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Catastrophic Injuries Understanding and Preventing CATASTROPHIC INJURIES BY STACEY OKE, DVM, MSC ER ST U L ILL B 26 25TH ANNIVERSARY SPONSORED BY PFIZER ANIMAL HEALTH TheHorse.com THE HORSE July 2008 DR. RoBIN PETERSON ILLUSTRATIONS ollowing the euthanasia of filly Eight Belles, who suffered cata- Six different types of catastrophic injuries: (left to right) condylar fracture of the cannon bone, strophic injuries to both front legs a quarter mile after finish- sesamoid fracture, long pastern bone fracture, ing second in the Kentucky Derby, members of every sector of third carpal slab fracture (in the knee), tibial the Thoroughbred industry have banded together to proactively fracture (in the stifle; this is actually relatively common in racing Thoroughbreds), and the Faddress safety and welfare issues. In this article, representative mem- rupture of the suspensory apparatus. bers of the equine industry together provide an in-depth exploration of catastrophic injuries in the Thoroughbred racehorse, focusing on what veterinarians know about catastrophic injuries based on the available scientific data, and looking at what work is still to be done. What are Catastrophic Injuries? According to epidemiological surveys The term “catastrophic injury” in the What happened to Eight performed in California, Kentucky, On- context of equine veterinary medicine tario, the United Kingdom, Australia, refers to a severe musculoskeletal injury Belles is tragic, but it has gal- and Hong Kong, the number of cata- sustained by athletic horses during rac- vanized the industry like I have strophic injuries incurred by racehorses ing or training that results in an acute is small. lameness. Such injuries include (either never witnessed before. Maybe “Obviously the entire industry wants alone or in combination): this will give us some sort of the number of catastrophic injuries ■ Condylar fractures (fractures of sustained by Thoroughbreds to be ze- the lateral or medial condyle of the central purpose. ro,” emphasizes C. Wayne McIlwraith, third metacarpal bone, also called BVSc, PhD, FRCVS, DSc, Dr. med vet the cannon bone); — Dr. larrY BRAMLAGE (hc), Dipl. ACVS, Barbara Cox Anthony ■ Fractures of the sesamoid bones; University Chair and Director of Ortho- ■ Displaced slab fractures in bones such injuries result in humane euthanasia. Inju- paedic Research at Colorado State Univer- as the third carpal (in the knee) bone ries involving multiple structures, such as sity. “We need to continue to work towards or central tarsal (in the hock) bone; the injuries sustained by horses like Bar- this goal and look at all possible ways of ■ Rupture of the suspensory apparatus baro (who fractured three separate bones reducing the numbers of injuries.” or other tendons or ligaments; in his hind leg and dislocated the fetlock Antonio Cruz, DVM, MVM, MSc, Dr. ■ P1 (long pastern bone) fractures/ joint in the same limb), are most often life- med vet, Dipl. ACVS, ECVS, of the Depart- sagittal fractures (or any fracture of threatening. ment of Clinical Studies at Ontario Vet- the distal limb); and erinary College in Canada, recently per- ■ Any other bony fractures, including Thoroughbred Injury Rates formed a study on catastrophic injuries in those of the tibia, humerus, pelvis, fe- Larry Bramlage, DVM, Dipl. ACVS, an Canadian Thoroughbreds. mur, or stifle. equine sugeon at Rood & Riddle Equine “Our research group collected data from Isolated musculoskeletal injuries can be Hospital in Lexington, Ky., says, “The two Ontario racetracks in 2004 and 2005 successfully managed surgically and, de- Triple Crown, historically, is a very clean and found that 76 horses were euthanized pending on the exact nature of the injury, (series of races). Before Barbaro we have following the development of catastroph- many of these horses have a good prognosis to go back 15 years to cite the previous in- ic injuries, which was equivalent to 2.36 for return to racing post-surgically follow- jury. From a scientific aspect, two injuries and 1.69 fatalities per 1,000 racing starts,” ing appropriate rehabilitation. Only rarely in three years does not constitute an ‘epi- Cruz says. are these injuries career-limiting, and it is demic,’ but rather a heartache for both the This data is consistent with other epi- even more uncommon that catastrophic equine industry and the casual fan.” demiologic studies. In 1996, Sue Stover, July 2008 THE HORSE TheHorse.com SPONSORED BY PFIZER ANIMAL HEALTH 25TH ANNIVERSARY 27 Catastrophic unsound/unfit for racing by the regulatory Why do Catastrophic Equine veterinarians at 30 different racetracks Athletic Injuries Happen? (a list of the participating tracks is avail- According to McIlwraith, durability of INJURIES able at www.jockeyclub.com/mediacenter. the horses, use of pharmaceutical drugs DVM, PhD, Dipl. ACVS, a professor from asp?story=288). These veterinarians are too close to racing, differences in track the University of California Davis School voluntarily collecting data and submitting surfaces, and underlying musculoskeletal of Veterinary Medicine, and colleagues re- it to the database using standardized crite- disease are all factors that can result in ported 1.7 fatalities per 1,000 starts in Cali- ria and terminology. catastrophic injury. fornia Thoroughbreds. A Kentucky study “Using the available data from 2007, the It should be noted that it is generally not co-authored by Noah Cohen, VMD, MPH, fatality rate of racing Thoroughbreds was the injury itself that forces veterinarians to PhD, Dipl. ACVIM, currently a member of 1.47 and 2.03 per 1,000 starts on synthetic euthanize injured horses. Texas A&M’s Department of Large Animal surfaces and dirt, respectively,” summa- “Instead, it is the postoperative com- Medicine and Surgery, reported 1.4 fatali- rizes Scollay. plications associated with severe injuries ties per 1,000 starts. In 2001, Mary Scollay, “Ultimately, we will be able to pool the and our inability to manage these compli- DVM, associate veterinarian at Calder Race data and generate meaningful statistics,” cations that ultimately result in the demise Course and Gulfstream Park in Florida, explains Scollay. “Since industry buy-in of horses with severe musculoskeletal in- and colleagues reported the incidence of has been overwhelming, I am optimis- juries, as we clearly saw in the case of Bar- fatality due to catastrophic injuries as 1.2 tic that it will not be long before this is baro,” explains Bramlage. per 1,000 starts in Florida Thoroughbreds. a comprehensive database applicable to He continues, “The decision of whether In addition, preliminary data collected Thoroughbred racing throughout North to euthanize an injured horse or not is of- by Scollay through the new on-track in- America.” ten very complicated and dependent on jury reporting system, which came about The Jockey Club Information Systems’ the horse’s prognosis to return to racing in 2007 as a result of the first summit on InCompass Systems developed the soft- or breeding, as well as emotional and eco- the safety and welfare of racehorses, con- ware for the database and is providing use nomic factors.” curred with these earlier studies. of the software free of charge to all partici- He suggests that for most major inju- Scollay’s reporting system was designed pating racetracks. ries, the decision to euthanize is due to to catalog the frequency, type, and outcome “It is time for us to be realistic,” says laminitis. of racing injuries in a database capable of McIlwraith. “According to these epide- “The terminal blow usually comes in the identifying horses at risk for injury. Veteri- miological surveys the number of (cata- opposite foot,” says Bramlage, referring to narians in the program are currently look- strophic injuries) is small, but we can do supporting limb laminitis, which can de- ing at data from horses determined to be better.” velop when an injured horse places uneven S N O I T RA ST N ILLU SO ER T BIN PE Ro DR. 28 25TH ANNIVERSARY SPONSORED BY PFIZER ANIMAL HEALTH TheHorse.com THE HORSE July 2008 SPONSORED BY PFIZER ANIMAL HEALTH horses and participants, and to protect the Catastrophic RacING DEatHS interests of the betting public (www.rmtc- LOCATION FATALITY RATE PER net.com). INJURIES OF STUDY 1,000 STARTS One of the primary and persisting prob- weight on his limbs for an extended period (date of data collection) lems concerning medications is that each of time. California 1.7 (1992) state has its own rules regarding drug use, While the potential complications when Kentucky 1.4 (1992-1993) testing, and withdrawal times. To date, managing horses with severe musculosk- anabolic steroids are banned in multiple Florida 1.2 (1995-1998) eletal injuries are too numerous to count, states, but they are still allowed in others. one major issue to consider is that veteri- Ontario, Canada 2.36, 1.69 (2004, 2005) Lately, and particularly since Eight 0.8 (1987-1993) and 0.9 Belles’ euthanasia, there has been much narians are not able to deliver high enough United Kingdom concentrations of antibiotics to the distal (1990-1999) discussion of adopting “zero tolerance” limb via the bloodstream. Victoria, 0.33 (1986-1993) and for not only anabolic steroids, but race day “In anatomic regions where there is Australia 0.44 (1989-2004) medications in general (although it should mostly tendon and bone rather than mus- be noted that no illegal drugs or steroids cle, the blood supply is low,” says Bram- noted that existing reports have shown were found during Eight Belles’ necropsy lage. “This is probably the main reason risk for injuries resulting in death decreas- and drug testing). why infection is such a problem for us in es with age. The incidence of fatalities due to cata- the distal limb. We just can’t keep the tis- Stover’s review, “The epidemiology of strophic injuries reported in the United sue alive.” Thoroughbred racehorse injuries,” was Kingdom and Hong Kong—where rules published in the journal Clinical Tech- governing the use of medications are more Sex, Drugs, and Rock ‘n’ Roll? niques in Equine Practice in 2003.
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