There is no question that stabilizing the pastern, incorporating the pastern joint treatment into the arthrodesis of the fetlock
joint, is part of managing certain types of traumatic breakdowns of the fetlock region. But it doesn't have to be done in
every instance. "There are different ways of approaching that problem, including Bramlage's use of a cable technique to the
back of the pastern joint," explains Richardson. "We've tried different techniques. It is an important point that the ones
that need their pastern fused are a subset of the majority of fetlock breakdowns. The majority of them don't need that."
"I pretty much do it the way Bramlage does it," says Schneider. "I haven't really modified anything."
Perhaps the biggest change for the procedure is a new plate, a locking compression plate, where the screws not only go into
the bone, but the head of the screw enters the plate. Because of that feature, screw heads and screw fatigue life is much
"I do think the implant, the technique ... has continued to evolve, from a point where it was fairly high-risk to a more routine
orthopedic surgery," Schneider suggests. "And it still has a higher rate of complication than some of the things that are
done. But on the other hand, when it works well, it is definitely something that saves horses' lives."
Value of the procedure
Bramlage has taught the procedure in an internal-fixation course at Columbus, Ohio, every other year for 25 years, with the
help of AO North America, sponsor of the laboratories. "I think most all of the surgeons in the country probably learned (it)
in the AO course," says Bramlage.
"In the first group of horses we presented, the success rate of the primary treatment approached 70 percent," he says, "and
for certain kinds of injuries, such as degenerative arthritis, it's as high as 80 percent. Our biggest problem is still laminitis.
The ones we have difficulty with are those with the other foot already failing, although it (the procedure) will actually
rescue some of those horses."
"What is still not completely understood by a lot of people in the industry is how successful the surgery can be in terms
of taking a horse that has a painful, severely arthritic fetlock joint and making it very comfortable and capable of living
essentially a normal life in terms of being breeding-sound," says Richardson. "It's really not that well understood out there
how normal these horses can be after the fetlock is fused. It's a very important surgery in terms of being able to save horses'
lives with major fetlock injuries."
"Regarding Chelokee, he's to the point now that he has his cast off and has been totally without external fixation for a month,"
Bramlage says. "He's starting his walking. His incisions are well-healed. So far his other foot shows no problem."
Chelokee is expected to be out of the hospital in a few weeks and ready for stud, retiring from racing with five career victories
and earnings of $384,125.