The making of a miracle

BALTIMORE — He was on the cusp of immortality when the country's premier Thoroughbred stumbled into a potentially fatal tragedy. Fans gasped and then cried as the undefeated Kentucky Derby winner suffered multiple fractures at the Preakness Stakes. But the veterinary miracle that was about to unfold became an epic of inspiration for racing enthusiasts around the world as fate, innovation and expertise converged to save the life of a horse that many hoped would win the Triple Crown.

"It turned from a possible dream come true to a nightmare," said Scott Palmer, VMD, Dipl. ABVP, proprietor of New Jersey Equine Clinic. The immediate past president of the Association of American Equine Practitioners (AAEP) was a spectator that day at Pimlico, but he soon became an integral part of a team that worked to stabilize Barbaro's battered lower leg.

Jockey Edgar Prado was considered "the first responder" with his ability to keep Barbaro "quiet" until veterinarians arrived.

Barbaro remained unusually calm and docile, making him a good surgical candidate even though his success rate was a long shot, says Dr. Nick Meittinis, Pimlico's attending veterinarian.

"When we looked in this horse's eye, he knew we were helping him," he says.

There was no shortage of help. Maryland State Racing Commission Chief Veterinarian Dr. David Zipf, AAEP On-Call Veterinarian Dr. Larry Bramlage, Dipl. ACVS, and Pimlico veterinarians Drs. Dan Dreyfuss and Rachel Beard also examined the ailing racehorse, all the while fans called out to save him.

Radiographs before and after surgery. With the locking plate system, the heads of the screws can be threaded directly into the plate.

It was the beginning of an outpouring from well-wishers and admirers from across the globe. Momentum was building for Barbaro.

"This horse received as good or better care as any celebrity counterpart that one could imagine, only bigger with all the horse issues," Palmer says.

More than 50 media outlets swarmed Penn to keep tabs on Barbaro. The college of veterinary medicine fielded thousands of requests for interviews and information.

Zipf applied a Kimsley splint that was sufficient to get Barbaro back to Stall 40 in Barn E, the one always reserved for the Kentucky Derby winner. The team continued to treat him before the Baltimore City Police's motorcycle escort to Route 83. The motorcade continued by the Maryland State Police and Pennsylvania State Police all the way to the University of Pennsylvania (Penn) New Bolton Center.

"He got top-notch care right from the get-go, which was something that helped a lot — the track crew, the ambulance driver, all those people were tremendous and all deserve some credit," Palmer says.

The diverse team played critical roles, but the man in the spotlight now was Dr. Dean Richardson, chief of surgery and the Charles W. Raker Professor of Equine Surgery at Penn's Widener Hospital at New Bolton Center.

Dr. Dean Richardson checks on Barbaro the day after his five-hour surgery. Notice the stall turned into a giant get-well card. Below, they visit two weeks later.

Palmer recommended Richardson after the diagnosis had been made because of Richardson's expertise in repairing comminuted P1 fractures. They needed a savior. "Dr. Richardson is that surgeon," Palmer says. New Bolton Center was close, has a pool recovery system and an overhead sling for the induction of anesthesia. Palmer made the arrangements.

"I was in Florida doing (another) surgery during the Preakness," Richardson says. "Though I had the digital radiographs taken at the racetrack e-mailed to me shortly after the injury occurred, and thereafter dealt with my colleagues at New Bolton Center."

He arrived on the scene with a stable horse and a global support network that began with colleagues and extended into the hearts of race fans everywhere. Internet message boards called for prayers for Barbaro and his surgeon shortly after Bramlage told the viewing audience to "keep your fingers crossed and say a prayer."

"Of all the people I know and respect in this profession, Dr. Richardson is the one. They're so lucky that he happened to be their surgeon," says Patty Hogan, VMD, Dipl. ACVS, veterinary orthopedic surgeon at the New Jersey Equine Clinic and Richardson's former student. "He is a very innovative person with tremendous vision and foresight. He can think in three-dimensional ways that not many people can. The surgery was a masterpiece from an orthopedic point of view. He put those fractures together as best as it possibly could be done."

Richardson says the surgery was a combination of established techniques that typically are used for individual repairs. In Barbaro's case they were used in concert.

The fetlock joint and the pastern joint were fused to give the leg as much stability as possible. To repair the fracture, a fairly new innovation, the locking compression plate (LCP) was used. This plate, available commercially for about two years, is potentially better for very unstable injuries like Barbaro's. It is an improved design for this type of very unstable fracture, Richardson says.

With the locking plate system, the head of each screw can be threaded directly into the plate. This results in a more stable fixation than traditional plate fixation, in which the screws provide stability only by their ability to compress the plate against the surface of the bone. With the locking plate, the fixed angle of the screw within the plate provides stability, even with an imperfect plate position or bone-fragment reconstruction.

But despite the groundbreaking nature of the process, Richardson says all the notoriety and acclaim is "a little much," even though an Internet search for "Dr. Dean Richardson" yields almost 6 million entries, and more reporters follow his routine checks on Barbaro than cover President Bush's physicals. Still, he's modest.

"There have been many people involved so far, and I'm just one person," he says. "It's important to note that it's been a team effort here; it's not like I invented anything. I'm just one person who is trying to do a good job."