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Tag: gomez

When the Bone Breaks

Palm Beach Equine Clinic is Changing the Prognosis for Condylar Fracture Injuries

Palm Beach Equine Clinic is changing the prognosis for condylar fracture injuries in race and sport horses. Advances in diagnostic imaging, surgical skillset, and the facilities necessary to quickly diagnose, treat, repair, and rehabilitate horses with condylar fractures have improved dramatically in recent years.

Palm Beach Equine Clinic is changing the prognosis for condylar fracture injuries among sport horses.
Photo by Jump Media

Most commonly seen in Thoroughbred racehorses and polo ponies, a condylar fracture was once considered a career-ending injury. Today, however, many horses fully recover and return to competing in their respective disciplines.

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.

A condylar fracture is a repetitive concussive injury that results in a fracture to the cannon bone above the fetlock due to large loads transmitted over the cannon bone during high-speed exercise. On a radiograph, a condylar fracture appears as a crack that goes laterally up the cannon from the fetlock joint and out the side of the bone, essentially breaking off a corner of the cannon bone, sometimes up to six inches long.

“A condylar fracture is a disease of speed,” said Dr. Robert Brusie, a surgeon at Palm Beach Equine Clinic 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 around the track on a weakened bone and increased loading.”

Scan showing the screws inserted during surgery (right). This patient, a Thoroughbred racehorse, walked away from surgery comfortably and is recovering well.

Condylar fractures are further categorized into incomplete and non-displaced (the bone fragment hasn’t broken away from the cannon bone and is still in its original position), or complete and displaced (the fragment has moved away from the cannon bone itself and can often be visible under the skin).

Additionally, condylar fractures can occur laterally or medially. According to fellow Palm Beach Equine Clinic surgeon Dr. Weston Davis, most condylar fractures tend to be lateral on the outside condyle (a rounded projection on a bone, usually for articulation with another bone similar to a knuckle or joint).

“Most lateral condylar fractures are successfully repaired,” said Dr. 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 in effectively treating a condylar fracture through surgery is to accurately and quickly identify the problem. Board-certified radiologist Dr. Sarah Puchalski utilizes the advanced imaging services at Palm Beach Equine Clinic to accomplish exactly this.

“Stress remodeling can be detected early and easily on nuclear scintigraphy before the horse goes lame or 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.”

Surgical lag screws are used to reconnect the fractured condyle with the cannon bone.
Photo by Jump Media

Once the injury is identified as a condylar fracture, Palm Beach Equine Clinic 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. During either process, surgical leg screws are used to reconnect the fractured condyle with the cannon bone.

“For a 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 really compress the fracture line. A lot of times the fracture line is no longer visible in x-rays after it is surgically compressed. When you get that degree of compression, the fractures heal very quickly and nicely.”

More complicated fractures, or fractures that are fully displaced, may require additional screws to align the 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.

Palm Beach Equine Clinic surgeon Dr. Jorge Gomez approaches a non-displaced condylar fracture while the horse is standing, which does not require general anesthesia.

A view of Palm Beach Equine Clinic’s standing surgical suite.

“I will just sedate the horse and block above the site of the fracture,” said Dr. Gomez. “Amazingly, horses tolerate it really well. 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. This is made even easier thanks to a state-of-the-art standing surgical suite at Palm Beach Equine Clinic. The four-and-a-half-foot recessed area allows doctors to perform surgeries anywhere ventral of the carpus on front legs and hocks on hind legs from a standing position. Horses can forgo general anesthesia for a mild sedative and local nerve blocks, greatly improving surgical recovery.

“A condylar fracture was once considered the death of racehorses, and as time and science progressed, it was considered career-ending,” concluded 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 can come back from an injury like this.”

Condylar Fracture: Your Horse’s Career Isn’t Over!

Palm Beach Equine Clinic (PBEC) is changing the prognosis for condylar fracture injuries among sport horses. Advances in imaging, surgical talent, and the facilities necessary to quickly diagnose, treat, repair, and rehabilitate horses with condylar fractures have recently improved immensely.

Most commonly seen in Thoroughbred racehorses and occasionally polo ponies, a condylar fracture was once considered a career-ending injury. Today, however, odds are in favor of a full recovery with horses regularly returning to competition in their respective disciplines.

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 over the cannon bone during high-speed exercise. On a radiograph, a condylar fracture appears as a crack that goes laterally up the cannon from the fetlock joint and out the side of the bone, essentially breaking off a corner of the cannon bone, sometimes up to six inches long.

“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 around the track on a weakened bone and increased loading.”

Condylar fractures are further categorized into incomplete and non-displaced (the bone fragment hasn’t broken away from the cannon bone and is still in its original position), or complete and displaced (the fragment has moved away from the cannon bone itself and can often be visible under the skin).

Additionally, condylar fractures can occur laterally or medially. According to fellow PBEC surgeon Dr. Weston Davis, most condylar fractures tend to be lateral on the outside condyle (a rounded projection on a bone, usually for articulation with another bone similar to a knuckle or joint).

“Most lateral condylar fractures are fairly simple for us to fix,” said Dr. 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 in 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 accomplish exactly this.

“Stress remodeling can be detected early and easily on nuclear scintigraphy before the horse goes lame or 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.”

Surgical lag screws are used to reconnect the fractured condyle with the cannon bone.
Surgical lag screws are used to reconnect the fractured condyle with the cannon bone.

Once the injury is 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. During either process, surgical leg 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 really compress the fracture line. A lot of times the fracture line is no longer visible in x-rays after it is surgically compressed. When you get that good compression, the fractures heal very quickly and nicely.”

More complicated fractures, or fractures that are fully displaced, may require more screws to align the 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.

PBEC surgeon Dr. Jorge Gomez, approaches a simpler non-displaced condylar fracture while the horse is standing, which helps to aid in a faster recovery and more successful surgical outcome.

“I will just sedate the horse and block above the site of the fracture,” said Dr. Gomez. “Amazingly, horses tolerate it really well. 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. This is made even easier thanks to a state-of-the-art surgery pit installed at PBEC. The four-and-a-half-foot recessed area allows doctors to perform surgeries on anything from a horse’s hock and below from a standing position. Horses can forgo the risks of general anesthesia for a mild sedative and local nerve blocks, greatly improving outcomes.

Palm Beach Equine Clinic is changing the prognosis for condylar fracture injuries among sport horses
Palm Beach Equine Clinic is changing the prognosis for condylar fracture injuries among sport horses

“A condylar fracture was once considered the death of racehorses, and as time and science progressed, it was considered career-ending,” concluded 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 can come back from an injury like this.”

Dr. Jorge Gomez of Palm Beach Equine Clinic Looks Forward to the Olympic Games in Rio

The 2016 Olympic Games in Rio de Janeiro, Brazil is finally here and Palm Beach Equine Clinic is proud to have its own Dr. Jorge Gomez present to provide veterinary support for some of the world’s most elite horses. Dr. Gomez is not only a top sport horse practitioner, but is also a renowned Board-Certified Surgeon.

Dr. Gomez will be in attendance at the prestigious Games to serve as the veterinarian for the team horses in show jumping events representing Venezuela and Colombia held August 14-18. Two elite horse and rider combinations competing for individual medals will represent each country. On behalf of Colombia, Daniel Bluman with Apardi and Rene Lopez aboard Con Dios III will compete individually. The riders representing Venezuela competing for individual medals include Pablo Barrios riding Antares and Emanuel Andrade with Hardrock Z.

Olympic Veterinary Responsibilities

There is a tremendous amount of work that is required in preparing and maintaining a top performance horse for a significant world championship event such as the Olympic Games. While in Rio, Dr. Gomez will closely monitor that each horse is in optimal health conditions while competing. He is responsible for providing and administering permitted medications for muscle, joint, and tendon support, as well as vitamins and intravenous fluids, if necessary. Dr. Gomez also assists the competitors by providing and prescribing physical alternative therapies that help maintain the horse in the best possible form for competition.

Dr. Gomez, originally from Colombia, has been affiliated with Palm Beach Equine Clinic since 2011 and has since represented the clinic at the 2012 Olympic Games in London, England, the 2015 Pan American Games in Toronto, Canada, and the 2014 Alltech FEI World Equestrian Games in Normandy, France.

“It is a good opportunity to meet people at all levels and from all over the world that are involved in equestrian sports,” Dr. Gomez said of representing the clinic worldwide. “Palm Beach Equine Clinic becomes a familiar place for all those acquaintances to come to and to refer their horses when they come to Wellington. Many of the horses that we take care of during the Winter Equestrian Festival in Wellington are referred to us because of the connections that we have made at the international competitions.”

Caring for Olympic Equine Athletes

Since he has served at many major international events, Dr. Gomez understands the larger significance of preparing for the Olympic Games. An Olympic medal is a lifelong dream for most grand prix competitors, and having the right horse in peak condition is essential.

“Caring for the horses at the Olympic Games is the same as any other competition, but there are maximal responsibilities,” Dr. Gomez detailed. “Because of the nature of the event, riders want us to be checking the horses entirely on a daily basis for at least one week before the event starts.

“Of the four horses that will be under my care, three of them are my regular clients, so I keep a fairly close eye on them already,” Dr. Gomez added. “In conjunction with trainers and riders, we planned a schedule that we think is the best for the event. I look forward to the competition, and I hope that the horses under my care perform according to expectations.”
Palm Beach Equine Clinic, the industry leader in sport horse veterinary care, features an illustrious list of veterinarians who are experts in their respective fields. Dr. Gomez and PBEC’s team of 30 veterinarians, including Board-Certified Surgeons and Radiologists, are available to provide services to clientele throughout North America and around the world in the various horse sport disciplines

Palm Beach Equine Clinic at the 2015 Pan American Games

The 2015 Pan American Games were held in Toronto, Ontario showcasing exciting equestrian competition in the disciplines of show jumping, dressage and eventing. Countries from North, South and Central America, as well as the Caribbean, fielded teams for the prestigious event which served to secure qualifications for the 2016 Olympic Games in Rio de Janeiro, Brazil. Palm Beach Equine Clinic was proud to have two of its finest sport horse veterinarians in the middle of the action, providing veterinary support to the world’s elite horses. 

horse veterinarians 2015 pan american games

Palm Beach Equine Clinic’s Dr. Jorge Gomez was in attendance at the Pan American Games to care for many of his competing clients throughout the event. Dr. Gomez is not only a top sport horse practitioner but is also a board-certified surgeon. Dr. Natalia Novoa was also one of the treating veterinarians at the Games, where she provided conventional veterinary services as well as alternative medicine including chiropractic adjustments and acupuncture for many of the equine stars.

Drs. Gomez and Novoa were witness to great sport and tremendous results during their time in Toronto. The show jumping portion of the Games was held July 18-25, awarding medals for individual and team events. Both veterinarians were fortunate enough to watch the Canadian Show Jumping Team win gold. Argentina went home with the silver medal and the United States earned bronze. They also proudly watched several of their own clients earn top finishes in the individual competition. McLain Ward (USA), Andres Rodriguez (VEN), and Lauren Hough (USA) earned the gold, silver and bronze medals respectively.

There is a great deal of work that is vital to maintaining a world class performance horse in peak condition for an event such as the Pan American Games. Dr. Gomez was selected to be the Team Veterinarian for Venezuela and Guatemala. Dr. Gomez teamed up with Dr. Novoa to provide veterinary support for silver medal winner Darlon van Groenhove with Andres Rodriguez (VEN) and sixth place finisher Hardrock Z ridden by Emanuel Andrade (VEN). Dr. Novoa was honored to work with and care for many of the event’s most successful horses, including Canada’s Tripple X III (Tiffany Foster) and Coco Bongo (Eric Lamaze), Argentina’s Abunola (Luis Pedro Biraben) and Cannavara 9 (Matias Albarracin), and Venezuela’s Darlon van Groenhove (Andres Rodriguez), as well as Hardrock Z (Emanuel Andrade). 

“Such success is attained with the contributions of a number of people, including the riders, trainers, owners, grooms, veterinarians, farriers and other support personnel, and I wish to take this opportunity to congratulate each and every person involved,” Dr. Novoa stated. “It is my honor and pleasure to provide veterinary care to such top caliber horses. It is truly exciting to watch these athletes compete at the highest level, earning personal bests, such as Andres Rodriguez winning the Individual Silver Medal for Venezuela! Good luck to everyone in the preparations for the Olympic Games in Rio in 2016!”

Palm Beach Equine Clinic, an industry leader in sport horse veterinary care, features a renowned list of veterinarians who are experts in their respective fields, and available to provide services to clientele throughout North America and around the world in the various horse sport disciplines.

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