Two bone plates, 20 screws and a large temporary pin stabilize the shattered leg of Europe’s richest racehorse, St. Nicholas Abbey. Dr. Dean Richardson of Chester County, PA’s New Bolton Center flew to Ireland to assist with the surgery and follow-up. Photo credit: Coolmore
At dawn on a Tuesday morning in July, world-renowned surgeon Dean Richardson, DVM, opened an e-mail from two equine surgeons in Ireland. Included were two radiographs of a horse’s shattered leg. The questions: “Can this horse be saved? What are the chances of survival?”
St. Nicholas Abbey, the greatest money-winning, European-trained racehorse of all time, had shattered his right fore pastern while exercising at Ballydoyle, the racing arm of legendary international Thoroughbred breeders Coolmore Stud. It was to be his final exercise before a major race at Royal Ascot.
The Chief of Large Animal Surgery at Penn Vet’s New Bolton Center in Kennett Square, PA, Dr. Richardson immediately examined the radiographs. “I said I thought there was at least a 50-percent chance that we could save the horse,” he recalled in a recent interview. “They said that was enough for them to give it a go.”
Dr. Ger Kelly and Dr. Tom O’Brien had known Dr. Richardson – one of the world’s preeminent experts on the repair of complex equine fractures – for years. In fact, the two surgeons had learned from Dr. Richardson during lectures and laboratories at several international conferences.
Dr. Richardson packed up several large cases filled with highly specialized surgical equipment and implants from New Bolton Center, as well as some loaned by the Synthes company in nearby Paoli, PA, and headed to the airport, boarding a private jet just before midnight on July 23. Landing at Shannon Airport in western Ireland, he hopped on a waiting helicopter and flew directly to the Fethard Equine Hospital in County Tipperary.
Drs. Kelly and O’Brien met Dr. Richardson at the hospital, and the surgeons examined the injured Thoroughbred. After discussing the surgical plan and double-checking that all instruments and implants were available, the team went straight into surgery.
“It was an extremely challenging surgery,” said Dr. Richardson, explaining that the horse had multiple fractures of the proximal and middle phalanges, which are two out of three bones below the fetlock joint. There was marked separation of fracture fragments in both the fetlock (metacarpophalangeal) and the pastern (proximal interphalangeal) joints. The fetlock was surgically dislocated in order to accurately reconstruct the joint in an effort to minimize the likelihood of severe arthritis.
“The bones weren’t just fractured, they were shattered,” Dr. Richardson said.
During the surgery, it was evident that some of the smaller bone fragments had lost their blood supply and had to be removed, leaving several gaps that required a bone graft from the horse’s pelvis to replace the damaged bone.
“We had to carefully piece back together the major fragments with multiple individual screws. After the basic reconstruction was done, we used two locking bone plates to further stabilize the fractures and bridge the pastern joint,” Dr. Richardson said, estimating the surgery took three hours. “We used a total of two bone plates and 20 screws and a large temporary pin above the fetlock to further protect the site.”
Although Dr. Richardson has been brought in for surgeries around the country and the world, St. Nicholas Abbey’s case was extraordinary. “I would put this among the most difficult fractures I have ever repaired,” he said.
And this is a special horse. The six-year-old bay stallion is one of the biggest money-winning horses in European racing history, earning the equivalent of $8 million before his devastating injury.
Fortunately, St. Nicholas Abbey had a smooth recovery from anesthesia, and the three surgeons retired to McCarthy’s pub for dinner.
The next day, the surgeons were anxious to check on St. Nicholas Abbey. “I looked at the horse the next morning,” Dr. Richardson said. “He looked really, really good.”
About 22 hours after he had arrived, Dr. Richardson boarded the same jet and headed back home to Pennsylvania.
The next day, St. Nicholas Abbey developed colic – not surprising, given the stress of hospitalization, fasting, anesthesia, and anti-inflammatory drugs – and was rushed into major abdominal surgery. Dr. Richardson, already back at New Bolton Center, was in constant contact with his colleagues in Ireland.
“It was very nerve-wracking because he had to be anesthetized and then stand back up on his broken leg again, so that was a big deal,” Dr. Richardson said. “Fortunately he was able to do that.”
Dr. Richardson flew back to Ireland 10 days later to check on St. Nicholas Abbey’s condition. “He looked great,” he said. “He lost a lot of weight because of colic surgery, but he otherwise looked bright, happy, and healthy.”
In August, the temporary pin in the injured leg broke, and had to be removed. “That was anticipated,” Dr. Richardson said.
On October 23, Coolmore announced that St Nicholas Abbey had developed mild laminitic changes in the left foreleg over the previous 24 hours. “This is disappointing as he is now weight bearing and walking well on the operated (fractured) leg which has healed amazingly well to date.
Although laminitis could be a life threatening complication we are hoping the condition will stabilize. Consultations are on-going between veterinary surgeons Dr Tom O’Brien and Dr Ger Kelly of Fethard Equine Hospital and the USA based Dr Dean Richardson (Head of Surgery at New Bolton Centre Pennsylvania) and Dr Scott Morrison (Head of podiatry at Rood & Riddle Equine Hospital in Kentucky) regarding the best possible treatment plan for St Nicholas Abbey,” the dispatch read.
"The fracture in the right forelimb is healing extremely well. We are happy with that. But we still have serious concerns about his left front foot," said Dr. Richardson on November 7.
Dr. Richardson remains a part of the team caring for St. Nicholas Abbey. He reviews radiographs and videos each week, evaluating the horse’s comfort level. The leg is now out of a completely rigid cast and the fractured limb is gradually bearing more weight.
When will the horse be considered fully recovered?
“The real definition of success for him is that he eventually becomes sound enough to be a happy, comfortable breeding stallion,” Dr. Richardson said. “With horses, you just can never say they are saved until they are actually saved.”