Barbaro: Pastern Joint Infection, more surgery this weekend

The latest from New Bolton Center, direct transcript provided by the hospital:

Veterinarians treat Barbaro for infection, replace plate and screws in injured leg

July 9, 2006

KENNETT SQUARE, PA – Late Saturday, July 8, Dr. Dean Richardson, Chief of Surgery, replaced the plate and many of the screws that had been inserted into Barbaro’s injured hind leg on May 21. “Barbaro had developed some discomfort and a consistently elevated temperature so we believed it was in his best interest to remove the hardware and thoroughly clean the site of the infection,” said Dr. Richardson. “We also applied a longer cast on that leg for additional support.”

While the main fracture is healing well, the pastern joint that doctors are attempting to fuse continues to be the area of concern. This joint was stabilized with new implants and a fresh bone graft.

“The recovery process from anesthesia took longer with this surgery, but Barbaro is now back in his stall in the Intensive Care Unit,” said Dr. Richardson. “He is receiving pain medication, antibiotics and other supportive care.”

Barbaro continues to be monitored closely in the Intensive Care Unit of the George D. Widener Hospital at the University of Pennsylvania’s New Bolton Center. Dr. Richardson emphasized that the complications are potentially serious. Both Barbaro’s owners and trainer continue to visit him at least twice daily.

Barbaro's Good-Foot Abscess is No Big Deal, Says Farrier Rob Sigafoos

Ok, everyone calm down. All the gloom-and-doom types out there are predicting that Barbaro is crashing with laminitis in his good foot. We went straight to the source.

New Bolton Center Chief of Farrier Services Rob Sigafoos reports that the horse does have a minor abscess near the tip of the frog which, to quote Rob, "Could (and does) happen to any horse." Accordingly, Rob "just put the same type of shoe back on and treated the abscess." He did not mention that he put a drain in, and I think he would have commented on that if he had done it.

Stay tuned...

Another Conference on the Equine Spine...

I don't know about you, but I think the surge of interest (and research) on the horse's spine is fascinating. I want to soak it all up. The conference in Newmarket, England in October is featured in this blog if you scroll further down the page, and now I find out about another to be held in The Netherlands in September.

This one is an eight-day course and includes speakers like Willem Back, Kevin Haussler, Jean-Marie Denoix, and some new Dutch and Belgian names that I would like to get to know. Learn more here:

http://www.cursuscentrum.nl/fes/

Nothing to do with lameness, but...

Here's a nice story from the World Paint Championships, about a halter horse that was missing for three months after Hurricane Katrina but was finally reunited with his owner, just as vets were about to put him down because of his injuries. His owner was an emergency room nurse in New Orleans who did not leave her post when the storm hit. She never gave up looking for him; the vets ID'd the gelding by microchip. From today's Fort Worth Telegram.

(Those of you who know me, know I am not usually so sentimental but some of the Katrina stories really get to me.) Click on the colored-type link in the opening sentence to read the story.

More info from AAEP on foot-related presentations

Scroll down in this blog for lecture topics on the foot at the upcoming AAEP 2006 Convention in San Antonio, Texas in December, which will feature a farriers-only seminar.

Meanwhile, Dr. Steve O'Grady has updated the speaker/topic list with info on the "table topics"; these are 90-minute lunchtime discussions.

Barefoot vs. shod, Dan Marks and Steve O'Grady
Foot lameness, Kent Carter and Tracy Turner
Hoof wall cracks and defect repair techniques, Bill Moyer and Rob Sigafoos
Therapeutic shoeing, Scott Morrison and Steve O'Grady
Managing acute and chronic laminitis, Rustin Moore and Andy Parks

Save me a seat! (That's sort of a joke, since the table topics are usually "Standing Room Only", and I am sure that will be the case this year.) I am intrigued by the choice of USET jumper vet (and former jumper rider) Dr. Danny Marks for the barefoot topic. He is an astute observerer of the horse and functional biomechanics and should have something interesting to say. He's never let me down...

For more about the convention, please visit http://www.hoofcare.com for foot-related news, or go directly to the AAEP site, where registration information should be available soon.

Barbaro 7/7/06 Update: Another New Cast, Abscess in Good Foot

I am posting information as it was provided last night by New Bolton Center.
Fran Jurga, HoofBlog editor

July 6, 2006

KENNETT SQUARE, PA – On Wednesday, July 5, Dr. Dean Richardson, Chief of Surgery, replaced the cast on Barbaro that he had received on Monday, July 3. “Barbaro was not comfortable with the second cast, so we decided it would be best to replace it sooner rather than later,” said Dr. Richardson. “His appetite is healthy, and we are continuing to monitor him closely for an elevated temperature or other signs of discomfort.”

New Bolton Center continues to receive requests for additional information on Barbaro’s condition. Below are some of the most recent questions asked with responses from his medical team.

Q. Why was Barbaro’s cast changed again?
A. For several days before the second cast change, Barbaro showed a slight elevation in body temperature and his hind legs appeared uncomfortable, which led to Dr. Dean Richardson’s decision to reassess the leg and then change the cast. He was still not as comfortable as he had been so a new cast was applied on Wednesday.

Q. Why were two screws replaced and three new ones added?
A. Two previously implanted screws that cross the pastern joint were bent, so Dr. Richardson, who had predicted that bent screws in that area were likely, replaced them and added three new screws for additional support. Barbaro has been very active on his cast, and the repairs were needed as a result of force and motion in the affected area. The screws are bridging the pastern joint. They are not part of the repair of the primary fractures. The pastern joint needed to be fused because the proximal phalanx (long pastern bone) was so badly broken that the middle phalanx (short pastern bone) was needed to anchor the distal (lowest) part of the plate.

Q. What do the radiographs show about how well Barbaro is healing?
A. Barbaro's new radiographs show excellent progressive bone healing, a very positive sign.

Q. Were the repairs considered major surgery?
A. Barbaro was put under general anesthesia for the procedure. The repairs themselves were made under fluoroscopic control, which gives surgeons a live-X-ray view of the patient. This means that small one-centimeter incisions were made rather than any large incision.

Q. Did Barbaro have an abscess on his foot?
A. During the examination, doctors found a small infection on the sole of Barbaro’s uninjured left hind hoof near the frog, a V-shaped cushiony growth that helps absorb shock. Dr. Richardson is treating the infection topically; in addition, Barbaro is on systemic antibiotics, which is common post-surgical practice. He also has a new protective shoe.

Q. What is laminitis and what are you doing to prevent it in Barbaro?
A. Laminitis is a painful condition in horses that can be the result of a number of causes, including excessive weight bearing in one limb. It occurs when laminae, the strong connecting tissues that attach the pedal bone and the inner hoof wall, are inflamed. Laminitis is very serious and can result in severe consequences. To reduce this risk, we applied a supportive shoe to Barbaro's left hind foot immediately following the surgery for the fracture of his right hind leg.

Q. How long will Barbaro have to stay in a cast?
A. Barbaro will remain in a cast until we believe that the fracture and joint fusions have developed adequate strength.

Q. How long will Barbaro remain in Intensive Care?
A. Barbaro will remain in the Intensive Care Unit at the George D. Widener Hospital as long as necessary. Even though he is progressing well and has not had major complications, he is not out of danger. Even if things progressed perfectly from this point forward, it is likely that he would be here two more months.

Photos by Sabina Louise Pierce/University of Pennsylvania (except where noted). All rights reserved.