On July 23rd St Nicholas Abbey presented to Fethard Equine Hospital for evaluation and surgical correction of a complex fracture to the right fore pastern which occurred while exercising at Ballydoyle.
The limb had been promptly and properly stabilised in a thick padded splint bandage on the gallops at Ballydoyle and St Nicholas Abbey was referred immediately to Fethard Equine Hospital in a specialised equine ambulance. These early interventions are of exceptional importance and can be lifesaving.
Radiographic examination revealed multiple fractures of both the proximal and middle phalange of the right front limb which involved both the fetlock and proximal interphalangeal joints. (Slide 1 and Slide 2)
In St Nicholas Abbey’s case we can see that the proximal and middle phalanges are fractured in many pieces involving both the fetlock and proximal interphalangeal joints. In an effort to save his life the bones had to be reconstructed with screws and bone plates
As soon as both Dr Ger Kelly and Dr Tom O’Brien of Fethard Equine Hospital evaluated the fracture they immediately contacted one of the leading experts in the world on fracture repair in horses, Dr Dean Richardson of New Bolton Equine Centre in Pennsylvania. Through his expertise and input the best possible surgical repair of the fracture would be performed in an effort to save St Nicholas Abbey’s life.
The morning following his injury St Nicholas Abbey was placed under general anaesthesia and his fractured leg prepared for surgery.
During the surgery it was found that some of the smaller bone fragments had lost their blood supply and had to be removed leaving a gap in the bone. For this reason a bone graft was taken from St Nicholas Abbey’s right hip to replace the damaged bone, which will hopefully speed up the healing process.
The team then focused on reconstructing and stabilising the pastern and fetlock joints using a total of twenty screws and two bone plates in the limb. (Slide 3)
In the last stage of the repair a large steel pin was placed through the lower end of his cannon bone. This pin was then incorporated into a fibreglass cast. The pin will minimise the amount of weight placed on the repair in the first month following the surgery. Instead of the weight of the horse being transferred through the injured leg, bone plates and screws the weight is now supported by this steel rod and the fiberglass cast. (Slide 4) This procedure in addition to the screws, plates and cast allow a repair which is as rigid and stable as possible.
It is important to realise that a horse cannot stand on one front leg for a very long period of time as they can quickly develop laminitis on the good supporting foot. This in itself can be a life threatening consequence of this type of injury. Therefore when repairing a fracture of this magnitude, the horse has to be able to take weight on the fractured leg immediately following the surgery.
St Nicholas Abbey’s recovery from anaesthesia was excellent and he returned to his stall for intensive postoperative care.
This whole series of events puts huge stress on a horse’s system. Through hospitalisation, anaesthesia, periods of fasting and the adverse effects of anti-inflammatory drugs it is extremely easy to throw the delicate digestive tract off balance.
Approximately 48 hours following the initial fracture surgery St Nicholas Abbey began to show signs of colic. Fighting another life threatening condition St Nicholas Abbey was rushed back to surgery where his abdomen was opened to empty and flush his caecum (equivalent to the appendix in humans). Again St Nicholas Abbey had to face recovery from anaesthesia which he came through with flying colours.
Following St Nicholas Abbey’s second surgery Dr Nathan Slovis of the Hagyard Equine Medical Institute in Kentucky was consulted to oversee his on-going recovery and treatments. St Nicholas Abbey’s food intake was restricted and he was placed on intravenous nutrition to fulfil his daily requirements. His food intake will be slowly increased as he recuperates and he is now enjoying small amounts of freshly cut grass.
A major life threatening fracture has been repaired and a major life threatening colic complication has been corrected but St Nicholas Abbey still has a long way to go. Other life threatening complications may yet arise including laminitis, surgery site infection and failure of the implants in the repaired fracture. Each new day is a victory on his road to recovery.
St Nicholas Abbey winning one of his three G1 Coronation Cups at Epsom