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Tag: weston davis

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.”

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.”

Success Story: Diligent Pre-Purchase Practices Put “Mater” in the Winner’s Circle

When Margo Crowther of Fort Myers, FL, was looking to add a new addition to her string of barrel racing horses, she made one very important phone call. That call was to Palm Beach Equine Clinic. Dr. Weston Davis, board-certified surgeon and veterinarian at Palm Beach Equine Clinic, has been working with Crowther to keep her horses healthy, as well as performing career-saving procedures.

Success Story: Diligent Pre-Purchase Practices Put “Mater” in the Winner’s Circle

In 2016, Dr. Davis helped Crowther and her 2012 Quarter Horse mare Shes Packin Fame, or “Sissy,” return to the ring after what could have been a detrimental injury. Sissy suffered a rare slab fracture to the central tarsal bone in her left hock while competing in a barrel racing competition. After a diagnosis aided by Palm Beach Equine Clinic’s advanced diagnostic imaging equipment and a surgery performed by Dr. Davis, Shes Packin Fame not only returned to running barrels, but the mare was also back to winning the next year.

When Crowther found a new prospect named Grandiose Guy, or “Mater,” she turned to Dr. Davis to ensure her intended purchase would be a good fit. The Quarter Horse gelding was named the Barrel Futurities of America (BFA) Horse of the Year just after she purchased him, crowning him the top four-year-old in the country.

“When I was thinking about buying him, I called Dr. Davis and sent him videos of the horse working to review,” said Crowther, who started the purchase process late last year and chose to involve Dr. Davis in all aspects of the pre-purchase evaluation. “The horse was in Georgia, so he reviewed them from Palm Beach Equine Clinic in Wellington and gave me the stamp of approval. Once a pre-purchase was performed, I sent all the x-rays to Dr. Davis and he told me to move forward.

“I trust Dr. Davis and the team at Palm Beach Equine Clinic so much!” continued Crowther. “Barrel horses work hard and it’s so important to have a great relationship with the vet who oversees their care and knows them well in order to keep them happy and healthy.”

Regardless of breed or discipline, a pre-purchase exam involves certain steps that allow the potential owner and veterinarian to investigate the horse’s health and condition. The veterinarian gathers and interprets information by physically examining the horse’s body systems and conformation, as well as reviewing the health history. A lameness assessment is completed, including flexion tests, soft tissue structure palpation and movement evaluation. Diagnostic medical imaging tools, such as radiography, ultrasonography, endoscopy, magnetic resonance imaging, nuclear scintigraphy, or computed tomography, may be used to provide a more detailed and comprehensive profile of the horse.

Crowther purchased Mater and started running him at the beginning of last year, bringing him to the largest one-day rodeo, The American, in the Dallas Cowboys stadium in Texas in February. The competition had a $1 million payout and Mater and Crowther placed fifth.

“Mater” in the winner’s circle. Photo courtesy of Margo Crowther

“After so many runs, we brought him home from Texas and got him over to Dr. Davis for any maintenance work that needed to be done to keep him feeling his best,” said Crowther. “I am very picky about where I take my horses; there has to be good ground and I will not run their legs off. In conjunction with that, maintenance work with Dr. Davis is important. He performs flexion tests, utilizes the imaging at Palm Beach Equine Clinic if necessary, and makes recommendations about my horses’ health and overall well-being.”

Dr. Davis sent Mater home from Palm Beach Equine Clinic with a clean bill of health and Crowther gave the gelding a little time off before their next run. After returning to work, Mater headed to the National Barrel Horse Association (NBHA) Florida State Championships in Kissimmee.

Crowther’s diligence and Dr. Davis’ knowledge paid off when Mater won both his runs and clinched the open final at NBHA Florida State Championships. With more than 700 entries, Mater and Crowther topped them all and were crowned overall champions of the event.

“Palm Beach Equine Clinic and Dr. Davis have been a huge part of the success I have had with all of my horses,” said Crowther. “They are always there when I need them, whether I’m headed to the clinic in Wellington or they are coming to me in Fort Meyers. It’s nice to be able to know your vet will be there for you whenever you need them.”

Palm Beach Equine Clinic Helps Keep Horses of Vinceremos in Top Form

Feature in the March 2019 issue of Wellington The Magazine


The horses at the Vinceremos Therapeutic Riding Center perform miracles every day. Whether by carrying a person coping with a physical disability to a sense of independence, providing comfort to a soul suffering from emotional trauma or teaching a child beyond the confines of a classroom, the Vinceremos horses are heroes. But they aren’t the only ones wearing capes. A local group of dedicated and passionate equine veterinarians share in the magic.

The veterinarians of the Palm Beach Equine Clinic (PBEC), based in the heart of Wellington, have been caring for horses in South Florida for decades. Founded by Dr. Paul Wollenman in 1981, PBEC has grown to include a staff of 40 veterinarians, with five boarded specialists and the most state-of-the-art facility in the country. Situated in the winter equestrian capital of the world, Palm Beach Equine Clinic treats the top-performing show jumping, dressage, polo and racing athletes throughout the year.

Official Veterinarians of Vinceremos Therapeutic Riding Center

Dr. Janet Greenfield Davis Vinceremos Therapeutic Riding Center
Dr. Janet Greenfield-Davis is one of the primary treating veterinarians for Vinceremos Therapeutic Riding Center.

In addition, the clinic is a saving grace for the horses of Vinceremos. The 23 specially selected horses stay true to the nonprofit’s mission of conquering disability and hardship in people of all ages. Founded in 1982, Vinceremos, based in Loxahatchee Groves, serves people from all stations in life with physical, cognitive and emotional disabilities through the power of equine therapy. The treatments they offer include therapeutic riding and carriage driving, hippotherapy, equine-assisted learning and equine-assisted psychotherapy.

Palm Beach Equine Clinic does its part by keeping the horses healthy and happy with pro-bono veterinary care.

“We have the people and, most importantly, the horses, of South Florida to thank for the success that PBEC has enjoyed over the years,” said Palm Beach Equine Clinic President Dr. Scott Swerdlin, who spearheaded the clinic’s involvement with Vinceremos in 2011. “It is our honor to give back to that community through our work with Vinceremos. The whole team is dedicated to each and every horse we treat, as well as to the riders who love them.”

Healing Together

While their commitment to the nonprofit is extensive, it’s not about the hours spent or the cost of time and supplies. Swerdlin and his team focus on a bigger goal; healing horses so they can heal people. “There’s no greater reward than seeing how the horses of Vinceremos benefit their riders,” he said. “You see the riders light up and how excited they are to be on those horses.”

Swerdlin is proud of the clinic’s work with Vinceremos. “I continually remind my team that it is a privilege to treat the caliber of horses we have in Wellington and that should compel us to give back to the community,” he said. “The response from Palm Beach Equine Clinic veterinarians has been overwhelming. The entire team has volunteered to be involved.”

From routine treatments and services, such as vaccinations and health exams, to emergency care, Palm Beach Equine Clinic veterinarians are available to Vinceremos night and day. Last summer, such emergency care was called on, and one Vinceremos horse got a second chance at life thanks to a group of devoted veterinarians.

Clark Kent

Vinceremos favorite Clark Kent — a sturdy black mount with an eye as kind as they come — suffered an injury to his right front leg. The laceration extended into his tendon sheath, which is a layer of membrane around a tendon on the back of the lower leg. What could have been a simple cut on the surface was much more serious.

Initially treated on-site at Vinceremos by Dr. Marilyn Connor, Clark Kent was then transported to PBEC for surgery to repair the injury. The case turned into a team effort and involved the work of surgeons Dr. Weston Davis and Dr. Michael Myhre, as well as Dr. Janet Greenfield.

After surgery and a recovery period at PBEC’s onsite equine hospital, Clark Kent returned to Vinceremos to recover. He was back to his therapy work by fall, giving riders a sense of independence and confidence with his skills on the lunge line and his forward way of moving.

Clark Kent Vinceremos Palm Beach Equine Clinic Veterinarians

“This treatment was no easy feat, but the veterinarians and staff of Palm Beach Equine Clinic took a tragedy and turned it into a miracle. Clark Kent was surrounded by extraordinary veterinarians and technicians throughout his care,” Vinceremos Director of Development Susan Guinan said. “The diligence of this team makes miracles happen every day. We are so appreciative of Palm Beach Equine Clinic and their team of veterinarians. They give so much support to Vinceremos and the horses here. They keep them in top shape so we can impact our community in such a special way through equine therapy.”

Rewarding for Horses and Humans

For Connor, it’s cases like Clark Kent’s that convinced her to pursue veterinary medicine. Growing up around horses, she spent time volunteering with a therapeutic riding program before attending veterinary school at Texas A&M.

“It was a very rewarding experience to be able to give back to a cause that is important to me. And even more so now that I can do that in a different capacity as a veterinarian,” said Connor.

She can often be found checking on the horses of Vinceremos while on the job. “Being able to help horses as special as the ones at Vinceremos and the people who love them is what ultimately made me realize I wanted to be an equine veterinarian,” Connor said.

To find out more about the Palm Beach Equine Clinic, call (561) 793-1599.

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.


Success Story: Palm Beach Equine Clinic Patient in the Winner’s Circle

When Margo Crowther of Fort Myers, FL, was looking to add a new addition to her string of barrel racing horses, she made one very important phone call. That first call was to Palm Beach Equine Clinic (PBEC). Dr. Weston Davis, board-certified surgeon and veterinarian at PBEC, has been working with Crowther for several years and has helped maintain her horses and even performed some career-saving procedures.

In 2016, Dr. Davis helped Crowther and her 2012 Quarter Horse mare Shes Packin Fame or “Sissy” return to the ring after what could have been a detrimental injury. Sissy suffered a rare slab fracture to the central tarsal bone in her left hock while competing in a barrel racing competition. After a diagnosis aided by PBEC’s state-of-the-art diagnostic imaging equipment and a surgery performed by Dr. Davis, Shes Packin Fame not only returned to running barrels, but the five-year-old mare was also back to winning the next year. Click here to learn more about Sissy!

Crowther Meets “Mater”

This time, Crowther turned to Dr. Davis to ensure that her intended purchase of a new horse was a good fit. When she met Grandiose Guy, known to her as “Mater,” she had to have him. The Quarter Horse gelding was named the Barrel Futurities of America (BFA) Horse of the Year just after she purchased him in 2017, crowning him the top four-year-old in the country.

“When I was thinking about buying him, I called Dr. Davis and sent him videos of the horse working to review,” said Crowther, who started the purchase process late last year. “The horse was in Georgia, so he reviewed them from PBEC in Wellington and gave me the stamp of approval. Once a pre-purchase was performed, I sent all the x-rays to Dr. Davis and he told me to move forward.

“I trust Dr. Davis and the team at PBEC so much!” continued Crowther. “Barrel horses work hard and it’s so important to have a great relationship with the veterinarian who oversees their care and knows them well in order to keep them happy and healthy.”

Success Story: Diligent Pre-Purchase Practices Put “Mater” in the Winner’s Circle
Margo and Mater during one of their winning runs. Photo by Mike Rastelli

Crowther purchased Mater and started running him at the start of 2018, bringing him to the largest one-day rodeo, The American, in the Dallas Cowboys stadium in Texas in February. The competition had a $1 million payout and Mater and Crowther placed fifth.

“After so many runs, we brought him home from Texas and got him over to Dr. Davis for any maintenance work that needed to be done to keep him feeling his best,” said Crowther. “I am very picky about where I take my horses; there has to be good ground and I will not run their legs off. In conjunction with that, maintenance work with Dr. Davis is important. He performs flexion tests, utilizes the imaging at PBEC if necessary, and makes recommendations about my horses’ health and overall well-being.”

Dr. Davis sent Mater home from PBEC with a clean bill of health and Crowther gave the gelding a little time off before their next run. After returning to work, Mater headed to the National Barrel Horse Association (NBHA) Florida State Championships in Kissimmee in mid-June.

Success for Crowther and Mater

Crowther’s diligence and Dr. Davis’ knowledge paid off in full when Mater won both his runs and clinched the open final at NBHA Florida State Championships. With more than 700 entries, Mater and Crowther topped them all and were crowned overall champions of the event.

Mater being crowned National Barrel Horse Association (NBHA) Florida State Champion. Photo by Mike Rastelli
Mater being crowned National Barrel Horse Association (NBHA) Florida State Champion. Photo by Mike Rastelli

“PBEC and Dr. Davis have been a huge part of the success I have had with all of my horses,” said Crowther. “They are always there when I need them, whether I’m headed to the clinic or they are coming to me in Fort Meyers. It’s nice to be able to know your vet will be there for you whenever you need them.”

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

Regenerative Medicine Steps into the Future at Palm Beach Equine Clinic

As sport horses become faster and stronger, veterinary medicine is often challenged to break barriers to provide the best in diagnostic and maintenance care. Palm Beach Equine Clinic is consistently on the forefront of those advances and employs a team of veterinarians equipped with the latest developments in regenerative medicine.

Two resources that have become increasingly popular to treat equine injuries are Platelet Rich Plasma (PRP) and Interleukin-1 Receptor Antagonist Protein (IRAP) to encourage regeneration of injured or degenerative tissue. Managing joint diseases and injuries using these methods is ground-breaking, but logical at their core. They essentially use naturally-occurring proteins, cells, and other natural bodily processes. Regenerative therapies put the horse’s own biological mechanisms to work stimulating healing without the use of steroids or other drugs.

What is PRP?                                              

Platelets are among the very first cells to accumulate at an injured site, making them very important when simulating the repair process. Platelets contain granules filled with growth factors (the elements that aid in healing) and stimulate specified tissue to heal at an increased rate. To treat a horse with PRP, the veterinarians at PBEC are able to take a sample of the horse’s blood and concentrate the platelets in a high-speed centrifuge onsite. The harvest and processing procedure takes approximately 30 minutes before the concentrated platelet rich sample is injected back into the horse at the specific area of injury using sterile techniques and guided by ultrasound.

A PRP tendon injection taking place at Palm Beach Equine Clinic.
A PRP tendon injection taking place at Palm Beach Equine Clinic.

PBEC’s Board-Certified Staff Surgeon, Dr. Weston Davis, explained PRP use in more detail: “We harvest a large quantity of blood, anywhere from 60 to180 milliliters, and we process that to concentrate the segment that is very rich in platelets. We get a high concentration of platelets – we are hoping for five to eight times the concentration that you would get from normal blood. Then we take that platelet-rich extract and inject it back into an injured area to encourage a more robust healing response. Whenever you have an injury, platelets are one of the first cells that get there. They will aggregate, clump, and de-granulate. They release these granules, which are very rich in growth factors, and signal the body to start the healing process.”

What is IRAP?

IRAP is used to treat equine athletes that are susceptible to musculoskeletal injuries and osteoarthritis or degenerative joint disease. Joint trauma results in the release of inflammatory mediators such as Interleukin-1 (IL-1). IRAP uses a horse’s own anti-inflammatory protein found within the blood to counteract the destructive effects of IL-1 to slow the process of osteoarthritis. The process works by binding to the IL-1 receptors in the joint and blocking the continuation of damage and inflammation.

An injection being administered by use of a guided ultrasound. Palm Beach Equine Clinic
An injection being administered by use of a guided ultrasound at Palm Beach Equine Clinic.

“We often see joint damage in sport horses because of the nature of their work, but we try to avoid overuse of steroids in joints because steroids can have long term effects on cartilage,” said PBEC veterinarian Dr. Samantha Miles. “This is a way we can manage joint disease and stop inflammation without having to consistently use steroids every time. Some of our clients will maintain their horses on IRAP alone for joint injections.”

The goal to better serve sports horses that continue to improve athletically is the driving force behind the development of even more developed and precise techniques used in regenerative medicine. And, at PBEC, the work to break new ground is never finished.

“I believe we are learning more about these technologies with more advanced science behind what they do and how they do it,” said Miles. “These treatments are natural, drug-free, and competition safe, and necessity drives the need for regenerative therapies in the sport horse world.”

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!”

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