Barbaro in Recovery: Active, Inquisitive, Agile

"He's pretty agile," said Dean W. Richardson, DVM, Dipl. ACVS, chief of surgery at the University of Pennsylvania's New Bolton Center, referring to his well known patient, Barbaro, whose fractured leg he repaired on Sunday afternoon. "He's done a couple of things that manifest his level of comfort. He actually was scratching his left ear with his left hind leg," which shows he is comfortable putting weight on the injured right hind leg.

"When I was in there working with him this morning, he kind of waved at me with his left hind leg....he's feeling very good, he's walking very well on the limb," added Richardson.

Barbaro underwent surgery for three fractured bones--his cannon bone, long pastern bone (P1), and a sesamoid--in his right hind leg on Sunday afternoon (May 23). On Day 2 post-surgery, Richardson seemed encouraged by Barbaro's visible signs of recovery. "He's actually so far a very good patient," said Richardson. "His mental attitude is great--he's very active, inquisitive, bright type of horse...he looks just the way he should look."

Members of the New Bolton team are keeping an eye on Barbaro around the clock for any subtle signs of pain or discomfort. Richardson explained how he makes discernments involving Barbaro's care: "I walk in and say, 'How 'ya feelin? Where's it hurt?'" he kidded, and then he listed the objective signs he monitors such as food intake, heart rate, temperature, voluntary movement around the stall, and manure and urine production.

"You look at the horse's eyes," he added. "Anybody that's a horse person knows that you can look at a horse and see if it's bright, happy, and alert....anybody that's around animals knows that you can catch a gleam of something in animals' eyes, whether or not it's feeling good...that's not the hard part."

The more difficult aspect of Barbaro's care is making sure that he is comfortable on his recovering limb in its plaster cast, and that he's bearing weight evenly on his limbs. Richardson explained that he has taken steps to prevent laminitis in the uninjured hind limb, which is at risk if it bears more weight than the other leg for an extended period of time. "When he came in, his racing shoes were removed altogether, and his left hind foot was shod with a special glue-on shoe that has special padding, which also raises his foot up a little bit so his limb length is equivalent to the cast limb on the right hind. So he has a special shoe in place."

Generally, hind limb injuries are no more problematic than forelimb injuries, unless the horse is going to enter the breeding shed. "If we get to a point when he has to mount a mare, that could be a problem," said Richardson. "We're not worried about that now."

The fractures could take many months to heal, and Richardson emphasized that bad things could happen at any time. "The single most important thing is that we are able to maintain his level of comfort on the fractured limb. If we keep him comfortable on his right hind limb, that is the most important thing in a horse in terms of healing a catastrophic fracture. We obviously look at indications of infection, in terms of blood work, any kind of local heat, pain, or swelling...we'll be changing his cast on a regular basis. We're basically doing just good, solid nursing care for the next few months."

Barbaro will wear a cast over the next few months to assist the internal fixation plates in keeping the leg stable. There are up to 27 screws holding the bones together and to the plate; in earlier interviews the number had been 23, but he corrected that number to 27.  "The internal fixation--the plates sand screws, in this particular case--for this fracture, are not adequate to allow him to bear weight without the cast," explained Richardson. "There are many types of surgical repairs that we do that the plates and screws are enough to hold it together. In this case, this is far too complicated a fracture for that."

The team plans to change Barbaro's cast early next week and to take more radiographs to monitor healing progress. Changing the cast can present its own challenges. "Generally speaking for this type of a case, we will try to change his cast with Barbaro actually partially in a sling and heavily sedated, so that way he can't kind of slip, stumble, fall, while changing the cast, but at the same time he won't be placed completely under general anesthesia," explained Richardson. "If for some reason Barbaro takes exception to that, he would be placed under general anesthesia, just the way he was before and woken up in the swimming pool again."

Richardson said the advancement of veterinary medicine over the past 20 years or so made it possible for Barbaro's surgery to be successful. "It's important to keep in mind that the actual expertise and experience on handling more and more difficult injuries develops over time, so it's really more a matter of just normal evolution of medical practice. It's not any different in veterinary medicine than it is in human medicine," he said.

Reflecting on the surgery, Richardson said it was long and difficult, but he emphasizes that he would've "worked that hard on the same case if it were a $5,000 gelding." In fact, he performed a similar fracture repair surgery a few weeks ago in a gelding. Richardson declined to comment on the cost of fracture repairs of this magnitude, but joked that it was "a heck of a lot less than one minor procedure would be in you," referring to human medicine.

Following the surgery, Richardson and his team gave Barbaro epidurals for pain, but now Barbaro remains on a "fairly low" level of systemic analgesics.

With each day that passes the risk Barbaro faces lessens, and everyone associated with Barbaro and his surgery hope his condition remains stable. "Alex Matz (trainer Michael Matz's son) said the best thing about this horse is that it wins all its races," said Richardson. "That encourages me, because the race of healing his fracture is going to be one that we really would like him to win."

About the Author

Stephanie L. Church, Editor-in-Chief

Stephanie L. Church, Editor-in-Chief, received a B.A. in Journalism and Equestrian Studies from Averett College in Danville, Virginia. A Pony Club and 4-H graduate, her background is in eventing, and she is schooling her recently retired Thoroughbred racehorse, Happy, toward a career in that discipline. She also enjoys traveling, photography, cycling, and cooking in her free time.

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