Friday, June 25, 2010

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




fetlock support brace construction for equine suspensory ligament collapse
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.
equine fetlock brace stability design to support suspensory ligament collapse
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."

fetlock support for suspensory ligament collapse with only one support system
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). 

Thursday, June 24, 2010

Friends at Work: Farrier Kelli Rhoderick Will Make Horseshoes for History

Pennsylvania farrier Kelli Rhoderick will be making horseshoes at the Armstrong County Historical Museum's outdoor display and agricultural exhibit open house this weekend at the museum's home in the McCain House on North McKean Street in Kittanning, Pennsylvania. Kelli is featured today in an article in the Pittsburgh Tribune-Review; this photo is one of several by photographer Louis B. Ruediger of the Valley News Dispatch that accompany the online Pittsburgh Live version of the article. The forge seems to be built on a hillside but Kelli doesn't let that slow her down. I bet people will have fun with her this weekend.
24 June 2010 | Fran Jurga's Hoof Blog at Hoofcare.com 
© Fran Jurga and Hoofcare Publishing

Please, no use without permission. You only need to ask. 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). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.

Monday, June 21, 2010

The First Day of Summer: Favorite Guinness Commercial and Favorite Horse Commercial Are One and the Same


Surfers wait for that one wave. Guinness drinkers wait for their pints (they take a long time to draw). And around here, we wait a long time for summer to come around again, but so it has arrived today. To celebrate, here's a little bit of classic video, courtesy of our friends at Guinness.


This commercial is perennially called the best television commercial ever made. It's labeled "iconic". I've watched it enough times over the years, to be sure, but I still can't really tell you what's going on. But I also think that might be the point.

It's summer. President Obama tells us it's even "recovery summer". So let's just sit back and take this minute's entertainment at face value. Don't worry, Captain Ahab, we're living the dream.

I hope you agree that this video is a fitting salute to the first day of summer...and one of the most creative uses of horses in a commercial, ever!

By the way, the inspiration for this commercial was the famous children's book illustrator Water Crane's painting, Neptune's Horses. Neptune,  of course, was the ruler of the sea and in his second identity, as Neptune Equester, he served as the patron saint of horses in Roman mythology. He was supposed to protect all the horses in the chariot races. I've always loved this painting.

If you have a slow connection and you're having trouble seeing any horses in the Guinness commercial, try toggling the stop and play button, and leave the screen alone for a while to see if perhaps YouTube needs to load. You can also click on the lower right of the YouTube screen on the blog and the video will open in YouTube and it might play at a better resolution. This video was made in the last century so it is not HD.


21 June 2010 | The First Day of Summer | Fran Jurga's Hoof Blog at Hoofcare.com 
 © Fran Jurga and Hoofcare Publishing

Please, no use without permission. You only need to ask. 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). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.

Saturday, June 19, 2010

CT Scans Added to Washington State University Vet School's Equine Imaging Options


Horse in CT Scanner
A Quarter horse mare recently underwent a spiral
CT scan to examine a mass near one of the
carotid arteries leading to her head
Washington State University's Veterinary Teaching Hospital (VTH) has installed a new spiral computed tomography (CT) scanner for use in both small and large animals, with funds donated by a generous family. 
The VTH has had a CT scanner for more than two decades and a magnetic resonance imaging machine (MRI) since 1996.  With the new Toshiba Aquilion 16-slice spiral CT unit operational, both MRI and CT in WSU's veterinary college are among the most advanced complementary tools for diagnostic imaging in the profession. 
 "Before the new CT, we only imaged a few horses a month  (using CT), but now I would expect to do 10 times that," said Professor John Mattoon, a board certified veterinary radiologist and chief of WSU's diagnostic imaging section.  "There were limitations with the old technology that hampered its everyday use, but the new CT is truly state-of-the-art, with brand new software that greatly improves its capabilities.  Our goal is to examine 100 horses a year with the CT, and several small animals a day."
Speed is one of the new CT's main features.  It can scan 1750 millimeters (mm) or about 5.75 feet of a patient's body in 1 mm slices in 38 seconds.  Twelve images per second are displayed and all 1750 digital images are delivered within three minutes.  The machine's resolution can "see" details as small as 0.35mm; a little more than 13/100ths of an inch.  The imaging is produced in a variety of planes as well as in three-dimensional representations of anatomic structures. A small animal can often be imaged in the new CT scanner in seconds, in many cases without general anesthesia.
"A horse with a complex fracture was examined with the new CT in early June and it was completed in a couple of minutes," Mattoon said.  "The anesthesia and prep-work it takes to get the horse into the machine takes much longer than the actual exam.  By comparison, MRI may take an hour or more. Still, these two imaging modalities are complementary to each other, and one does not necessarily exclude the use of the other."
Horses are too large to fit entirely in the CT scanner, so only the head, upper neck, and lower limbs are imaged.  For smaller animals, the entire body can be scanned, and is especially useful for examining the lungs and abdomen.
"CT scans are the first choice in human medicine for imaging the lungs and abdomen, and I think it should become the standard of abdominal imaging in smaller animals as well," said Mattoon, who has practiced radiology for more than 25 years.    
As a result of the CT's speed, animals have to spend much less time under anesthesia, if at all.  "For horses, we can use a short-acting anesthetic, and some small animals can just be sedated without undergoing anesthesia," Mattoon said.  "This is an important advancement because there are always risks associated with anesthetizing an animal.
"Overall, CTs at WSU should be less expensive because exams take less time and anesthesia.  This particular new CT scanner should also open up a whole new area of research, including vascular imaging and shunt studies. I imagine that in the beginning we will do a lot of cases in which we use both CT and MRI."
This brief video showcases Washington State's new CT service, as illustrated by the Quarter horse with the cartoid artery mass that needed to be imaged.
Information and elements for this article are the property of Washington State University.

19 June 2010 | Fran Jurga's Hoof Blog at Hoofcare.com
© Fran Jurga and Hoofcare Publishing

Please, no use without permission. 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). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.

Thursday, June 17, 2010

Lameness Detection: Symmetrical Accelerometer Alignment Means Your Horse Is Sound

A sensor developed by scientists from the University of Copenhagen in Denmark may soon be able to help detect the earliest and most subtle signs of equine lameness; use of the device is hoped to enable veterinarians and trainers to intervene and remove a horse from training or competition before an injury can become worse, and to treat an injury while it is still in its early stages.

"An objective measure is needed because it's not always obvious visually, and even trained observers of horses can disagree when a horse is going lame," explains Maj Halling Thomsen of the Faculty of Life Sciences in Copenhagen, who has been involved with the research.

Thomsen and her colleagues use miniature accelerometers calculated in three dimensions. The accelerometers were originally developed for use in cellphones, where they are used to orient information displayed on the screen.

Thomsen's accelerometer devices are, according to New Scientist magazine, three piezoelectric cantilevers set at right angles to each other. Each one produces a voltage when it is compressed by forces due to acceleration or gravity, so the three together can detect forces in three dimensions.

"Just like humans, the gait of a horse changes when it starts to hurt. Unlike humans though, a horse's four legs make it hard to detect with the human eye. But when horses are about to go lame they start to move asymmetrically left-right as they trot. An accelerometer, mounted on the animal's back should be able to detect this," Maj Halling Thomsen explained in an article in the University Post.

She and her team have studied healthy horses, and now plan to conduct further tests on lame horses to see if deviations from the "symmetry indices" they have drawn up can help predict the onset of lameness. With the device attached to a surcingle on the horse's back, they will be expecting a change in vertical motion of the horse's body as it moves from left to right.

Sensoring technology is in demand from race and show jump trainers in Europe, with some studies for example trying to optimise the link between stride length and speed. In the United States, accelerometer-based gait technology has been centered at the University of Missouri College of Veterinary Medicine.

"But there where I see the most value for this sensor is as a support for practicing vets in diagnosing lameness," says Thomsen.

For more information, see "Symmetry indices based on accelerometric data in trotting horses" in
Journal of Biomechanics, by Maj Halling Thomsen, Anders Tolver Jensen, Helle Sørensen, Casper Lindegaard, and Pia Haubro Andersen


18 June 2010 | Fran Jurga's Hoof Blog at Hoofcare.com
 © Fran Jurga and Hoofcare Publishing 

Please, no use without permission. You only need to ask. 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). To subscribe to Hoofcare and Lameness (the journal), please visit the main site, www.hoofcare.com, where many educational products and media related to equine lameness and hoof science can be found. Questions or problems with this blog? Send email to blog@hoofcare.com.

Monday, June 14, 2010

Jerry Black DVM Will Leave Pioneer Equine Hospital for Colorado State University Equine Science Program Role

Hoofcare and Lameness has learned that Jerry Black DVM, co-founder of Pioneer Equine Hospital in Oakdale, California, will leave veterinary practice at the end of June to pursue a new role in the horse industry as Equine Science Program Undergraduate Director at Colorado State University in Fort Collins, Colorado. Dr. Black founded Pioneer Equine Hospital in 1973 and built it into one of the leading veterinary hospitals in North America.

A statement sent today by Pioneer Equine Hospital on behalf of the hospital "family" read, "We wish him great success and want him to know that he will always be a part of our family here in California. "

Dr. Black brings unique qualities to his new role at CSU. In addition to his experience as a veterinarian who specializes in performance horse lameness, Dr. Black has been a leading breeder and exhibitor of cutting horses, and owner of Valley Oak Ranch, a stallion station and breeding farm in California. He is past president of the American Association of Equine Practitioners, is currently a member of the board of trustees of the American Horse Council, and has had many horse and veterinary industry roles.

Dr. Black earned his veterinary degree at Colorado State University. The "equine science" program at CSU includes the reproductive and orthopedic research laboratories, among other units, and grants degrees to both undergraduate and graduate students.




14 June 2010 | Fran Jurga's Hoof Blog at Hoofcare.com 
 © Fran Jurga and Hoofcare Publishing. Please, no use without permission. 
Photo: Pioneer Equine Hospital