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Tag: surgery

Happy Birthday Belle: Recovering Geriatric Colic Case Turns 34

When Jennifer Penn learned that her horse Belle was in the beginning stages of a bout with colic in February, she knew she was not ready to say goodbye to her beloved horse. The 33-year-old American Quarter Horse named “Wagners Mint Joker”, but known to Penn and her family as Belle, was the horse of a lifetime.

Penn’s mother, Becky Seton, and late grandfather, Bob Lowery, both of Vero Beach, FL, purchased a then 12-year-old Belle for Penn in 1998. “We were both 12-years-old and it was a match made in heaven,” recalled Penn. “I had outgrown my show pony, so it was time to look for an all-around horse that I could show and have fun with. I am an only child, so she is like a sister to me. As I grew up, I experienced life right alongside her.”

Belle quickly lived up to her reputation as an all-around horse, actively competing with Penn at AQHA breed shows, open and 4-H circuits throughout Florida, show jumping events, and they excelled in western trail competitions. Belle even pulled a cart for a time!

When Penn was 18, she started her own lesson program with Belle at the helm. “Belle provided a solid foundation for many riders, both young and old,” she said. “She not only taught me how to become a horsewoman, but she has also impacted so many young people’s lives and taught them showmanship skills. She’s special to me and my mother Becky, but also to so many people who have gone on to become very successful horsemen and women.”

While Belle was partially retired in 2018, the same year she was the guest of honor and Penn’s wedding, the mare gave her last lesson about six months ago. She was still being ridden once a week with the occasional trail or pony ride for yet another up-and-coming rider.

Jennifer Penn Geriatric Colic Case Palm Beach Equine Clinic Surgery

Belle was thriving in retirement until colic threatened to disrupt her life of luxury.

On Saturday morning, February 1, Belle had not been drinking from her water buckets, did not finish her breakfast, and had only passed manure twice throughout the night before; abnormal signs that Penn took very seriously. “She’s tough as nails, so she was not showing any signs of discomfort; she was just standing there quietly in her stall. By knowing her habits we were able to identify a problem and make early decisions.”

Belle was initially treated by her primary veterinarian, Dr. Kelly Alderman of Alderman Veterinary Services based in Fellsmere, FL. Based on Dr. Alderman’s recommendation, Belle was transported to Dr. Karie Vander Werf’s Treasure Coast Equine Emergency Services in Palm City, FL, where an ultrasound on Sunday showed a displacement of her large colon.

“It was very obvious to us that if we were going to consider surgery, we would have to do it sooner rather than later,” said Penn. “The decision was made to preserve her strength and transport her to Palm Beach Equine Clinic for Dr. Weston Davis to operate on her.

“It was because of his confidence in the surgery despite her age, that I had a peace in the decision to proceed with surgery,” continued Penn.

One of three board-certified surgeons at Palm Beach Equine Clinic, Dr. Weston Davis performed the emergency colic surgery to remove a right dorsal impaction in the large colon and correct a severe displacement caused by the altered motility within the intestines.

“Her primary veterinarian had done everything that she could medically do for the horse before referring the case to Palm Beach Equine Clinic,” said Dr. Davis. “In some colic cases, a prolonged course of medical treatments might result in the horse no longer being a surgical candidate. When things were not improving quickly enough, the horse was sent to us. Our main concern was to determine if Belle was as healthy a surgical candidate that she could possibly be.”

According to Dr. Davis, Belle’s physical examination and blood work revealed her to be a very healthy, albeit geriatric, colic case. “She is the oldest horse that I have performed colic surgery on. At the time of her arrival, Belle was well-hydrated with balanced electrolytes levels and stable organ systems. She was an overall good candidate for colic surgery, even at 33-years-old,” he said.

While not every geriatric colic case is well-suited for surgical intervention, Dr. Davis considers two factors before moving forward with any surgery. “The surgery has to make sense for the horse, meaning that they are a healthy candidate with the ability to recover, and they have the will to live,” said Dr. Davis, who noticed how resilient Belle was from the moment he saw her. “The other point is that the surgery needs to be financially reasonable for the client. In Belle’s case, there was a will to live, and a strong emotional connection with this horse.”

After a successful colic surgery, Belle was moved to recover in the Palm Beach Equine Clinic Hospital where she was cared for round-the-clock by Dr. Candelaria Chunco and hospital staff.

“Dr. Davis was great, and Candelaria was fantastic,” said Penn. “They were both so kind, and I received regular text updates. I knew that they were invested in her recovery. When she stood up after anesthesia, I remember Dr. Davis saying to me, ‘this horse is a badass’, and she really is!”

Belle returned home to Vero Beach, FL, on February 19, and celebrated her 34th birthday on March 27. “Her recovery was slow, but she is doing well, regaining an appetite, working her way back to regular turnout, and starting to act like her old self again,” said Penn. “She is an incredibly special horse to not only me and my mother, but to my husband, family, friends, and the horse community here. It’s so wonderful to have her back home.”

Standardbred Gelding Back to the Track with Palm Beach Equine Clinic

Dr. David Priest Utilizes Dynamic Endoscope and Performs Surgery to Help Four-Year-Old Harness Racer Get Back in Action

For equine athletes to perform their best, optimal respiratory health is crucial, and particularly paramount for harness racehorses. According to Dr. David Priest, Palm Beach Equine Clinic veterinarian with a keen interest in respiratory health, a racehorse moves roughly 70 liters of air through its lungs over the duration of one second while exercising. To simulate the movement of that amount of air outside the anatomy of a horse’s body, it would require two industrial ShopVacs on full power.

David Priest Palm Beach Equine Clinic Veterinarian

A colloquial condition known as “roaring”, or recurrent laryngeal neuropathy, is a fairly common issue among horses, and it restricts the amount of air able to reach the lungs through the horse’s upper respiratory system. The condition usually affects the left side of the larynx – the equine left recurrent laryngeal nerve is longer than the right – with paralysis that does not allow for an adequate amount of air to travel to the lungs.

According to Dr. Priest, equine anatomy plays a factor in the prevalence of this condition. There is a correlation with the length and size of the neck to the nerve pathways that travel from the brain to the chest, around the heart, and back up to the throat. Although mild cases of recurrent laryngeal neuropathy can be tolerated, the condition becomes particularly serious when a horse’s work involves high-intensity aerobic exercise.

“We often see recurrent laryngeal neuropathy described as a paralyzed flapper,” said Dr. Priest. “If you imagine the flaps of the larynx as cabinet doors, then the horse should be able to hold the doors open without problem while at rest. Yet, when the airflow picks up during exercise, that muscle is sometimes not strong enough to hold the doors open, and it collapses into the airway.”

Just before the start of 2019, Dr. Priest received a call from Stephanie Reames, the trainer of a four-year-old harness racehorse with symptoms pointing to recurrent laryngeal neuropathy. During his diagnostic process, Dr. Priest performed an endoscopy while the horse was resting to provide a baseline observation.

“I saw what I thought was a minor abnormality, but I did not know what amount of laryngeal strength this horse had,” said Dr. Priest. “The roaring noise usually occurs when the disease is progressive, and this horse was making a little bit of noise.


Palm Beach Equine Clinic - Dynamic endoscope showcasing the collapse of the left larynx flap
Dynamic endoscope showcasing the collapse of the left larynx flap.
Palm Beach Equine Clinic - Dynamic endoscope of the larynx with clear air flow at exercise after tie-back surgery
Dynamic endoscope of the larynx with clear air flow at exercise after tie-back surgery.

“This particular horse was in training for the harness racing season, so the owners and trainer wanted to figure out the root of the issue as swiftly as possible,” continued Dr. Priest. “The most effective way to accomplish that is to utilize a dynamic endoscope.”

A dynamic endoscope is a video recording device worn by the horse during exercise. It allows veterinarians to see the larynx, and therefore view signs of recurrent laryngeal neuropathy in real-time. Dr. Priest observed the disease as a grade C on the universal grading system for rating the disease, which translates to a full collapse of the left larynx flap.

Once diagnosed, Dr. Priest recommended an aptly-named laryngeal tie-back surgery, which involves stitching the larynx flap to surrounding cartilage in order to hold it open for optimal airflow. He performed the surgery at Palm Beach Equine Clinic a couple of days after making the diagnosis, and the horse returned home to its training base at South Florida Training Center in Lake Worth, FL, the same day.


The dynamic endoscope on a harness racehorse ready for exercise
A view of the dynamic endoscope on a harness racehorse.
The dynamic endoscope on a harness racehorse ready for exercise.

The suggested recovery time is 30 days to allow for the surgical incisions to heal. Once healed, this horse immediately returned to full harness racing training.

“The horse is doing fantastic and we are hoping to qualify for racing in the next three weeks, and we will most likely head north to Pennsylvania to race,” said Reames. “Dr. Priest is absolutely amazing and was extremely professional from start to finish. There is always a hesitation when you learn that a horse needs surgery, but Dr. Priest was so prompt with the diagnosis and procedure, and the horse healed so quickly. We have high hopes for another successful racing season!”

In February of 2020, Dr. Priest performed a second dynamic endoscopy to observe the condition and effectiveness of the tie-back surgery. “The disease usually results in a 20-30% reduction in airflow, which causes a small performance decline resulting in a speed reduction of maybe one second. This horse’s particular case was perfect at the one-year check, which is key because that one second can be the difference between winning and losing!”

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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.”

Meet Palm Beach Equine Clinic’s Dr. Robert Brusie

Palm Beach Equine Clinic’s surgical team leader, Dr. Robert Brusie, is a nationally renowned board-certified surgeon whose surgical specialties include orthopedic, arthroscopic, and emergency cases. Dr. Brusie has been the head surgeon with Palm Beach Equine Clinic for the last 20 years and is a beloved part of the team. 

Dr. Brusie graduated from Michigan State University (MSU) College of Veterinary Medicine. He completed his surgical residency at the Marion DuPont Scott Equine Center in Virginia in 1989 and has been in private practice ever since. He became a Diplomate of the American College of Veterinary Surgeons in 1994. Dr. Brusie joined the Palm Beach Equine Clinic team in 1996.

Board-certified surgeon, Dr. Brusie is recognized for his expertise in colic surgery, as well as for his skill in arthroscopic surgery. His surgical experience expands the clinic’s progressive care in both emergency and elective procedures. He has published articles on numerous topics, including the equine intestinal tract and septic arthritis in horses. Dr. Brusie is married and has three daughters. Read on to find out more about Dr. Brusie!

What is your background with horses?

I grew up on a farm in Michigan. We had usually between 200 and 600 head of cattle and always between four to six horses. Our horses were cow ponies or driving horses. My dad loved horses and had to have them around. My family has owned our farm for six generations and it pretty much occupied all of our time besides sports and school. Needless to say, we didn’t have much time to show horses.

When and why did you decide to become a veterinarian? Did you know you wanted to be a surgeon from the start?

I decided to become a veterinarian at an early age. I think I was seven or eight years old when I pulled my first calf. One of my dad’s hired men called me “Doc” when I was about that age. When I went to college, my plan was to become a large animal veterinarian and live in my hometown and continue to farm part-time with my three brothers. All of that changed when I was in veterinary school at MSU. Dr. Ed Scott was one of the five surgeons there; he was a gifted surgeon and a great teacher. He steered me into an equine internship at Auburn University. It was one of those things that the more you did, the more you wanted to do to improve yourself. I operated on my first colic by myself when I was three weeks out of vet school (32 years ago).

How did you first start working at Palm Beach Equine Clinic?

I was a surgeon at a clinic in Atlanta, and in 1996 I had performed a surgery for a client of Dr. Paul Wollenman’s. He had started this practice in 1975 and asked me if I needed a job. I was planning on staying in Atlanta for the rest of my career. I received phone calls from the other two partners over the next nine months, and eventually with encouragement from my fiancé, now wife, Melissa, I took the job.

What do you love most about working at Palm Beach Equine Clinic?

We have an exceptional group of veterinarians and staff here. The depth and scope of our veterinarians is amazing due to the large caseload. On any individual case, there may be two to three doctors that have input on the case to ensure no stone is left unturned. Additionally, we are so privileged to work on some of the best show, race, and polo horses in the world. It is truly an honor.

Meet Palm Beach Equine Clinic’s Dr. Robert Brusie

What sets the surgical services at Palm Beach Equine Clinic apart?

Between Dr. Jorge Gomez, Dr. Weston Davis, and myself, we perform just about every type of soft tissue and orthopedic surgeries that are done in our field. Personally, my greatest sense of success is when I see a horse back after surgery going as well or better than it was prior to surgery.

What are the biggest changes you have seen in sport horse medicine over the years?

Currently, the most exciting thing we see going on in medicine is regenerative therapy. Twelve to 15 years ago, we were harvesting bone marrow from the sternum and injecting it into lesions in tendons and ligaments. Now we manipulate the bone marrow or other sources of stem cells to promote more rapid and more functional healing of some of these injuries. I can assure you that in 10 to 20 years what we are doing now will seem stone-aged by then. There are some very clever minds performing some serious research in this field.

How do you stay up-to-date on new medical advances?

Every veterinarian at Palm Beach Equine Clinic tries to attend as many meetings as time allows. We also do a weekly journal club at our clinic to discuss recently published papers in veterinary and human medicine and surgery.

What is the most interesting or challenging surgery that you have done?

Dr. Gomez and I had a three-year-old racehorse that had split his P1 (long pastern bone) and cannon bone in the same leg in a race. We were able to piece together both bones perfectly and the horse recovered brilliantly. He probably could have returned to racing, however, the owners elected to retire him to life as a breeding stallion.

What is something interesting that people may not know about you?

I have three daughters who I am very proud of and tend to brag on maybe a little too much.

How else is the family involved in horses?

My wife [Melissa] and youngest daughter [Kayla] are horse nuts in the true sense of the word. Anything to do with horses, especially show hunters, they are dialed in. Melissa loves riding, and Kayla shows in hunters and equitation.

What makes Palm Beach Equine Clinic a special place for you?

I am blessed to have three good men as business partners. They are my good friends and great people. We are very lucky to have 20-plus veterinarians working with us who are very knowledgeable and caring individuals. We feel like a little practice, but with a lot of people who just get the job done.

Palm Beach Equine Clinic Case Study: Ethmoid Hematoma

A horse was recently admitted to Palm Beach Equine Clinic (PBEC), based in Wellington, FL, with symptoms that included bleeding from the nostril. The patient’s referring veterinarian had diagnosed the horse with an ethmoid hematoma, which in layman’s terms is essentially a mass that fills with blood in the nose or sinus cavity.

The patient was placed under the care of PBEC’s board-certified surgeon Dr. Weston Davis and Dr. Michael Myhre. They performed an airway endoscopy to locate and evaluate the hematoma that the referring veterinarian had identified. After confirming the diagnosis, Dr. Davis and Dr. Myhre were eager to ensure that it was the one and only hematoma they were battling.

Computed Tomography

PBEC is one of an elite group of equine veterinary clinics to have a computed tomography (CT) machine in their arsenal of diagnostic imaging equipment. A CT gives veterinarians a unique look at the head, neck, and spine of a horse that they would never be able to accomplish with other imaging modalities. After a CT of the patient’s sinuses, more masses were indeed identified.

Watch the CT scan that spotted the additional masses in progress!

“This was a fairly typical presentation of an ethmoid hematoma, but there were certainly more masses than normal,” said Dr. Myhre. “It’s for this reason that the CT was very useful. If we were not able to obtain the scans that we did, we may have missed the masses that were located deeper in the sinus.”

The cause of an ethmoid hematoma is unknown, but the mass resembles a tumor in appearance and development without being neoplastic. Horses with extensive masses may have reduced airflow and an expanding hematoma can cause pressure necrosis of the surrounding bones, but rarely causes facial distortion. Treatments of the ethmoid hematoma can range from conservative management to surgery. The conservative treatment route includes the injection of formalin – a mixture of formaldehyde gas and water – into the mass using a guarded endoscopic needle. Once injected, the mass typically regresses rapidly, but recurrence is common. For some cases, surgical excision is achieved via a frontonasal bone flap procedure.

The Approach

Palm Beach Equine Clinic Case Study: Ethmoid Hematoma
Palm Beach Equine Clinic Case Study: Ethmoid Hematoma

Due to the location and advances nature of the masses in this case, injection was not an option and the CT imaging was used to plan a surgical approach. “After sedation and a local block, we went into the sinus through a flap approach where we took a section of bone, cut it into a flap, and moved it back so we could go into the sinuses through a nice window,” said Dr. Myhre. “We removed a mass four centimeters in diameter as well as several smaller masses two to three centimeters in diameter, then flushed the area and closed.”

According to Dr. Myhre the advantages of a standing procedure included fewer risks from bleeding and fewer risks of recovering from anesthesia.

Post-surgery, the bone flap will require several weeks to heal, but the skin itself healed within one to two weeks, which is when the horse was cleared to return to normal activity.


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.”

From the Show Ring to the Operating Room and Back Again

Success Story: Ameloblastic Fibroma

When a middle-aged mare with a mysterious mass in her mouth came under the care of Palm Beach Equine Clinic in Wellington, FL, Dr. Weston Davis pulled out all the stops to find a definitive diagnosis. The oral mass was growing at a rapid rate and was positioned just behind the bottom incisors on the left bar of the horse’s mouth.

A view of the oral mass being examined by Dr. Davis.
A view of the oral mass being examined by Dr. Davis.

A view of the oral mass being examined by Dr. Davis.

Computed Tomography Imaging

First, Dr. Davis turned to the use of PBEC’s state-of-the-art computed tomography (CT) machine to obtain an image of the mass and its exact location within the horse’s mouth. Then, a surgical biopsy was performed and the histopathology, or microscopic examination of the biopsied tissue, revealed the manifestation of an ameloblastic fibroma. An ameloblastic fibroma is a mixed odontogenic (dental) tumor composed of soft tissues.

“Although this tumor type rarely metastasizes, it tends to be locally invasive and aggressive, requiring the complete removal and/or aggressive radiation therapy,” said Dr. Davis, who is a board-certified surgeon at PBEC.

The CT scan revealed a tumor.
The CT scan revealed a tumor.

Ameloblastic Fibroma Treatment Plan

A tumor of dental origin is rarely found in humans and is extremely rare in equines, but upon diagnosis, Dr. Davis quickly identified a treatment plan, saying, “In this case, the CT mapping that was performed enabled us to completely remove the tumor via a rostral mandibulectomy with preservation of the mandibular symphysis (the joint between the two halves of the mandible).”

Dr. Davis ready to begin the rostral mandibulectomy.
Dr. Davis ready to begin the rostral mandibulectomy.

The horse underwent surgery at PBEC and Dr. Davis removed the tumor along with the rostral (front) mandible, which includes the lower incisor teeth and essentially the entire front portion of the lower jaw of the horse.

The obvious question that arises from a rostral mandibulectomy is “how effectively will the horse be able to eat without bottom teeth?” For this patient, however, the answer came quickly and it was nothing short of encouraging. The mare returned to eating just hours after surgery and, at her two-week checkup with Dr. Davis, was back on a normal diet of hay, grain, and – of course – treats.

According to Dr. Davis, the majority of animals that undergo this type of surgery often compensate well and have little trouble eating. For this mare, her only struggle in the future may be the prehension of very short and/or tough pasture.

Post Mandibulectomy Surgery

Also at two weeks post-surgery, Dr. Davis approved the mare for light riding activity with a hackamore. The mare competed in the jumper ranks before surgery and at a four-week checkup, Dr. Davis gave the all-clear and the mare returned to full work. She even made a comeback in the competition ring at Palm Beach International Equestrian Center with very little visual evidence that a mandibulectomy was ever performed.

“This was a rare tumor and a rare surgery, but the horse recovered incredibly well and fast!” said Dr. Davis. “It was an excellent patient outcome. “I gave her the all-clear at four weeks post-surgery and she is already back to winning classes.”

All Photos Courtesy of Dr. Weston Davis

Palm Beach Equine Clinic Success Story: Beatrix

Any horse owner’s worst nightmare is realized when their mount begins to show the dreaded signs of colic. For Jody Stoudenmier, a Wellington, FL, resident and avid dressage rider, she knows the symptoms all too well.

Beatrix success story palm beach equine clinic colic surgery
Beatrix looking happy and fully recovered from her surgery.

Patient History

Stoudenmier owns an 11-year-old American-bred Dutch Warmblood mare that joined her string of horses at the end of 2016 and has competed through the Intermediate II level. Sidelined by a suspensory injury last year, Beatrix was prescribed stall rest to aid in her recovery by Dr. Robert Scott of Scott Equine Services based in Ft. Lauderdale, FL. An unfortunate but common side effect of the necessary stall rest was colic. Beatrix suffered from six bouts of colic that were resolved without surgery when Dr. Scott referred Stoudenmier and Beatrix to Palm Beach Equine Clinic.

“She is such a wonderful mare; a nice mover, very athletic, sweet, sensitive, and easy to handle in the barn,” said Stoudenmier of the mare that regularly competes at the Adequan Global Dressage Festival during the winter season. “When she was recovering from her injury we tried everything to prevent her from colicking – diet, medications, hand walking – but, nothing seemed to be working.”

It was then that Palm Beach Equine Clinic’s board-certified surgeon, Dr. Weston Davis, suggested a laparoscopic surgical approach.

“Her colic had never progressed so far that we needed to do surgery before,” explained Stoudenmier. “But, at that point, I was open to anything! After speaking with Dr. Davis, I immediately had a positive feeling about it.”

Dr. Davis’ Surgical Procedure

The procedure that Dr. Davis suggested was an endoscopic ablation of nephrosplenic space. In layman’s terms, as a result of Beatrix’s colic, her colon was essentially getting caught or entrapped over the nephrosplenic ligament, which connects the left kidney to the spleen. When the colon is entrapped in this position, its contents cannot move through it and the colon becomes distended, causing the horse considerable pain, and the inevitable colic.

Dr. Weston Davis surgery palm beach equine clinic

Dr. Davis’ solution was to close or perform an ablation of the nephrosplenic space to prevent further entrapment. The procedure can be conducted endoscopically where the horse does not have to be anesthetized, but undergoes a standing surgery with sedation and local anesthesia. A small incision is made in the left flank and the laparoscope is inserted through a smaller incision close by. The nephrosplenic space is then sutured closed so that the trough that forms the space between the kidney and spleen is obliterated and can no longer entrap the colon.

On October 9, 2017, Beatrix underwent a successful ablation of the nephrosplenic space at the hands of Dr. Davis.

“In the past, I have had several horses undergo surgery where they had to be anesthetized and it was very difficult to get them standing again after surgery,” said Stoudenmier. “We did not have that worry with Beatrix and the approach absolutely made a difference in her recovery.”

Post-Surgery Care and Recovery

Beatrix remained at Palm Beach Equine Clinic for a week and a half after surgery to jump-start her recovery before returning home to Stoudenmier, who has managed her post-surgery care with the help of both Dr. Davis and Dr. Scott.

“Dr. Davis was absolutely wonderful to work with,” said Stoudenmier of her experience at Palm Beach Equine Clinic. “He listened to my concerns, was patient, and kept his mind open.”

Dr. Davis paid a visit to Beatrix in mid-November to perform an ultrasound and together with Dr. Scott approved the mare to return to work. Stoudenmier has begun to introduce trot work into Beatrix’s routine and is optimistically expecting a full recovery, saying, “She looks super and everything looks good for the next two months. My goal by the end of the season is to get her back in the show ring!”

Success Story: Freeman

In January 2016, the Pine Hollow team noticed something seemed off just before driving out of the Winter Equestrian Festival (WEF) with their horses. Stopping to check the horses before continuing off the showgrounds, Pine Hollow discovered Freeman, a promising and successful Dutch Warmblood, had swung his hind leg over the back of the trailer. Freeman’s stifle had ended up squarely on one of the hooks used to secure the back door, lodging the hook into his stifle and into the femoropatellar joint.

Emergency Veterinary Care

Recognizing the extreme peril facing Freeman, Pine Hollow immediately called for help from Palm Beach Equine Clinic, the Official Veterinarians of WEF.

“It took tremendous effort, creative thinking, and exceptional teamwork to free Freeman from the hook impaling his leg,” said David Blake, Pine Hollow’s internationally acclaimed rider and trainer. “Palm Beach Equine Clinic sent several of their top vets to help us rescue Freeman. The team of vets is truly great.”

Thanks in very large part to the help and determination of the vets, Pine Hollow and Palm Beach Equine Clinic were able to free Freeman from the trailer door.

At the Equine Hospital

From there, Freeman was transported to the nearby Equine Hospital, where he spent a few days recovering before it was agreed to pursue arthroscopic surgery on his femoropatellar joint.

“To be honest, it wasn’t looking good at all for the first day or so Freeman was there,” said Blake. “The joint was so severely damaged we didn’t know if it could be fixed. Our only chance of fixing the joint was surgery, so we agreed we would try everything possible.”

Dr. Weston Davis Palm Beach Equine Clinic
Dr. Weston Davis of Palm Beach Equine Clinic.

Dr. Weston Davis performed the surgery, after which Freeman remained in Palm Beach Equine Clinic’s care while he regained use of the leg.

“The team did a fantastic job there and kept Freeman until he was ready to begin long-term rehab with James Keogh,” said Blake.

When Freeman was finally ready to return home to Pine Hollow, Blake hoped at best Freeman would eventually be able to do light work and perform at a low level.

Early Response to Equine Joint Disease Improves Career Longevity

At Palm Beach Equine Clinic in Wellington, FL, the team of Board-Certified surgeons are experts in minimally invasive surgical techniques, aiming to reduce joint disease, resolve lameness, and improve the longevity of sport horse careers.

Arthroscopy (or arthroscopic surgery) is a minimally invasive surgical technique that can be performed on an injured joint or synovial structure to accurately explore and treat pathology.
Arthroscopy (or arthroscopic surgery) is a minimally invasive surgical technique that can be performed on an injured joint or synovial structure to accurately explore and treat pathology.

Arthroscopy (or arthroscopic surgery) is a minimally invasive surgical technique that can be performed on an injured joint or synovial structure to accurately explore and treat pathology. The surgery generally involves two very small (8mm) keyhole incisions. The first incision is where the surgeon will insert the arthroscope, which is an instrument with a small surgical grade camera installed that allows a complete, clear view of the interior joint surface. The second small incision is created to insert the surgical instrument to perform the procedure.

Arthroscopy is used to treat a broad range of injuries inside of a joint. Chip fracture removal is a procedure that is particularly commonly in both young Warmblood horses with developmental disease and in racehorses travelling at high speeds. A small chip fracture can cause persistent irritation in the joint as well as arthritis if left untreated. It is best removed immediately so that no further damage is created. The surgeon can go into the joint, remove the chip, and clean up the surrounding cartilage. Most horses recovery quickly and return to their normal athletic activity.

Board-Certified Surgeon Dr. Weston Davis performs many arthroscopic surgeries at Palm Beach Equine Clinic alongside fellow surgeons Dr. Robert Brusie and Dr. Jorge Gomez.

“In many horses, we consider arthroscopy as a prophylactic measure, intervening after injury, but before the development of a generalized degenerative arthritic cycle ensues,” Dr. Davis stated. “Arthroscopy is definitely something that you want to do early in the game if you feel like the horse has joint disease, or a chip, or cartilage disease, or an undefined injury that is not responding appropriately to medical therapy. Arthroscopy can be curative for some of these horses. But if you do not intervene early on in the course of the disease and there is already advanced arthritis, then you have missed your window.

“Arthroscopy is a preferred treatment because it is minimally invasive so most horses can go right back to work,” Dr. Davis continued. “In a typical scenario, we thoroughly explore the joint with the arthroscopic camera, we remove a chip or repair a lesion, and the horse is not lame after the surgery. Because of the small incisions, there is minimal aftercare and horses are often able to go back to work quickly.”

Other common indications for arthroscopic surgery are meniscal disease in the stifle, subchondral cystic lesions, primary cartilage lesions, and debridement of damaged tendinous/ligamentous tissue (such as deep digital flexor tendon tears in the navicular bursa). The surgeons at Palm Beach Equine Clinic can perform arthroscopy on virtually any joint in the horse. Anything from the Temporomandibular Joint (TMJ) of the head to the navicular bursa within the hoof capsule can be explored and treated with this minimally invasive approach.

BEFORE Large prolapsed meniscal tear.
BEFORE Large prolapsed meniscal tear.
AFTER Post debridement of torn meniscal tissue.
AFTER Post debridement of torn meniscal tissue.
BEFORE Tear of deep digital flexor tendon in navicular bursa.
BEFORE Tear of deep digital flexor tendon in navicular bursa.
AFTER Surface of deep digital flexor tendon after cleanup.
AFTER Surface of deep digital flexor tendon after cleanup.

Almost all arthroscopies are performed under general anesthesia with the horse on its back. New renovations at Palm Beach Equine Clinic include a set of stocks of adjustable height adjacent to a surgeon’s pit, allowing the surgeons to have eye-level access to the joint they are working on, enabling many new procedures on the legs of standing horses.

Minimally invasive surgery allows for a simple and quick recovery for the horse. The traditional horse would be on stall rest with a bandage on until the sutures come out at two weeks, and then start doing some light hand walking and physical therapy. Barring severe damage in the joint or associated tendon/ligament disruption, most cases will undergo a six-week rest and rehabilitation protocol, then return to normal work.

As always, the advanced diagnostic imaging at Palm Beach Equine Clinic permits the surgeons to get a complete evaluation of an injury involving a joint to ensure the best possible outcome. Depending on the injury type, digital radiographs, ultrasound, MRI, and Nuclear Scintigraphy, or a combination thereof, may be used for pre-operative diagnosis and planning. Ultrasound and digital radiography are available for intra-operative use. Intra-operative CT scanning will also be available in the future with the new additions at Palm Beach Equine Clinic.

“When you are inside the joint with an arthroscopic camera, you have the most complete picture of the surface and health of that joint,” Dr. Davis noted.

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