A New Bolton Center team’s beat-the-odds surgery means survival for a special horse

For Monty, a 10-year-old thoroughbred, the odds were about as bad as they get.

“Less than 10 percent” – those were the survival odds the gray gelding’s owners remembered being told by several veterinary surgeons last March 17, shortly after they found him bleeding and holding up his front left leg in a paddock at Meadow Spring Farm in Oxford, Pennsylvania, where he lives.

Erika Jo Beck, a local veterinarian who owns Monty with Meadow Spring partners Ali Rawles and Megan Calibey, took X-rays with equipment in her truck. The images confirmed their worst fears:

A compound radial fracture. The horse’s large broken radius bone was protruding from his skin. The radius bone is the primary weight-bearing bone located between the elbow and the knee of the horse’s forelimb.

“I just looked at Ali after I saw that first (X-ray) picture and burst into tears. I realized how broken it was,” Beck said. “I thought we were going to have to euthanize him.”

But instead, Monty was whisked to Penn Vet’s New Bolton Center that evening. The next day, a veterinary team of three surgeons led by David Levine, associate professor of large animal surgery, performed a complex, five-hour operation on Monty’s broken leg, not like any other attempted before, including experimental materials followed by a recovery system unique to New Bolton Center, and more than two months in a body sling.

Even so, Levine warned Monty’s owners that his chances of making it weren’t high.

“There’s a lot of complications we can hit along the way, and it’s going to be super expensive,” Levine said he told them.

“They said, ‘This horse is worth it. Try it.’ ”

Today, Monty is back home at Meadow Spring Farm, standing on all four legs, regaining his strength and range of motion. Soon, his owners say, he’ll be ready to return to pasture on his own again.

“I think he’s a miracle,” said Beck.

“This is a horse I would have said had very little chance to survive,” said Levine, “and this horse now has a chance to go back and be ridden.”

Pulling out all the stops to save Monty

Monty’s survival is a testament to the love and determination of Monty’s owners, the teamwork and ingenuity of the New Bolton Center clinicians, but also one very special horse.

Monty – or officially Lucifer Morningstar – was originally purchased with the intent of having him be a racehorse. He was just a yearling then; his then-dark coat had yet to turn snowy white. As he matured a bit more, a weakness in one of his knees ended up having his owners decide that racing was not the career for him. His owners, who also manage an off-track thoroughbred nonprofit called Pastured Place, weren’t perturbed. They started training him in dressage.

But Monty, they discovered, had other gifts.

“He’s great as a fox hunter. He did super at that,” said Rawles.

Specifically, Monty excelled as the horse ridden by the whipper-in – a key member of the hunt who manages the hounds. Besides possessing the requisite agility, Monty had the ideal character.

“He’s got a very good, laid-back personality, and he’s very smart,” said Rawles.

“He’s very brave and independent,” added Beck.

After his surgery, those same qualities would aid his survival.

A unique surgical plan for a life-threatening fracture

But first, his New Bolton Center team had to devise a surgical plan that had the potential to beat the very tough odds for survival with a compound radius fracture.
“I can tell you it’s a fracture that we fix in foals occasionally when they get kicked or stepped on by a mom, but the success rate on this upper limb fracture on adult horses is low,” said Levine. A grown horse’s greater weight makes the likelihood of healing much more problematic.

For a closed radial fracture, the success rate is only about 20 to 30 percent, at best, Levine said. But Monty’s injury wasn’t closed. It was a compound or open fracture, with the bone protruding through his skin, greatly increasing the risk of infection.

“When you get an open fracture,” Levine said, “the success rate goes down substantially.”

The surgery embarked on by Levine and colleagues, Holly Stewart, assistant professor of large animal surgery, and Thomas Schaer, associate professor of comparative orthopedic surgery, was intended to give Monty a fighting chance.

“It was a collaborative effort between a bunch of us to get this fracture fixed,” said Levine. “We took out all the stops of what we have available.”

Stewart said all the clinicians were very mindful of importance of working as a team.
“I think this case highlighted a strong collaboration between surgeons here at New Bolton Center, and everyone was involved in the pre-operative planning and intra-operative decision-making process to provide the highest level of patient care possible,” said Stewart. She also gave kudos to the operating room, anesthesia and nursing teams who all contributed to Monty’s care.

“We all got to know Monty well and his animated personality during his stay at New Bolton,” she said, “and I couldn’t be happier for his continued success.”

The surgeons’ plan was designed to give the best possible hope for a good outcome.

To give Monty’s radius bone the stability it needed, they decided to brace it internally with a special type of locking compression plate device – two large metal plates that are held in place by a series of screws. At the time of the surgery, they used a special lavage solution researched at Penn Vet to rinse the bone and get rid of any bacteria that might have been present.

“Then we filled the defects in the bone with an experimental bone substitute infused with tobramycin,” a type of antibiotic, said Levine.

Then, while Monty was still under the effects of anesthesia, he was transferred to New Bolton Center’s unique pool raft recovery system. It allows equine patients to recover from surgery in a floating raft. When they awaken, they are lifted by a large sling and gently placed on the ground, Levine explained. “They don’t have to go from laying down to getting up which puts a lot of pressure on the bone.”

For the next 10 weeks, Monty was kept at New Bolton Center in a supportive sling so he wouldn’t lie down and put pressure on his healing bone. Some horses do not tolerate the sling well. But Monty wasn’t just any horse.

“I felt he had the temperament. He’s stoic,” explained Rawles, a former New Bolton Center nursing assistant. “He’s got that tough personality. So, I felt if there was a horse that would handle it, it was him.”

“He was an amazing patient,” said Levine. “Horses are smart. They adapt pretty well. He did it remarkably well.”