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Saving Barbaro
Veterinary experts poured from all corners of Pimlico to aid an American inspiration


DVM360 MAGAZINE



Radiographs before and after surgery. Note the locking compression plate, which allows screws to be driven through it, an innovation for very unstable injuries.
"There is no one star in this picture," says Meittinis, "from Jamie Richardson (track superintendent) to Joe Miller, who drove the van, and the entire crew, which also included Drs. Dan Dreyfuss and Rachel Beard, both with the Pimlico veterinary staff, as well as Palmer. While Beard was holding the horse's leg as I was putting on the bandage, in comes Scott Palmer. It was organized and controlled. We got the horse to New Bolton in the same shape he left in. That was our goal."

Hours of complicated surgery

It was Barbara Dallap, VMD, Dipl. ACVS, ACVECC, assistant professor of emergency medicine/critical care, who admitted Barbaro while Dr. Dean Richardson returned from a surgery in Florida. But Richardson was able to access the digital radiographs via e-mail.

From a critical-care standpoint, New Bolton has three double-boarded clinicians, totally devoted to admit emergencies. The main determination was whether Barbaro was a healthy patient with a bad injury, or a badly injured patient with significant additional other problems. It was determined that he was in good physical shape; he seemed to be handling things pretty well, and going into surgery and coming out of anesthesia these were the primary emergency and critical-care concerns.

Dallap inserted an intravenous catheter to make sure he was hydrated, with appropriate blood volume and adequate perfusion. They also ran some blood work to make sure everything was normal, which it was, and adjusted the leg splint so he wouldn't hurt himself lying down and getting up during the night.

Richardson notes that the surgery was sort of a combination of a bunch of techniques that have been around for a while, though they are usually used for individual repairs.

During the surgery, the fetlock joint and the pastern joint were fused to give the leg as much stability as possible.

Dallap says today they have a better ability to monitor patients while under anesthesia than they used to, with better drugs and intravenous infusion, so the amount of inhalant used is quite a bit less than in years past. Induction of anesthesia is also improved. Rather than have the animal collapse in a heap, they suspend him in a sling, for support, which facilitates getting him to the table safely. Penn's pool recovery system helped protect the orthopedic repair during the process of the animal waking up from anesthesia, which is critically important with horses, especially with hind-limb injuries. After surgery, they tend to have more catastrophic failure with hind-limb injuries than with fore limb injuries, and the pool is definitely an advantage compared to 20 years ago.

Richardson repaired the fracture with a locking compression plate (LCP). This plate, available commercially for about two years, is potentially better for very unstable injuries like Barbaro's. According to Richardson, it is an improved design for this type of very unstable fracture. Though not needed for every kind of injury, it has significant advantages and should help quite a bit on such unstable injuries.

With the locking plate system, the head of each screw can be threaded directly into the plate. This results in a more stable fixation than traditional plate fixation in which the screws provide stability only by their ability to compress the plate against the surface of the bone. With the locking plate, the fixed angle of the screw within the plate provides stability even when the reconstruction of the bone fragments and the position of the plate up against the bone are not perfect.

"The surgery was a masterpiece from an orthopedic point of view," says Patty Hogan, VMD, Dipl. ACVS, veterinary orthopedic surgeon at New Jersey Equine Clinic and a former student of Richardson. "He put those fractures together as best as it possibly could be done."

Richardson is a bit more modest: "I've had a great opportunity to be in a position where I've been around a place to try different techniques, to use different materials. Working at New Bolton Center, you get the opportunity to try very difficult cases, and if you don't get to try, then you don't have a chance to succeed or advance the field."


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Source: DVM360 MAGAZINE,
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