A Horse for a Day
Published in modified form in EQUUS magazine. Justin Caler had a horse!

Justin grew up in a small western town playing baseball and as a young man he was learning cabinetry as a trade. A friend took him riding in the mountains and Justin caught the trail riding bug while mounted on a handsome wasp dun named Smokey, a six year old foundation bred horse with a strong build, a short Quarter Horse head with foxy ears and a gentle big eye. The horse was green but willing, and he bonded with Justin.

Justin had money in his pocket to buy his first horse as he met the brand inspector at his uncle’s place where Smokey had been moved. They walked out into the acres of snow-dotted grass where a few horses pawed through the snow to graze, but both men stopped and frowned when they saw the bright red blood pooling on the snow and the wound on Smokey’s right front pastern. The brand inspector suggested Justin call a vet.

I rode with my husband and partner, Dr. Jim Latham, out Snowball Road, slowing on the icy gravel and we observed the leaning barbed wire gate and the broken barbed wire fence strands in places along the road. Fall migration of elk and deer played havoc with a lot of fences in this part of the west. We realized we had found the site of our ranch call.

By this time, Smokey was tied to a tree by the driveway and he stood calmly on all four legs. But a quick look at the back and inside of his right front pastern showed the classic damage of a barbed wire fence; the chewed skin, ligaments, nerves and blood vessels from the sawing action of the barbs that trap a horse’s leg like clinging rose thorns and rip and tear as a horse tries to get free. Commonly the wound is aimed down and deep, literally separating the heel bulbs from the foot, disrupting the coronary band, or dissecting down the lateral cartilages of the hoof, even severing the collateral ligaments of the coffin joint. Penetration of the digital sheath around the tendons or the joint capsule of the coffin joint can be a life threatening injury if not dealt with aggressively and quickly.

We were hopeful as Smokey was putting full weight on his damaged hoof, but when he tried to walk, his lameness was obvious. The wound was still bleeding.

Immediate care for a barbed wire cut required ligating any significant bleeders, examination for tendon sheath or joint penetration, irrigating and disinfecting the wound, and stabilizing the lower leg to reduce motion that would continue to separate significant tissues and delay healing. Antibiotics and a tetanus booster are always indicated.

Jim gave Smokey a short acting sedative with an added pain killer, provided regional anesthetic with an abaxial nerve block, and tied off a small bleeder, debrided torn, frayed tags of skin and tissue, and flushed the wound repeatedly with sterile saline containing a very small amount of chlorhexidine solution. We did not observe any joint or tendon fluid that would indicate involvement of those structures, but we could see a frayed ligament on the inside of the pastern. Jim wrapped the wound with telfas, cotton, gauze and Elastikon.

Jim discussed further options with Justin and his family. The wound could be partially sutured and Smokey’s best chance for functional and cosmetic healing depended on immobilization of the wound for the first few weeks—a boot cast-- and that would require his confinement to a small, clean, and dry stall. Otherwise, the motion of the pastern with each step would slow the healing and proud flesh would be a likely sequelum. Luckily, Justin’s family had an available stall behind their 4-H projects barn, and Smokey loaded easily into a stock trailer for the 10 minute trip to the house. We met them there.

Jim removed the temporary wrap and reblocked the nerves to the foot with a longer acting local anesthetic. Again, he flushed the wound with sterile saline, finished with a flush of diluted gentamycin, an antibiotic, and trimmed the ragged edges of the skin. He removed additional macerated tissue that protruded from the wound. He sutured the wound with 0 sized Prolene, a synthetic suture, in interrupted and cruciate patterns. Once again, he wrapped the wound with telfas and brown roll gauze while Smokey stood quietly in the shed-like stall.

Jim drilled a small hole in the toe of Smokey’s hoof and inserted a stainless steel wire. He rolled two layers of stockinet from hoof to above the fetlock and roll cotton as padding over pressure points. He rolled on a support foam that forms to the leg and protects the tissues and bones of the pastern and fetlock. He then applied three rolls of Vetcast, a warm-water triggered resin-impregnated cloth mesh, over the foam, while I used the wire to keep the hoof in a normal placement. Commonly, we apply this boot cast while the patient is under general anesthesia, but Smokey proved to be an unusually compliant horse. Jim had Smokey’s foreleg resting on his knee while he applied the cast, and the young horse waited patiently while the Vetcast quickly dried. Jim tested the cast material and placed the hoof back on the ground. Smokey lifted his leg carefully to test the weight, and looked as though he was waiting for the next event.

Jim finished up by giving Smokey IV phenylbutazone for pain, a tetanus booster, and left trimethoprim-sulfa tablets for Justin to give Smokey twice each day along with Bute paste. Smokey would stay in his stall for a total of six weeks. The external wound would heal sooner, but we were concerned about Smokey’s degree of lameness and injury to deeper ligaments.

We checked on Smokey each week and worried about his discomfort on turning. We warned Justin about the signs of cast sores—sudden pawing, chewing the cast, worsening lameness, wet spots and odors. Justin kept Smokey’s stall clean and dry and Smokey remained peaceful.

Eighteen days after the injury, Jim and I gave Smokey a short sedative and using a cast cutter, removed the boot cast. The wound looked quiet and mostly healed. I removed a few sutures. Jim instructed Justin in wound care and wrap changes using a steroid-antibiotic crème on any red areas, Neosporin on quiet spots, telfas, cotton, roll gauze, and Elastikon.

One week later, the wound looked very quiet and wrap changes were extended to every five days. Smokey was still lame when turning but walked ahead quite well. He was still confined to his stall.

More than two weeks later, after a heavy snow and the stabling of other horses just outside of Smokey’s stall, we returned for a final check and discussed taking x-rays to look for bone damage that would show up by now if the horse was still lame.

Jim removed the wrap. Smokey’s wound was well healed with closed edges, some obvious disruption of the coronary band and no discomfort on palpation of the deeper structures around the inside or back of the hoof below the wound. Smokey was turning well on the foot, but with the distraction of nearby horses, he had pawed with both feet at the door of his stall until he had severely worn off his toes, bruised his hoof wall and solar callus at the toe of both front feet, and was now lame on both front feet. Complete evaluation of his wound-related lameness became complicated by his sore toes.

The good news was that Smokey’s wound had healed, and that he no longer needed a wrap or confinement. The bad news was that he would be lame for 3 or more weeks while his toes grew out and the bruising healed and we couldn’t evaluate his injury until then. We led him out into the sun with three other horses, turned him loose after a gram of Bute, and Smokey rolled in the driest spot he could find.

One month later, we stopped by to look at Smokey. He winced on his right front as he walked up to greet us, more lame than he had been when we had removed his cast. We took out the portable x-ray equipment and shot views around the hoof.

Smokey’s x-rays highlighted bone spurs that had developed along the dorsal and medial rim of the coffin joint—where the ligaments of the lateral cartilage had been torn. We cautioned that Smokey most likely would not return to steep trails and might require pain relief to be comfortable. After all of Justin’s dedication and expense, he’d really only had a sound horse for a day.

We did reevaluate Smokey when his hoof wall damage from the disrupted coronary band has grown down to the bearing surface, in another six months. Smokey was going on a camping trip.

Keeping him trimmed will be important, as always. Potential treatment will include injecting the distal interphalangeal (coffin) joint if bone spurs increase. We’ll try to give this honest young horse a quality life.

Barbed wire is for controlling cattle, not horses. Electric fence can be strung through snap-on extenders to keep horses away from barbed wire, but where cattle are not an issue, why not rip out the barbed wire down and build a safe fence. There are many alternatives. We may all be out here to enjoy the Western dream, but it is time for horse owners in the west to protect their horses.


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