CASE 4: Arabian Mare, 12 Yrs Old -- Acute Grade IV Laminitic Event



case_arabian_1This mare presented in severe pain; The left fore sole was open and the bone exposed; The right fore hoof was sinking.







Day 1: Condition of left fore sole at time of surgery; Note exposed bone (arrow).






30 days post-surgery. Note new growth (arrows).






Day 90: Although sinking had occurred with complete    loss of hoof capsule, circulatory collapse was not fatal.






At 120 days the mare has new soles, heels and quarters.                                                                                     




 At 6 months, the mare was sound with new hoof tissue.





Day 180: The mare is ready to return home!







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CASE 5: American Quarterhorse Gelding, 13 Yrs Old -- Chronic Acute Grade IV Laminitis




This middle-aged Quarter Horse was rescued by Cashvan Family Memorial Equine Fund. He was presented to us six months after an acute laminitic bout. He was unable to stand.







Pre-surgery: Condition of legs showing hyperflexion of fetlocks and abrasions of fetlocks.









Post-surgery: Shows correction of fetlock hyperflexion. Capsular derotation complete. The horse is able to stand and walk comfortably.







Pre and Post surgery: The radiograph on the left was taken before surgery and capsular derotation. The radiograph on the right shows the bones of the hoof back in their correct position.






Day 180: The hooves have been returned to normal shape and size, and was ready for adoption.






 Ready for a new home.






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 CASE 6:  Quarter Horse Mare, 15 yrs old -- Fatal Sinker Syndrome

case_fatal_sinker_1Fatal Sinker Syndrome is the worst case scenario in Laminitis. These horses have traditionally been put to sleep. Dr. Ric Redden of Versailles, KY started investigating saving these horses through a procedure known as transcortical fixation and hoof wall ablation. As of this writing nine research cases have been tried, three were at Serenity Equine.  We have a survival rate of two horses in our hospital.  It is critically important that the horse reach surgery before all blood flow is lost to the foot. Once the hoof dies, it contracts, acting as a tourniquet causing bone and lamellar death. By placing pins in the cannon bone, removing the hoof capsule and casting the leg so as to cause weight bearing at the cannon bone while suspending the foot in a non-weight bearing mode, we are able to save the blood supply and the lamina. In a matter of weeks the lamina will harden and new hoof will grow. In one year all new tissue is normal. We expect our two cases to return to their previous abilities. 
case_fatal_sinker_2Venograms of Right Fore & Left Fore. Note the lack of blood supply to Right Fore and congestion of blood above coronary band. Left Fore has adequate blood supply and is a Grade IV rotation that required a deep flexor tenotomy. 



case_fatal_sinker_3The hoof capsule after removal or ablation appears normal from the outside, but once turned on its side shows the congestion and swelling from the dying lamina.



case_fatal_sinker_4After 3 weeks in a cast, hardening of the digital corium (hoof wall) and solar corium (sole) is almost complete. The cast & pins were left on for a total of 11 weeks (note arrows pointing to transcortical pins).





14 weeks post-op mare is comfortable enough to try and escape from stall.






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CASE 7: Two year old Friesian gelding with bilateral solar penetration following acute episode of Potomc Horse Fever- a Grade IV laminitic event





Day 1- radiograph showing penetration of sole by tip of coffin bone- note that the sole below the bone has dropped to the ground.








Day 1- showing solar surface of left fore and exposed solar corium and bone. 









Six weeks post-surgery and digital realignment showing new sole growth and excellant alignment. Note- the dark area at the tip of the toe. This is the area that has grown out that was compressed circulation.







Day 1 radiograph of right fore showing same pathology as left fore.








Day 1 showing prolapsed sole and exposed bone and solar corium on right fore.









Six weeks post surgery showing new hoof, sole and digital alignment.








One year post surgery, horse was purchased with a clean pre-purchase exam and won his Keuring.




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CASE 8- 13 year old Hanoverian mare with Acute Grade III and IV. 





Prior to presentation to Serenity Equine, the owner tried to treat the coronary band rupture following a severe Grade IV attack of laminitis. The hoof wall has pulled away from the sensitive lamina and is necrotic. This was the mare's second attack of laminitis. The first attack left her with minor distortion and prone to a more severe reaction. The mare was Hyperinsulinemic and overweight.







Day 1- Left Fore- Grade IV laminitic event. Upon presentation to Serenity Equine: an elevated cuff was applied prior to shipping. There is no attachment  of the P3 to the dorsal hoof wall. The P3 is prolapsed through the sole and this foot has the coronary band rupture. 





Day 1- Right Fore Grade II laminitic event. This foot was considered a Grade III because there was no outward pathology. Had the foot not been treated rapidly, it would have progressed to a Grade IV. There is an internal shadow of hemorrhage in the dorsal hoof wall where the P3 has pulled away from the hoofwall. The rotation is not as severe and there is adequate sole depth. We elected to continue treatment with raised heels and monthly digital realignment.







90 days Post Treatment of the Right Fore. Notice the destruction of the dorsal hoof wall lamina that can be seen in the radiograph above.







Radiograph taken prior to the 90 day trim of the Right Fore, notice the destruction around the tip of the P3 bone. Both the dorsal hoof wall and underlying sole show major trauma, but there is healthy new sole and new hoof wall forming. 






90 day shoeing of the Left Fore. This foot was subjected to surgical correction and digital realignment. Note the healthy new sole under the tip of P3 and the new hoof wall growing out.







The Left Fore at 90 days post-op showing the healing coronary band rupture







The healing coronary band rupture 30 days after the photograph above, showing the cornification of the hoof wall. Also note the new hoof wall growth. 






Six months from the time of presentation, the Left Fore has healed and can be barefoot.







Six months later, the Right Fore is comfortable being shod with a modified pitch shoe.








This photograph was taken prior to the mare's first laminitic attack.The owner reports that today the mare is happy and just as sound as before. 




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