properly stabilized in a thick padded splint bandage on the gallops at Ballydoyle and St Nicholas Abbey was referred immediately to Fethard Equine Hospital in a specialized equine ambulance. These early interventions are of exceptional importance and can be lifesaving.

St Nicholas Abbey's original injury, first radiograph

Radiographic examination revealed multiple fractures of both the proximal and middle phalanges of the right front limb which involved both the fetlock and proximal interphalangeal (pastern) joints.

In St Nicholas Abbey's case we can see that the proximal and middle phalanges are fractured in many pieces involving both the fetlock and proximal interphalangeal (pastern) joints. In an effort to save his life, the bones had to be reconstructed with screws and bone plates.

As soon as both Dr Ger Kelly and Dr Tom O'Brien of Fethard Equine Hospital evaluated the fracture, they immediately contacted one of the leading experts in the world on fracture repair in horses, Dr Dean Richardson of New Bolton Equine Center at the University of Pennsylvania. Through his expertise and input the best possible surgical repair of the fracture would be performed in an effort to save St Nicholas Abbey's life.

A second view of St Nicholas Abbey's fractured pastern.

The morning following his injury St Nicholas Abbey was placed under general anaesthesia and his fractured leg was prepared for surgery.

During the surgery, it was found that some of the smaller bone fragments had lost their blood supply and had to be removed leaving a gap in the bone. For this reason a bone graft was taken from St Nicholas Abbey's right hip to replace the damaged bone, which will hopefully speed up the healing process.

The team then focused on reconstructing and stabilizing the pastern and fetlock joints using a total of twenty screws and two bone plates in the limb.

The first stage of the surgery fuses the long and short pastern bones.

In the last stage of the repair, a large steel pin was placed through the lower end of his cannon bone. This pin was then incorporated into a fibreglass cast.

The pin will minimize the amount of weight placed on the repair in the first month following the surgery. Instead of the weight of the horse being transferred through the injured leg, bone plates and screws the weight is now supported by this steel rod and the fiberglass cast.  This procedure in addition to the screws, plates and cast allow a repair which is as rigid and stable as possible.

This final slide illustrations the steel fixation rod through the cannon bone to the cast.

It is important to realize that horses cannot stand on one front leg for a very long period of time, as they can quickly develop laminitis on the good supporting foot. This in itself can be a life-threatening consequence of this type of injury. Therefore when repairing a fracture of this magnitude, the horse has to be able to take weight on the fractured leg immediately following the surgery.

Dean Richardson, DVM, of the
University of Pennsylvania
consulted on the surgery.
St Nicholas Abbey's recovery from anaesthesia was excellent and he returned to his stall for intensive postoperative care.

This whole series of events puts huge stress on a horse's system. Through hospitalization, anaesthesia, periods of fasting and the adverse effects of anti-inflammatory drugs, it is extremely easy to throw the delicate digestive tract off balance.

Approximately 48 hours following the initial fracture surgery, St Nicholas Abbey began to show signs of colic. Fighting another life threatening condition St Nicholas Abbey was rushed back to surgery where his abdomen was opened to empty and flush his caecum. Again St Nicholas Abbey had to face recovery from anaesthesia, which he came through with flying colors.

Nathan Slovis, DVM, of Hagyard
Equine Medical Institute in
Kentucky consulted on the
colic recovery.
Following St Nicholas Abbey's second surgery, Dr Nathan Slovis of the Hagyard Equine Medical Institute in Kentucky was consulted to oversee his on-going recovery and treatments. St Nicholas Abbey's food intake was restricted and he was placed on intravenous nutrition to fulfil his daily requirements. His food intake will be slowly increased as he recuperates and he is now enjoying small amounts of freshly cut grass.

A major life-threatening fracture has been repaired and a major life-threatening colic complication has been corrected but St Nicholas Abbey still has a long way to go. Other life threatening complications may yet arise including laminitis, surgery site infection and failure of the implants in the repaired fracture.

Each new day is a victory on his road to recovery.

Thanks to Coolmore Stud and Fethard Equine Hospital for their work to document St Nicholas Abbey's injury, treatment and recovery. 

To learn more:

"The Equine Pastern" free PDF download from The Compendium via vetlearn.com.


"Complications of Orthopaedic Surgery in Horses" by Dean Richardson DVM in Surgical Complications and Management Strategies: Vet Clinics of North America, 2008

Click to download Hoofcare's plastinate and visual anatomy education brochure.

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3 comments:

Anonymous said...

If you look at Coolmore's picture of Abbey's last win, you can see that his left leg is hyper-extended. Both of Eight Bells legs were even more so as she was propelled along to the finish. I do not know the mechanism, but it seems the joints, ligaments, and soft tissues are being stretched beyond normal range of motion. I have noticed this hyper-extension in many Thoroughbreds that later suffer injury a race or two later. Perhaps there is a need for a harness device applied to attend natural curvature of the legs. The restricted horse might not win the race, but also would not perish in the end. I believe Eight Belles was so caught in the adrenaline of the race that the filly was unaware of the progress of her injuries. A horse will always try mightily to please.

Laura Martin said...

It’s saddening to see the damage caused by this injury, complication that happened during surgery and further more complications post surgery. So much pain the poor creature has to go through, hope the horse gets all well soon to be seen in the races!

Karasu Veteriner said...

Nice sharing. Thank you.