Fetlock arthrodesis boost survival rates

Fetlock arthrodesis boost survival rates

Experts find procedure quick, effective for some traumatic injuries and degenerative damage
Aug 01, 2008

Photo 1: Chelokee, pre-op in the first-aid boot.
Lexington, Ky. — It is the most common fatal injury of the racing Thoroughbred — catastrophic injury to the fetlock, involving the distal cannon bone and/or the proximal sesamoid bones of the metacarpo/metatarsophalangeal joint, with a rupture of suspensory apparatus.

There are many traumatic and degenerative versions of fetlock damage, and Chelokee, a 4-year-old colt, suffered one of them during the Alysheba Stakes at Churchill Downs on May 2.

He was taken to Rood & Riddle Equine Hospital, where Larry Bramlage, DVM, MS, Dipl. ACVS, performed a fetlock arthrodesis to save him.

Chelokee's version of the injury involved destruction of all the supporting ligaments to the back of the fetlock and pastern joint.

Teuflesburg, a 2007 Kentucky Derby starter, suffered another version last October — comminuted fractures of both sesamoid bones behind the fetlock joint, destroying his ability to stand on the limb. Bramlage performed successful fetlock arthodesis on that horse as well.

Background of procedure

Photo 2: Chelokee, six weeks post-op.
Bramlage started working on fetlock injury during his residency in the mid-1970s, just after the death of Triple Tiara winner Ruffian. "There are several different versions of the injury, but it's something that we didn't have a solution for at the time, and it was virtually always fatal to a horse," he says.

After studying the mechanics of the fetlock joint and working with surgical approaches that would allow stabilization without added morbidity, in 1978 he handled the first clinical case, a mare that had ruptured the suspensory apparatus by pulling both sesamoids off the long pastern bone.

Photo 3: This X-ray, taken at presentation, shows Teuflesberg's comminuted sesamoid fractures. The limb is in a splint to prevent collapse of the fetlock.
"Dr. Robert Copeland and Dr. Gary Lavin in Lexington called and asked, 'Have you got anything?'" Bramlage recalls. The mare started to get laminitis in the other foot while undergoing treatments available at the time. Bramlage and colleagues fused the ankle.

The procedure itself worked, but wasn't early enough to save the other foot and the mare was lost to laminitis. Fetlock arthrodesis had shown promise earlier, when the team tried it on cadavers and research horses. They had performed it about 10 times, when Bramlage and Dr. Bill Reed were called upon to perform it on Noble Dancer after his injury at Belmont Park. The famous runner went on to a stallion career of 20-plus years before dying of infirmities at 25 or 26.

Photo 4: These final films were taken after the arthrodesis had healed at 10 weeks post surgery, just before Tueflesberg started unrestricted paddock exercise.
After several more successful surgeries, the procedure became known as a viable solution for fetlock injuries and for other joint issues such as degenerative arthritis (DA).

Expanded uses