But Richardson had an ally, a narrow, stainless-steel bar with 16 threaded screw holes. Inserting plates with screws beneath the skin to stabilize human bones is common, and it's been done as long as 35 years in horses. But in the past few years, Synthes Inc. of West Chester, Pennsylvania, has developed the locking compression plate (LCP), a particularly secure and effective type. No equine surgeon had more experience with it than Richardson.
Using an LCP about 12 inches long, as well as about a dozen independent screws and a cast on the outside, the veterinarian methodically reestablished a solid bone network in more than five hours of surgery. Steven Zedler, another surgical resident who assisted, said the process was a "piece-by-piece, step-by-step thing, ‘Yeah, I'll take that and screw it to that.'" Richardson had to fuse both the fetlock and pastern joints, though that would mean Barbaro would walk awkwardly. At no point, Richardson said, did he see any sign of preexisting bone damage. On the contrary, the staggering amount of breakage suggested "a very significant misstep."
No plate can hold the weight of a horse indefinitely by itself. And infection under and around it is always a threat. The hope was that the leg would heal and resume supporting Barbaro before either metal fatigue or infection became a problem. The overhead monorail took him to the recovery pool. In public comments during the next few days, Richardson made no promises. The horse had a fifty-fifty chance, no more. If those odds seemed low, Richardson was acutely aware that laminitis could undercut the surgical work.
For surgeons, is that prospect irritating?
"Irritating"? Richardson repeated, as if to say you're joking.
More like maddening.
On July 10, after weeks of good news about Barbaro's recovery, Roy Jackson telephoned his wife from an office he keeps near their home. He told her Richardson wanted them at New Bolton, immediately. Barbaro had laminitis as bad as a horse can have it. "To me, it was the kiss of death," Gretchen said. "So I went over there to say goodbye to him, basically."
A horse's feet are complex marvels, because the animal moves on its toes, like a ballerina. Each leg ends in a single digit called the coffin bone. That digit is surrounded by the hoof, which is the equivalent of a toenail that completely encircles the toe. In the middle, between coffin bone and hoof wall, are two layers of laminae.
Larry Bramlage, a former president of the American Association of Equine Practitioners and a surgeon at Rood & Riddle Equine Hospital in Lexington, Kentucky, likens laminae to a tiny forest of pines whose branches intertwine. They bind the coffin bone to the hoof wall, preventing the digit from shifting as the horse moves. Laminitis breaks that bond. The laminae start to give way, causing pain and discomfort; if enough laminae detach, the coffin bone rotates within the hoof or moves downward. The pain is usually so excruciating that often the only humane step is euthanasia.
In 1998 and '99, the U.S. Department of Agriculture checked thousands of horses and found that 2.1 percent had experienced laminitis in the previous 12 months, and that 4.7 percent of those horses had died or been euthanized. Applied to today's estimated population of 9.2 million horses, that would mean 193,000 cases and 9,000 deaths.