Horse beats odds to survive, recuperates after unprecedented surgery at UF

A year after University of Florida veterinarians removed a piece of bone from her badly fractured shoulder in a procedure believed to be the first of its kind, Graceful Leaguer, a 9-year-old quarter horse, is finally home with her owner after building back her strength through a combination of play and rehabilitative exercise.

That the horse, known as Gracie, is even alive is something of a miracle, given the medical challenges of her condition, said Sarah Graham, D.V.M., a clinical assistant professor in the UF College of Veterinary Medicine’s department of large animal clinical sciences and lead surgeon on the case. But the willingness of a local rehabilitation center to provide the horse with regular physical therapy to aid in her healing adds a special, well, saving grace to her story.

The horse came to UF as an emergency patient in November 2012. Andrew Smith, D.V.M., a large animal surgery resident, was on duty that night.

“Grace was unable to bear weight on her right front leg. She was in a lot of pain and distress,” Smith said.

Radiographs of the shoulder all were normal, but a subsequent bone scan revealed a rare fracture in an area of the humerus known as the lesser tubercle.

“There is no report in the literature of this type of fracture being fixed,” Graham said. “The fracture itself is very rare, but no one has ever tried to repair it or do anything with it.”

The prospect of surgery was daunting, in part because veterinarians knew the fracture’s location was deep and on the inside of the shoulder. Surgical access to that area is very difficult, Graham said. Routine fracture repair involves the use of bone screws and plates and would have been ideal, but that was not possible in Gracie’s case due to the location of the fracture, she said.

“The piece of bone that was fractured is an insertion point for a number of muscles that stabilize the shoulder,” Graham said, adding that muscles would pull constantly on the bone, therefore making healing of the fracture on its own impossible.

But the UF surgeons had noticed Gracie’s calm temperament and her willingness to let them help her. They also felt she had a good instinct for taking care of herself. Those characteristics, plus her owner’s attachment to her, were encouraging, Graham said.

“Her owner obviously loved her and was willing to give surgery a try, even though we weren’t able to tell her if it was going to be successful or not,” Graham said.So rather than repair the fracture, the UF veterinarians took a different approach. They removed the piece of bone entirely.

Graham and Smith performed the procedure, which took several hours. Overall, things went smoothly, as did the horse’s first weeks of aftercare.

Gracie returned home to Jacksonville with her owner and began the long process of recuperation, which included months of stall rest and limited exercise. But when Gracie returned to UF several months later for reexamination, her care team noted that she was showing signs of severe lameness.

The UF veterinarians felt that Gracie had developed a lot of scarring and restricted motion around the shoulder joint. Gracie needed more physical therapy to maximize her recovery but her owner was unable to provide the kind of extensive care they felt was needed.

“We really felt that this case was unique and needed to be written up for a scientific publication,” Graham said. “But more importantly, we wanted to give Gracie the best possible outcome.”

So Graham contacted Peter Kazakevicius, D.V.M., head veterinarian at the Sanctuary Equine Sports Therapy and Rehabilitation Center in Ocala, Fla. He and Brenda McDuffee, the center’s general manager, were excited to get involved in the case and to contribute their expertise in rehabilitation.

“I understood that this was an unusual and rather extreme surgery,” McDuffee said. “It’s not something that happens often, and the prognosis has never been good.”

She said she was pleased to be a part of Gracie’s recovery and hoped to show that proper rehabilitation could make a huge difference in the horse’s overall health.

“We started in July, with therapy in a water treadmill to make her more buoyant and offset some of her weight,” McDuffee said. In addition to hydrotherapy, Gracie received laser, vibration and magnetic pulse therapies to loosen up her muscles and offset body soreness.

Gracie was discharged from the Sanctuary on Nov. 24 to return home with her owner, to Jacksonville.

Graham said she believed the rehabilitation Gracie received allowed the horse to regain her strength, and that while she may never go back to being a full-time riding horse, she should be healthy enough to live comfortably in a pasture.

“Now she has increased range of motion, increased weight bearing and her whole body condition has vastly improved,” Graham said. “She looks healthier and happier. It’s definitely thanks to a team effort.”