Two weeks ago, I ended my post about The Perils of a Puncture Wound by talking about two friends who reached out to me and described similar experiences with their horses. Specifically, I said, “One had involvement of the splint bone which required surgery and six months of rehab. I consider us very, very fortunate that we appear, as of this writing, to be heading in the right direction.” We were not heading in the right direction. My poor boy did, indeed, have a fractured splint bone.
That post was published on October 12th, but our first time around at the Johnson Family Equine Hospital at CSU was October 7th. On October 18th, we were back at CSU. Kadeen was still very uncomfortable and lame. He was unwilling to fully extend his left front leg and was significantly short-strided. The wound from the first standing debridement had healed nicely. The problem was that there was still infection in or near the cannon and splint bones.
Processing the news that he needed surgery
Because the previous films and extensive ultrasound exam from October 7th had not demonstrated any bone fractures, the initial assumption was that infection was creating his pain and lack of improvement. Another round of films and another lengthy ultrasound revealed significantly more inflammatory reaction around the splint and cannon bones. The report stated:
Metacarpal radiographs and ultrasound were performed identifying a draining tract from the skin to the cannon bone with significant periosteal (the connective tissue covering over the bone) reaction. Surgical debridement of the wound and bone under general anesthesia was recommended and pursued.Dr. Laurie Goodrich
Unfortunately, trying to clean out the infection with Kadeen sedated and standing had not proven to be a vigorous enough approach. He needed to be under general anesthetic… a much bigger deal. The second round of films, while not clearly demonstrating a fracture, did raise some suspicion about the integrity of the bones themselves.
The surgery was scheduled for the day after our visit, on October 19th. Of course, he remained at CSU the night before his procedure. Before we left, we were sent to the front desk to leave a sizable deposit based on the total estimate.
It was very, very hard to return home with an empty trailer. Poor Sadie, Alan’s mare, was so excited when we pulled into the driveway. However, she was very confused when her pasture buddy didn’t exit the trailer. As it turned out, they were separated for 3 nights. It was incredibly difficult to see her wandering around alone.
The day of the surgery
Needless to say, I didn’t sleep well that night. While making my coffee the next morning, the sign hanging on my basket of Keurig pods caught my eye. Good morning, this is God. I will be handling all your problems today. Hanging right next to that sign is a wooden photo frame that spells Kadeen. I got the message, but it was still hard not to dwell on what lay ahead.
Kadeen’s surgery was scheduled for mid-afternoon. The sky was a beautiful blue and the leaves on the trees were God’s reminder… “I’ve got this!” We arrived about 30 minutes before they got started.
The anesthetic induction
An intravenous catheter was placed in Kadeen’s left jugular vein. He received an intravenous dose of Phenylbutazone prior to the surgery. Alan and I were allowed to watch the induction. I have excellent video footage that you can watch in the video at the end of the post.
Watching your horse go down is hard enough, but watching the manner in which they get him on the surgery table is not easy, either. When you watch the video, keep in mind that we didn’t believe he had a fractured splint bone at this point in time. His induction went smoothly. We watched until he was moved from the induction room into the surgery suite. At that point, we were taken to the locker room to don scrubs and booties.
The surgery and the surgeon
Alan and I were afforded an excellent view of the surgery. A hallway with a wall of windows allowed us to stay out of the way, but still see what was happening. A camera projected a close-up view onto a television screen above the surgery table.
After a sterile preparation, Kadeen’s leg was wrapped in a sterile sheet with only the wound area exposed. Ultrasound imaging performed by Dr. Kurt Solberg was used to place a spinal needle into the wound tract. That enabled Dr. Goodrich to make her incision directly above the infected area.
Speaking of Dr. Goodrich… Kadeen and his worried mom and dad really struck it rich when we snagged her as the surgeon. Dr. Laurie Goodrich is the second person to hold the Barbara Cox Anthony University Chair in Orthopaedic Research. The first chairholder was Dr. Wayne McIlwraith who founded the CSU Orthopaedic Research Center. He is primarily responsible for the growth and stellar reputation of CSU’s equine orthopaedics program.
Dr. McIlwraith did his residency at my Alma mater, Purdue University. His mentor was one of my professors, Dr. Jack Fessler. Dr. McIlwraith completed his residency and took a position at CSU in 1979 at the end of my freshman year of veterinary school. I remember him!
Dr. Goodrich is tasked with continuing the growth and development of the CSU Orthopaedic Research Center. This article from CSU details her incredible qualifications:
Goodrich’s research specialty is in regenerative medicine, gene therapies, and biologics to improve joint and bone repair. Her focus is on genetically modifying mesenchymal stem cells – stem cells found in bone marrow that help make and repair skeletal tissues – to suppress inflammation that commonly occurs in joint diseases like osteoarthritis in horses.
Though she works primarily with horses, Goodrich is a translational scientist, which means she seeks to develop medical solutions that benefit both animals and people. As a clinician, the work Goodrich does in the Orthopaedic Research Center with her team drives the veterinary work she performs on the clinic floor as a surgeon, and vice versa.By Jessica Cox
After making an incision over the wound tract, Dr. Goodrich used an osteotome to remove all of the infected bone and soft tissue. While probing the wound, she knew “something wasn’t right.” She could feel that the wound tract went into the splint bone. Radiographic films taken after a thorough debridement of the infected tissue showed that there was, indeed, a fractured splint bone.
Part of the difficulty in treating infected bone is the challenge of getting adequate levels of antibiotics to the source of the infection. Regional antibiotic infusion and the placement of antibiotic impregnated beads are two means by which higher concentrations of antimicrobials are delivered to the infected tissue. Both methods were used to treat Kadeen’s bone infection while he was still under general anesthetic.
I found this article written in 2007 by yet another of my Purdue professors, Dr. Stephen Adams! While it is somewhat technical, it will explain both techniques if you are interested in learning more. In next week’s update about this ordeal, I will show you a video of regional perfusion. In the feature photo for this post, you can see the beads visible in the post-surgery radiographs.
A dozen people in the surgery room
While Dr. Laurie Goodrich was the primary surgeon in the room, she had a stellar staff assisting her. The resident assigned to Kadeen’s case and the lovely lady that has regularly communicated with me is Dr. Charlie Barton. Teresa Le was the student, and she admitted to me that she was not a “horsey gal.” Nevertheless, she enjoyed working with my sweet boy.
There were 4 equine surgery technicians present: Debbie, Stevi, Kylie, and Jess. The anesthesia team was headed by Dr. Khursheed Mama and included a student, Caroline, and 3 technicians: Natalie, Kevin, and Sierra.
“Go big or go home!”
Kadeen’s leg was bandaged from his hoof all the way up to his chest. An antimicrobial gauze was initially wrapped around the wound, and then secured with elastic tape. Three bandage rolls provided the bulk of the padding. The padding was held in place by brown gauze applied with pressure. A layer of Coban or Vetrap provided additional stability, and was held in place by elastic tape on the top and bottom.
For the purposes of protecting his leg during his anesthetic recovery, a hard splint was placed on the back of his leg. It was cut to fit, insuring that it ran the entire length of that leg. In the video below, you can see the extensive padding placed between the splint and Kadeen’s leg. This hard splint was removed as soon as Kadeen was fully awake.
Note on the video that when moving Kadeen back into the recovery room, his heavily bandaged leg was loosely secured to his good front leg.
When Dr. Goodrich came into the hallway to tell us that post-op films had disclosed a fractured splint bone, I teased her about the extensive bandage she had applied. “Go big or go home!” was her answer, delivered with an impish grin. She also said that if she had known he truly had a fracture, she would have packed it with stem cells taken from his bone marrow. While that would no doubt have added to our already significant medical bills, it would have accelerated the healing… not a bad thing given that my boy is 20 years old.
I don’t know if the fracture occurred at the time of the original injury and just didn’t show up on previous films, or if it was a result of the lingering infection. I am inclined to believe it was the latter, but we will never know.
It was during that post-op discussion about Kadeen’s fractured splint bone that we learned there would be no hauling of my boy until that fracture healed. Forget our winter move to Arizona that was, at that point, scheduled for 2 days hence. We had totally expected to delay it, but had not planned on 6-8 weeks delay! Our Colorado horse facilities are more designed for summer weather.
It was imperative that Kadeen’s broken bone was protected during his attempts to stand when recovering from the anesthesia. A rope was placed on his tail and on his head, which was protected by a bumper pad as well. Dr. Tom O’Brien, the Equine Surgery Resident who examined Kadeen initially, was the tail man! He took the photos of Kadeen’s recovery, as Alan and I were not allowed to be there.
Dr. O’Brien noted during his initial exam of Kadeen on October 7th that I had a smart horse. Tom reiterated that sentiment when he observed how sensible my boy was when trying to get up after anesthesia. Yet another set of radiographs were taken after Kadeen recovered from anesthesia to insure that no displacement of his fracture had occurred during recovery.
A welcome text message
A little before 7 PM the night of the surgery, I received a photo and text message that Kadeen was awake and doing well. It was a great relief. It would be several days before I would sleep soundly again, but at least we were through the surgery.
This 10-minute video will walk you through everything from induction to recovery. Next week, I will share with you more details about regional perfusion and show a video. Stay tuned for updates on his recovery. It has been a very long few weeks and we are not out of the woods yet.