Custom Unibar Brace and Platelet-Rich Plasma Therapies Target Hind Limb Suspensory Collapse at Virginia's Marion duPont Scott Equine Medical Center

A horse arrived one night in November at the Marion duPont Scott Equine Medical Center in Virginia with collapsed fetlocks. The horse was in pain and needed a plan.

A three-pronged pain management, regenerative therapy, and mechanical support based on a unique fetlock support brace proved successful in treating an 18-year old Thoroughbred gelding at Virginia Tech's Marion duPont Scott Equine Medical Center (EMC) in Leesburg, Virginia. The horse arrived barely able to walk and was suffering from the collapse of both hind limb suspensory ligaments.

The owner told The Hoof Blog that the horse had been seen by three veterinarians but no diagnosis of its lameness problem had been made. When the fetlock problem became severely painful, she made the decision not to wait any longer and took the horse to the Leesburg referral center as an emergency case.

The hospital noted that the breakdown was so severe that both hind fetlocks were almost parallel to the ground. Instead of a more normal 145 degrees, they were at 116 (left fetlock) and 125 degrees (right fetlock), respectively.

The fetlock brace's foundation is an elaborate platform of toe and heel extensions on the hind shoes that will become the brackets that hold the brace's vertical members. (In this photo you can only see the heel platforms.)

“I’d say [the horse’s] condition was among the more severe that we’d seen, due to the acute nature of the problem and the severity of his pain,” noted Dr. Jennifer Barrett, assistant professor of equine surgery at the EMC. “When he arrived, this horse was in a life-threatening situation. His high level of pain was a serious concern, and the degree to which his hind limbs had dropped left an open question of whether we would be able to provide a humane level of comfort for him in the long term.”

Barrett developed a three-pronged strategy.

• First, his high level of pain was alleviated with a constant intravenous infusion of pain-relieving medications; 
• Second, his degenerating suspensory ligaments were treated with regenerative medicine techniques, namely platelet rich plasma (PRP) injections; and 
• Third, his fetlock joints were supported mechanically at a more normal position with custom-designed and fabricated shoes and braces.

This photo gives a sense of the structure of the heel platform and how the fetlock uprights are bridged for stability near the base (black cross-bar above bolts).

The horse received a three-dose series of injections of platelet-rich plasma (PRP) directly into the injured portion of the suspensory ligaments to help stimulate and speed up the healing process.

Because hind-limb suspensory ligament breakdowns typically recover poorly and have a reduced chance of complete healing, newer therapies — including surgery, PRP, and stem cell therapy — have improved the recovery chances for horses with this condition.

“We were counting on the PRP to spur healing for [the horse], while we re-aligned the fetlocks with custom-designed shoes. The fact that both his hind limbs were affected only made matters worse, but we didn’t give up hope,” Barrett said.

Paul Goodness's "unibar" brace's front bar has a hinge. "Our newer (and better) approach is a semi hard/flexible shell that contours to the leg with a half-inch gel pad liner," Paul said in June. Here you can see he has used a PVC collar that sits just below the hock; the top of the unibar is bolted into the PVC there.

Long-time hospital farrier Paul Goodness created two sets of shoes with fetlock support for the horse that would realign his hind limbs while the ligaments healed. Supporting the fetlock joints was a key factor in the process; however, that support created pressure sores in the areas of support.

“That horse was my New Year’s Eve date,” Paul Goodness recalled. “His skin was that difficult to manage. I had been away over the holidays and he was the first stop for Gwen (one of his current Forging Ahead interns) and me as soon as I got back."

Paul calls this design the “unibar” brace, since it has a hinged vertical extension running up the front of the limb that is exposed and visible. Most braces only extend up the back of the leg or, more commonly, have supports on either side of the limb; bandaging material then forms a sling between two poles under the fetlock. The "unibar", as Paul calls this design, is a much lower profile than the common brace designs in use and has two forks extending up on either side of the fetlock from bolts welded onto a shoe heel extension plate. The shoe is anchored in front and behind by extensions with bolts to attach the three vertical members.

“This was a challenge, since it was both hind limbs,” Paul shared. “In the past, I’ve had horses get all tangled up behind when they have braces on both hind legs. This brace is hinged in only one direction and is very low profile on the horse.”

“It was a race between the healing of the ligaments and treating the sores on the skin during the time [the horse] needed support for his rear limbs,” Barrett said. “Instead of the weight of the horse being supported by ligaments, it was being supported by slinging his fetlocks from the outside with extensions from his shoes. So, his skin experienced the pressure that the ligament usually supports.

“We expect a full recovery, and plan to monitor his progress because this treatment approach may help other horses out there,” Barrett noted.

Paul Goodness supplied The Hoof Blog with an alternate photo; it shows another method of attaching the limb to the brace. It is simply a modified "Robert Jones'"bandage slung to the frame with elasticon.

Paul reports that the horse is now turned out in a big field with normal-sized egg bars on his hind feet, dropped down in size from the previous extended heel egg bars. “By the fall he should be in regular shoes, and then, hopefully, he’ll just go barefoot,” Paul summarized. “I wish I had more clients who were willing to go this far to help these old guys.”

Paul also commented that some credit for the success of the treatment should be given to the horse’s residency at the hospital where his skin condition could be watched and treated as needed.

In hindsight, the owner offered this insight: "I do feel strongly that case write-ups can help others who may be in this situation. My advice to others would be to follow your own instincts. I tend to be very anal about horse care and try to follow the vet's instructions 'to the letter', but in this case I think that actually delayed me taking the horse to the EMC, which caused a delay in treatment. If the home vet isn't diagnosing the problem and the horse is in pain, I would encourage people to not be shy and go to the hospital for a proper diagnosis. The fact that three vets had seen him at home without a diagnosis was worrisome, but I wish I had taken him earlier."

The Hoof Blog thanks the owner, Paul Goodness, Dr. Barrett and Cathleen Lee of Virginia Tech for their assistance with this article. All photos are the property of the EMC and/or Paul Goodness. 

Fran Jurga's Hoof Blog is a between-issues news service for subscribers to Hoofcare and Lameness Journal. This blog may be read online at the blog page, checked via RSS feed, or received via a digest-type email (requires signup in box at top right of blog page).