The Breaking Point--Catastrophic Injuries

Catastrophic injuries, involving the fracture of a bone, take a heavy toll on racehorses in training and in competition. Research through the years has given the veterinary surgeon additional tools and knowledge to deal with these life-threatening injuries, and the result has been a higher survival rate than was recorded in the past.

To help make that point, let us tell the tale of two horses. One's injury ended its life. The other, which occurred nearly a quarter of a century later, ended the horse's racing career, but modern surgical procedures and emergency first aid allowed it to have a productive life in the breeding shed. This is not a comparison of injury, but an example of advances in veterinary medicine.

The Tragedy

The date is July 6, 1975. The race is a classic. Like two heavyweight boxing champions squaring off against each other with the championship of the world at stake. In one corner was the filly Ruffian. Beautiful. Tough. High-strung. Exceptionally talented. She had won 10 races in a row. So blazingly fast was this filly that she was in the lead at every call in each of those 10 races.

In the other corner was Foolish Pleasure. The hot-blooded colt which had won that year's Kentucky Derby.

Many in the press had dubbed the race "The Battle of the Sexes." It was to be run at Belmont Park in New York over a mile and a quarter. A huge crowd was in the grandstand. Another 18 million were watching on television. It was the race everyone had waited for, and it wasn't disappointing. They raced neck and neck down the backstretch before Ruffian began pulling away. She was a length in front when disaster struck.

Her proximal sesamoid bones shattered. These little bones located just behind the pastern serve as pulleys over which the deep digital flexor tendons pass.

Ruffian's jockey, Jacinto Vasquez, tried desperately to pull up the filly, but she raced on, literally smashing the already broken bones. She underwent surgery that day, but was euthanized that night after further injuring the leg as she thrashed about while coming out of anesthesia.

The Victory

The second tale is one with a happier ending. The horse is Charismatic, the one-time claimer who won the Kentucky Derby and the Preakness. He appeared poised to win the Belmont and the coveted Triple Crown.

Again, millions tuned in to watch. Charismatic's bid came up short, but as the race ended, the true drama began. Jockey Chris Antley pulled up the horse, jumped to the ground, fell, got quickly to his feet, and as millions watched, picked up and held Charismatic's injured foreleg.

Radiographs would reveal that the horse had suffered a condylar fracture of the cannon bone (the condyle is the bulbous bottom or distal end of the cannon bone that fits into the fetlock joint), and he also suffered from a longitudinal break in a sesamoid.

His career as a racehorse was over, but surgery allowed him to live and take on a career in the breeding shed.

The Moral

Could today's techniques in first aid and surgery have saved Ruffian's life? No one will ever know.

"One of the most important things we have learned since then is that we should not perform surgery immediately on horses with that type of injury," says Larry Bramlage, DVM, MS, Dipl. ACVS, a world renowned orthopedic surgeon with Rood and Riddle Equine Hospital in Lexington, Ky., who has been part of the on-call television veterinary team at major equine events. "We first stabilize the leg, allow the blood supply to the injured area to improve, and use antibiotics to prevent infection. In many cases, the optimum time to do surgery is two to three days after the injury."

The injured horse, he says, needs time to settle down, and accept the fact that it has an injury and learn to live with it before surgery is performed.

"We don't want the horse going under anesthesia remembering only that it was going into the starting gate, then there was pain, because that will be all it remembers when it wakes up. It may become very agitated," Bramlage says. "Their mental attitude when they wake up will be the same as their attitude when they get anesthetized."

This might have been the case with Ruffian. As she came out of anesthesia, she was still trying to run and win.

Another major assist at racetracks today, Bramlage says, is the Kimzey Leg Saver Splint, which not available in Ruffian's time. The device can be slipped quickly over an injured foot and lower limb of an adult horse to firmly stabilize the injured area. (It is manufactured by Kimzey Welding Works, 164 Kentucky Ave., Woodland, CA 95695; 888/454-6039; www.kimzeymetalproducts.com. It sells for about $275.)

"The important thing at that point," says Bramlage, "is that all of the bones be kept in a straight line. This isn't to say that the Kimzey Leg Saver Splint is the only device that can do this. The same thing can be done with a splint on the front of the leg that is firmly taped in place. The Kimzey Leg Saver Splint, however, is very easy to put on and can stabilize the limb very quickly. It has become a routine piece of equipment in equine ambulances at racetracks."

The device was used on Charismatic before he was loaded into the equine ambulance.

In the past, Bramlage says, techniques that worked with humans, such as air splints, frequently were employed with injured horses. The problem is that those devices often are not strong enough to properly support a full-grown horse's weight.

Today, Bramlage says, equine first aid devices are designed specifically for horses.

Injury Breakdown

The most common serious fractures, says Bramlage, are condylar fractures and ruptured suspensory apparatus involving fractures of the sesamoid bones, which can occur in the front or rear limbs, but most frequently occur in front.

In many cases, condylar fractures can be repaired surgically. The prognosis for survival and a return to racing soundness is dependent on the severity of injury.

The injury that has the most optimistic prognosis would be an incomplete, non-displaced condylar fracture. Next in line of severity would be a complete, non-displaced fracture. The third and most serious would be a fracture that was complete and displaced. A fracture that is complete and displaced is one where a segment of bone has broken free of the main bone and has moved. The problem is compounded if the fracture is comminuted--the bone broken into fragments within the joint.

The severity can be further complicated if the sesamoid bones are damaged. This is the injury Charismatic suffered. This can happen quickly if there is a complete condylar fracture, says Bramlage. When that occurs, the sesamoids no longer have a firm condyle to press against and will grind against the raw, jagged edge of the fracture. This occurs when a complete, displaced condylar fracture is sustained, and the horse continues to run. In moments, the sesamoids can be shattered beyond repair.

It was this type of injury that resulted in the euthanasia of Prairie Bayou, the hard-running gelding, and Go for Wand, a very talented filly, following their catastrophic injuries in racing competition. The injury was so severe the blood supply was destroyed at the fracture site.

However, there are many cases where damage can be surgically repaired to the point that the injured horse can return to competition. In some cases involving short incomplete, non-displaced fractures, surgery is elective. Some horses with that type of injury are treated with stall rest and a gradual return to exercise. This takes much longer but can be successful.

However, in the cases of complete, non-displaced fractures, and complete, displaced fractures, surgery is the treatment of choice. Normally, the surgery involves the insertion of bone screws that hold the fractured portion in place and allow the bone to remodel and heal.

Although a sesamoid might have been damaged, Bramlage says, it is normally not dealt with during the surgical process. Once the condyle has been repaired, the sesamoid again has a firm bone to press against and the damage to it heals over time.

That was the treatment of choice for Charismatic.

In uncomplicated cases, the return to training comes quickly. After leg screw fixation of uncomplicated condylar fractures, says Bramlage, the horse normally is given stall rest for one month, followed by stall rest and hand-walking for another month. After this 60-day period, follow-up radiographs are taken to determine the rate of healing.

If all is going well, there likely is another two to four weeks of paddock exercise before the horse might resume training.

In the case of more severe fractures, the recovery period could encompass many months before the horse is ready to return to training.

Ironically, the most severe condylar fracture often elicits the least noticeable pain, initially. If the fracture tears through the periosteum (which covers the bone), Bramlage explains, the nerves are destroyed and the horse feels little pain (see sidebar on condylar fractures on page 44).

A more rare, more devastating injury to racehorses, involves a ruptured suspensory apparatus. Ruffian suffered from a ruptured suspensory apparatus with fractures of the sesamoid. An example of a horse sustaining this type of injury and undergoing successful surgery is Mazel Trick. The stallion was the favorite for the Pacific Classic at Del Mar last year. He shattered both sesamoids in the right front foreleg. Bramlage and his colleagues fused the fetlock in a surgical process. The result? Mazel Trick can't race, but he covered a full book of mares this year at Airdrie Stud.

Bramlage explains, the fetlock has a plate in front and a system of wires behind the joint to provide the support function that had been served by the proximal sesamoid bones before they were damaged.

While there has been a good deal of progress in treating fractures of bones in the lower limb, a fracture to bones higher up in the skeleton, such as a fractured humerus, quite often carries a grave prognosis.

"If the injury is of a nature where you want to relegate the horse to stall rest while it heals, there is little that can be done," says Bramlage, "because that is impossible with the horse."

With advances being made in emergency medicine, surgical procedures, anesthesia, and recovery, there is increasing hope that a horse which suffers a catastrophic injury can be saved, and perhaps even go on to compete again or work in another career.


Condylar Fracture Study

A study conducted by a team of practitioners at Rood and Riddle Equine Hospital in Lexington, Ky., from 1985 through 1994 provided some telling information concerning progress in the treatment of various types of condylar fractures. Involved in the study were 135 horses with condylar fractures treated at Rood and Riddle. Those horses had a total of 145 fractures. Five were Standardbreds; the rest were Thoroughbreds. Following are the statistics of the study:

  • Eighty (59%) were males, and 55 (41%) were females;
  • Six had condylar fractures on more than one occasion;
  • Five had a second condylar fracture after treatment of the initial condylar fracture. All five raced after the treatment of the second fracture as well. One horse treated with surgery refractured and had to be treated with surgery.
  • Two had fractures in both forelimbs at one time, and one had fractures of both forelimbs and the right hindlimb simultaneously; Ninety-two limbs had complete fractures. Of that number, 46 were displaced and 43 were non-displaced. (In three limbs, determination of displacement based on radiographs was not possible);
  • Fifty-three limbs had incomplete fractures. Of those, 52 were non-displaced.
  • Eighty-one percent of the fractures occurred in the forelimbs, and 19% occurred in the hindlimbs. There was nearly an equal distribution between left and right limbs.
  • Lateral condylar fractures (those occurring on the outer half of the bone) represented 85% of the total, with 15% occurring in the medial condyle.
  • Complete, displaced fractures were most common in the right cannon bone
  • Incomplete, non-displaced fractures were most common in the left cannon bone.
  • Eighty-five percent of the fractures were repaired surgically.
  • Sixty-five percent of the horses started in a race after recovering from the injury. The mean time from injury to return to racing was 9.7 months.
  • Eighty-seven percent of horses with short incomplete, non-displaced fractures that were treated non-surgically raced again.
  • Seventy-four percent with long incomplete, non-displaced fractures were treated surgically raced again.
  • Fifty-eight percent of the horses which sustained complete, non-displaced fractures that were treated surgically returned to racing.
  • Sixty percent which sustained complete, displaced fractures that were treated surgically returned to racing.
  • Fifty-two percent of horses which had articular bone fragments removed from the joint surface returned to racing.

Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.

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