01/29/2007 1:00AM

Innovative treatment prolonged Barbaro's life


The injuries that Barbaro sustained in the Preakness Stakes were catastrophic - multiple fractures that shattered the bones in the lower part of his right hind leg. For most horses, such a breakdown would have been immediately fatal because complex injuries more often than not prompt owners and veterinarians to euthanize a horse rather than pay for expensive treatments that can last for months with a poor prognosis.

When they decided to try to save their colt, owners Roy and Gretchen Jackson set off on a path that was not unprecedented but was rare. They had one significant factor in their favor: the New Bolton Center's accomplished veterinary team and state-of-the-art technology.

In the end, Barbaro proved to be a brave patient, but post-surgical complications - in particular, complications from laminitis - were more than he could overcome.

The first task when Barbaro arrived at the New Bolton Center on May 20 was to stabilize his fractured right hind leg. The damage was extensive. There were fractures in the cannon bone, sesamoids, and long pastern bone. Dr. Dean Richardson, head of the veterinary team, said the pastern bone had shattered into more than 20 pieces. The following day, Richardson performed surgery for a little over four hours to implant a titanium locking compression plate and 27 titanium screws in Barbaro's leg. The hope was to stabilize the injured area enough to allow the bones to knit.

The procedure underscored the veterinary school's technical capabilities and the innovations that would help Barbaro survive as long as he did. The locking compression plate, for example, was a relatively new device. The university also offered a unique recovery pool for Barbaro after surgeries requiring general anesthesia. Suspended in the water with his legs in waterproof rubber sleeves, he was less likely to thrash and damage the leg as he woke up. When two of the titanium screws bent, Richardson used fluoroscopy, a technique that gives the surgeon what amounts to a live X-ray view of the patient during surgery, as he replaced them. Another innovation was a special, patented shoe that New Bolton Center farrier Rob Sigafoos applied to Barbaro's left hind foot shortly after the surgery to reduce the risk of laminitis, a painful hoof disease that often afflicts a healthy leg opposite an injured one as a horse shifts too much weight onto the healthy leg.

These tools and others showed how far technology and veterinary medicine had come in aiding stricken horses. The scientific advances, his veterinary team's skill, and Barbaro's own fortitude and tolerance all contributed to remarkable progress in healing his broken right hind leg. He had had a bout of infection in July that prompted Richardson to remove and replace the compression plate and screws, but by early November, Barbaro was able to bear his weight on the right hind leg without a cast or even a supportive bandage.

In the end, however, modern veterinary technology could not save Barbaro from the classic secondary disease of laminitis and the cascade of problems it created.

Laminitis struck Barbaro's left hind on July 12, days after Richardson had replaced the compression plate and screws. The disease progressed rapidly. It caused the sensitive laminae - tissue in the hoof that connects the coffin bone to the hoof wall - to loosen, separating the hard outer hoof wall from the soft foot beneath it. Richardson operated that day, removing about 80 percent of the hoof wall and cutting the deep digital flexor tendon to loosen its pull on the coffin bone, the main bone in the hoof capsule and a key to the hoof's stability.

Barbaro received a padded foam hoof cast for his left hoof. He was able to stand and spent several hours a day in a sling that allowed him to take his full weight off his hind legs while remaining upright. To alleviate pain, the veterinary team gave Barbaro an epidural.

Barbaro's hoof slowly regrew, from the top of his foot down toward the ground, over the next five months. But it grew asymmetrically, with little growth on the inside-facing area - a sign that was found ominous by equine podiatry specialist Dr. Scott Morrison, called in from Lexington's Rood and Riddle equine hospital to examine Barbaro.

When a portion of the hoof wall finally reached the ground, it proved unable to bear Barbaro's weight. On Jan. 9, when Barbaro showed signs of acute discomfort, Richardson removed the left hind cast and discovered that part of the new hoof wall had separated from the foot. In response, Barbaro had shifted his weight off of the left leg and onto the right one, now under threat to develop laminitis, too. Richardson tried to prevent that through aggressive pain management and by putting the colt back in his sling, all in an attempt to keep Barbaro's weight evenly distributed.

Despite those efforts, the right hoof became bruised, then developed an abscess. Barbaro was now facing serious conditions in each back hoof, and Richardson became concerned that he would shift excessive weight onto his front legs, putting them at risk for laminitis, too. When a custom-made plastic and steel leg brace failed to make Barbaro more comfortable on his right hind, Richardson did what he called the "only hope" for keeping the colt comfortable. On Saturday, with Barbaro under general anesthesia, he inserted two steel pins in Barbaro's right hind cannon bone and attached those to an external fixation device that would take Barbaro's weight on its steel framework and off of the right hind foot.

In the end, the mounting complications overwhelmed the colt. On Monday, Richardson said Barbaro had developed laminitis in both front feet and had become, for the first time, "clearly distressed" by his condition. Barbaro's devoted veterinary team and owners concluded they could do no more than offer a painless death to the patient they had fought for and cared for during almost nine months of rigorous treatment.