Equine orthopedic surgeon Dr. Larry Bramlage, a top veterinarian with world-renowned equine hospital Rood & Riddle, performed surgery on Kentucky Derby contender Archarcharch Sunday to repair a lateral condylar fracture to his left, front leg.
Bramlage, the on-call veterinarian for the Kentucky Derby, first diagnosed the injury at the conclusion of the Run for the Roses, after which, the horse was transported to Rood & Riddle the next day.
In the following Q&A with Off-TrackThoroughbreds.com, Dr. Bramlage, a nationally recognized pioneer in fracture-repair techniques, answers questions about the treatment method he performed on Archarcharch.
He also discusses the “common” nature of this type of injury, and explains how cartilage damage influences future activity for horses who have sustained similar fractures.
Dr. Bramlage was the recent recipient of The American College of Veterinary Surgeons Foundation’s Legends Award for his contribution to the field of equine orthopedic surgery. His 30-year career has included many highlights, including his contributions to more than 70 publications, which he has either authored or coauthored. Bramlage has also written numerous book chapters and served on or chaired several influential boards in the equine veterinary world.
He is most noted for developing a lifesaving procedure to treat severe fetlock injuries.
Q: In general, how common is a lateral condylar fracture in racehorses and sport horses, and what are some of the possible reasons a horse might be vulnerable to this particular injury?
It is a pretty common exercise-induced injury occurring in high- level athletes. It’s comparable to ankle fractures in people who participate in athletic events.
We treat about 25-30 cases of lateral condylar fractures every year.
The injury is caused by an accumulation of micro-damage to the bone, which can become macro-damage, and ultimately fractured, if loaded unevenly or awkwardly due to external influences. An injury of this nature can also occur if the horse is fatigued, just as it might in a person who fractures an ankle.
Q: Please describe the process you utilized to assess and treat the injury in the operating room.
An arthroscopic evaluation of the joint and the cartilage was done prior to the removal of the debris caused by the trauma to the joint. Removal of the debris was accomplished by using an arthroscopic lavage, and an additional articular incision was made to remove debris from the fracture plane.
Q: What techniques did you employ to make the repair, and were there any complications?
I used a standard surgical technique called lag screw fixation (a technique that helps achieve compression between fractured bone and places it back to a position that aids healing). The procedure went according to plan.
Q: In terms of recovery, how long might the healing process take, and would there be any concern about possible infection?
It will take two to three months for the bone to heal. And infection is a concern for about two weeks.
Q: Since the cartilage damage you discovered prohibits Archarcharch from returning to a racing career at the quality level he was competing at, what options would he have had if he were a gelding, and not heading to a breeding career? Could a horse with this injury possibly move on to work as a pleasure riding horse or sport horse?
There are no techniques to dependably replace articular cartilage. There are many surgical options to help, and stem cell treatment show some promise; however, to this point, you can not re-build a horse’s joint, or a person’s either for that matter, if they lose a significant area of cartilage.
We return the majority of horses with this injury back to racing. Most make a complete recovery. If they have cartilage loss, the potential future career depends on the amount of cartilage loss, and the degree of strain involved in the desired career.