Auburn University —
Emma and her second prosthesis. Her growth required reduction of the height of the overall prosthesis and lengthening of the height of the foot to keep her level.
Auburn University’s College of Veterinary Medicine and the Hanger Clinic, formerly Hanger Prosthetics and Orthotics, are working together on a case that could have implications in the treatment and rehabilitation of horses, donkeys and other equines with congenital deformities or injuries.
Emma, a miniature donkey foal, was just two days old when she arrived at the John Thomas Vaughan Large Animal Teaching Hospital in April with a severe hind limb deformity, one that required amputation of the limb and the placement of a prosthesis.
Dr. Fred Caldwell, an assistant professor in the Department of Clinical Sciences and equine surgeon, performed the procedure, and is working with clinician Billy Fletcher from Hanger Clinic – the same company which made the prosthetic tail for Winter, the amputee dolphin and star of the film “Dolphin Tale” – to develop a prosthesis for her limb. The two worked out a plan to both allow Emma time to heal from the surgery and transition from her cast to the prosthesis.
“Billy was excited and enthusiastic to assist,” Caldwell said. “Once we proceeded with the surgery and amputated the distal limb, he provided a small footplate to incorporate into the cast to even out the length of her hind limbs so she could bear weight until we could get the surgical site healed and have her fitted with a prosthesis. It has been a group effort on behalf of many caring individuals willing to go to great lengths to save her.”
Emma’s case is providing a unique and beneficial teaching opportunity for everyone involved. The practice of using prostheses with large equines is relatively uncommon due to size and weight-bearing limitations. Because Emma is a miniature donkey, she will be fairly small as an adult, weighing approximately 350 pounds full grown. This gave Caldwell and Fletcher hope for a positive prognosis and success in Emma’s treatment.
Equine surgeon Dr. Fred Caldwell and surgery resident Dr. Elizabeth Yorke with Emma.
Emma is now 11 weeks old and has thrived with her prosthesis, making an impression on everyone who has worked with her.
“She absolutely loved it from the get-go,” Caldwell said. “It was a very impressive design and she did very well in it. She has progressed to the second iteration of her prosthesis, which doesn’t incorporate as much of the limb and allows her more range of motion. She is getting stronger; she’s growing and doing wonderfully.”
Fletcher, who sees patients in the Opelika, Ala. and Columbus, Ga. Hanger Clinic locations, said that as Emma grows, she could potentially transition through eight or nine variations of the prosthesis before reaching full growth. At that point, she will be fitted with a piece that is more permanent.
The prosthesis is made of carbon fiber, Kevlar and fiberglass, materials that are strong and extremely light, and the same materials used for prostheses for Paralympic athletes. The materials are also flexible and adjustable to allow for growth and progression in Emma’s gait. The first finished prosthesis weighed less than a pound; the most recent iteration, which is pink, is smaller, but weighs a little more to provide stability as she’s grown taller and almost doubled her weight since surgery.
“The next step is trying to make sure we keep the prosthesis set up so she’s ambulatory and she can run and play and do things uninhibited, but also, to keep the area of concern, the surgical site, offloaded so Dr. Caldwell can do his job in keeping her completely healed,” Fletcher said. “As time goes by, we’ll continue to provide a prosthesis that’s going to allow for growth. We want to provide her with full range of motion, but also give her the ability to use full strength. I think she’s got that in her current set-up, so the big thing now is keeping everything offloaded so she heals completely; we’ll continue to increase the size of the prosthesis as she grows.”
Caldwell said he has learned a tremendous amount from the case and it has given him hope that in the future amputation and prosthesis could be a more feasible option for larger horse patients.
“Every opportunity we have with a case like this, I think we get a little closer to being able to consider this a viable option,” he said. “It’s been very educational for me as an equine surgeon to learn; this has certainly been my first case. I think we have a long way to go before we get to this being a procedure that’s routinely an option for our larger patients, but for a prosthetic limb to be an option in horses is something that’s pretty exciting.”
Emma and her owners, CeCe Smith
Founded in 1861 by the first amputee of the Civil War, Hanger Clinic, a business unit of Hanger Inc., owns and operates more than 700 patient care clinics nationwide. The certified clinicians of Hanger provide patients with the latest in orthotic and prosthetic solutions, including microprocessor devices for those with limb loss and neuromuscular technologies for those with paralysis due to stroke, multiple sclerosis and other debilitating conditions.
The Auburn University Veterinary Teaching Hospital provides state-of-the-art veterinary care and serves as a referral hospital and community practice facility to communities throughout Alabama and neighboring states. With board-certified specialists and a nationally renowned faculty, clients of the teaching hospital benefit from the combined expertise of specialists utilizing a team-based approach to patient health care. Challenging cases that require comprehensive diagnostics, imaging or therapies are sent to the hospital by referring veterinarians and this relationship ensures that animals receive the benefit of the latest clinical trials, research and treatment protocols available.
For more photos and video, go to http://ocm.auburn.edu/featured_story/saving_emma.html.