Palm Beach Equine Clinic (PBEC), located in Wellington, FL, offers advanced diagnostic imaging, world-renowned surgical talent, and state-of-the-art facilities necessary to quickly diagnose, treat, and repair horses with condylar fractures, making PBEC one of the leading facilities in the U.S. for condylar fracture repairs.
With thanks to the technology required for early diagnosis and experienced surgeons on staff, horses that are admitted to PBEC for condylar fracture repairs are more likely to return to training quickly. Most commonly seen in Thoroughbred racehorses and occasionally polo ponies or eventing horses, a condylar fracture was once considered a career-ending injury. Today, however, advances in technology aid in a full recovery with horses regularly returning to competition in their respective divisions.
What is a Condylar Fracture?
A condylar fracture is a repetitive strain injury that results in a fracture to the cannon bone above the fetlock due to large loads transmitted during high-speed exercise. On a radiograph, a condylar fracture appears as a crack that goes from the fetlock joint up the cannon bone. Lateral fractures many times exit the bone usually one-third of the way up the bone. Medial fractures will oftentimes spiral up to the hock or knee. Medial fractures are much more common in the hindlimb than the forelimb. It is the spiral fractures that are more difficult, due to the fact that the extent of the spiral cannot be identified radiographically. If the surgeon cannot identify the fracture, then that part of the fracture cannot be repaired.
“A condylar fracture is a disease of speed,” said Dr. Robert Brusie, a surgeon at PBEC who estimates that he repairs between 30 and 50 condylar fractures per year. “A fracture to the left lateral forelimb is most common in racehorses as they turn the track on a weakened bone and increased loading on the lateral condyle.”
Condylar fractures are further categorized into two classes. An incomplete and non-displaced fracture means that the bone fragment is not separated from the cannon and is still intact with its original position. A complete and displaced fracture means the fragment has detached from the cannon bone and this fracture can often be visible under the skin. Displaced condylar fractures have a somewhat lower prognosis due to the fact that soft tissue structures, such as the joint capsule, become torn. When these structures heal, they are thicker, which makes the joint less flexible.
“Most lateral condylar fractures are fairly simple for us to fix,” said PBEC surgeon Dr. Weston Davis. “Medial condylar fractures tend to be more complicated configurations because they often spiral up the leg. Those require more advanced imaging and more advanced techniques to fix.”
What is the Treatment?
The first step to effectively treating a condylar fracture through surgery is to accurately and quickly identify the problem. PBEC’s Board-Certified Radiologist Dr. Sarah Puchalski utilizes the advanced imaging services at PBEC to assist in the diagnosis.
“Stress remodeling can be detected early and easily on Nuclear Scintigraphy before the horse goes lame or even develops a fracture,” said Dr. Puchalski. “Early diagnosis of stress remodeling allows the horse to be removed from active race training and then return to full function earlier. Early diagnosis of an actual fracture allows for repair while the fracture is small and hopefully non-displaced.”
Once identified as a condylar fracture, PBEC surgeons step in to repair the fracture and start the horse on the road to recovery. Depending on surgeon preference, condylar fracture repairs can be performed with the horse under general anesthesia, or while standing under local anesthesia and sedation. During either process, surgical lag screws are used to reconnect the fractured condyle with the cannon bone.
“For a very simple and small non-displaced fracture, we would just put in one to two screws across the fracture,” explains Dr. Davis. “The technical term is to do it in ‘lag fashion’, such that we tighten the screws down heavily and compress the fracture line. Many times the fracture line is no longer visible in x-rays after it is surgically compressed. When you achieve good compression, the fractures heal very quickly and nicely.”
More complicated fractures, or fractures that are fully displaced, may require more screws to align parts of the bone. For the most severe cases of condylar fractures, a locking compression plate with screws is used to stabilize and repair the bone.
Severe condylar fractures often require general anesthesia, but for PBEC surgeon Dr. Jorge Gomez, approaching a simpler non-displaced condylar fracture while the horse is standing helps to aid in a faster recovery and successful surgical outcome.
“I think it takes the risk of anesthesia away and is a faster surgery from the time the horse comes in to the time the horse recovers,” said Dr. Gomez. “I will just sedate the horse and block above the site of the fracture. Amazingly, horses tolerate it really well, and it is very convenient for medial condylar fractures. In these cases, the fracture can spiral all the way up through the cannon bone, and they have a tendency to develop complete catastrophic fractures that can happen at any time after the injury. That risk can be significantly increased by the recovery from general anesthesia. Our goal is always to have the best result for the horse, trainers, and us, as veterinarians.”
According to Dr. Gomez, the recovery time required after a standing condylar fracture repair is only 90 days.
While Dr. Brusie, Dr. Davis, and Dr. Gomez are all seasoned in quickly and effectively repairing condylar fractures, PBEC is helping them to stay on the cutting edge of surgical techniques. PBEC is currently renovating its facility with plans to give surgeons a new approach to fix condylar fracture repairs. A set of stocks and surgeon’s pit have been added with the ability to give the surgeon eye-level access to the fracture with the patient standing and subsequently simplifying the procedure by reducing the risk from recumbent recovery.
What is the Prognosis?
One of the most common questions regarding an equine injury is, “Will the horse return to work?” Thanks to advanced imaging and surgical techniques, the answer to that question when involving a condylar fracture is most likely, “Yes.” At PBEC, a condylar fracture diagnosis rarely results in the end of a racehorse’s career.
Diagnostic imaging plays a major role in assisting to diagnose, surgically map, and follow up on condylar fractures. After primary use to diagnose a condylar fracture, digital radiographs are also used after surgery to ensure that a fracture repair was completely successful. According to Dr. Davis, scanning two planes during and after surgery gives a full view of the fracture and repair techniques, immediately indicating the success of the procedure before moving the horse on to recovery.
“A condylar fracture was once considered the death of racehorses, and as time and science progressed, it was considered career-ending,” said Dr. Brusie. “Currently, veterinary medical sciences are so advanced that we have had great success with condylar fracture patients returning to full work. Luckily, with today’s advanced rehabilitation services, time, and help from mother nature, many horses will come back from an injury like this.”