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ISSUE 39 OUTSIDE COVERS2b_Layout 1 20/08/2012 09:52 Page 1

European Trainer ISSUE 39 – AUTUMN 2012

European

ISSUE 39 – AUTUMN 2012 £5.95

www.europe.trainermagazine.com

THE QUARTERLY MAGAZINE FOR THE TRAINING AND DEVELOPMENT OF THE THOROUGHBRED

MICHAEL FIGGE

The up-and-coming trainer from Munich, taking the right risks

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JOCKEY FEES AND TRAINERS PERCENTAGES Who gets what across Europe?

Is China the new racing frontier?


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VETERINARY

STAND AND DELIVER

An important step forwards in equine fracture repair In the past, surgical repair of equine limb fractures has always been performed under general anaesthesia. Anaesthesia in horses is an inherently risky procedure, and the surgeon’s careful work can be destroyed in a moment as the horse wakes and rises unsteady on his feet only to break the limb for a second time. A second break at this stage is usually beyond repair. A new study, published in Equine Veterinary Journal (EVJ), has shown that a new approach has excellent results. WORDS: Celia M MaRR, POlly COMPStOn PHOtOS: ROSSDaleS anD PaRtneRS

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TANDING surgery in the horse is growing in popularity across soft tissue and orthopaedic disciplines, as it is often quicker and avoids the inherent risks of general anaesthesia. At Rossdales Equine Hospital in Newmarket, some racehorses with specific fracture configurations now have surgery ‘standing’- that is, under standing sedation and local anaesthetic. As increasing numbers of racehorses have had fractures repaired in this way, it has developed into a routine procedure for certain patients. General anaesthesia is known to be of particularly high risk in the horse, and this is especially true for horses that are having a fracture repaired. Racehorses are extremely high performance athletes and therefore injuries that require surgery are inevitable. Two very common fracture sites in racehorses involve the fetlock joint: condylar fractures of

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Polly Compston, clinical researcher at Rossdales

the cannon bone and midline ‘split pastern’ fractures. Both can be repaired with bone screws, which has been traditionally performed under a general anaesthetic. However, in 2006 two scientific studies advocated a novel approach so that these fractures could be repaired using local anaesthetic to desensitise the leg in a sedated patient. Shortly thereafter, Richard Payne at Rossdales started to perform this operation on standing horses. Horses are sedated heavily, in an area with padded floors and walls. The reasons for this are three-fold: firstly it is a clean and quiet environment; secondly it means that if the horse should need the procedure to be completed under a general anaesthetic for some reason (it has not happened yet!) then everything is set up and the horse is in the right place for this; and thirdly, it is thought that the padded floor helps disperse the vibrations from the drill


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STANDING FRACTURES that is used to place the screws in the bone, making it less likely that the horse reacts. The operation itself is very similar to when it is performed under a general anaesthetic except for the position the horse is in. Polly Compston, a clinical researcher at Rossdales, followed the progress of 34 racing thoroughbreds and arabs that had a fracture repaired standing between March 2004 and June 2011. All these horses tolerated the operation very well, although four had some post-operative gastrointestinal problems – a fairly common complication of any major surgical procedure, independently of any veterinary treatment they are given. Sadly one of these could not be saved despite intensive care. One horse developed minor skin sores, which again resolved without incident following appropriate treatment. Thirty-three horses left the hospital to return to race training. Three of these were operated on less than six months before the study was conducted and therefore subsequent performance information was not

“General anaesthesia is known to be of particularly high risk in the horse, and this is especially true for horses that are having a fracture repaired” collected for them. Twenty-eight horses successfully returned to training. Two-thirds of the group raced and of these twelve, were placed or won at least one race. These fantastic results compare well to horses that have had similar fractures repaired under general anaesthesia. For example, in the split pastern category, 71% of the horses that were operated on standing raced again, compared to 59% – even 67% in a large study in the U.S. – of those under a general anaesthetic. Standing fracture repair is not suitable in all fractures or for all horses. This is only possible in relatively simple lower limb fractures such as split pasterns and condylar fractures – both common racing injuries. It is very important that the fracture itself is not displaced – in other words, that bone has not moved along the fracture line. This has two important implications: The first is that many of the fractures in this study are relatively small and ‘incomplete’ – that is, they are a crack in the bone rather than a full fracture line that breaks the bone into two pieces. In the EVJ study, horses operated on standing return to racing more quickly than those that had been operated on under a general anaesthesia. However, this is most likely because the initial

RP performing surgery (left): Richard Payne prepared to begin the procedure. The padded floor is extremely important as the drill vibrations are dispersed through this surface Split pastern repair (right): A midline incomplete fracture at the top of the pastern within the fetlock joint, or ‘split pastern’, fracture that has been repaired using two bone screws

Condylar fracture before (left): This X-ray shows how a condylar fracture spirals as it runs almost vertically up the cannon bone Condylar fracture after (right): The fracture has been repaired with 3 screws through the cannon bone

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VETERINARY

“Only those with an amenable temperament should be selected for standing surgery, as they must stand totally still whilst the operation is taking place” fracture was smaller rather than a direct effect of standing surgery. Small, incomplete fractures are being increasingly diagnosed using the more sophisticated methods that are now available, such as MRI (magnetic resonance imaging) and CT (computed tomography). This allows early recognition, for example of stress fractures, so developing solutions to these problems that may not have been recognised in the past becomes ever more critical. Condylar fractures, the second type of fracture in which standing repair is possible, are important. The term condylar fracture refers to a vertical break in the lower part of the cannon bone, often spiralling around the bone from the inside towards the outside as it travels up the bone. This “spiralling” process,

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This X-ray shows how a condylar fracture spirals as it runs almost vertically up the cannon bone

although incomplete and non-displaced initially, can be progressive, ever weakening the bone. This has important consequences if the horse is going to be anaesthetised, as it is at a higher risk of becoming a complete and catastrophic fracture following surgery as the horse gets up. If this happens then the fracture cannot be repaired and the horse must be euthanased. This has been a major motivator for developing standing fracture repair techniques. The procedure may not suit every horse: only those with an amenable temperament should be selected for standing surgery, as they must stand totally still whilst the operation is taking place. A highly skilled hospital team is needed, with wellchoreographed nursing, horse-handling, and x-ray support for the surgeon. Finally, the bone screws are placed through small ‘stab’ incisions in the skin. Fractures that are higher up the leg cannot be repaired in this way as there is too much muscle covering them. To summarise, the results of this Equine Veterinary Journal study have shown that fracture repair under standing sedation and local anaesthesia appears to have comparable results with fracture repair under a general anaesthetic. Standing fracture repair avoids the inherent risk of general anaesthesia and offers a viable alternative to getting horses back to the racecourse. n


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Standing fracture repair- an important step forward in fracture repair  

In the past, surgical repair of equine limb fractures has always been performed under general anaesthesia. Anaesthesia in horses is an inher...