equis - Articles
Head: fractures
Introduction
- Cause: trauma.
- Signs: abnormal facial contours, evidence of trauma
- local pain, swelling 
, epistaxis, bleeding from ear(s), instability or crepitus, eye 
, nervous signs. - Diagnosis: radiography Head: radiography, CT scan Computed tomography, MRI Magnetic Resonance Imaging.
- Treatment: systemic stabilization, surgery +/- later reconstruction.
- Prognosis: depends on site, severity and clinical signs.
Presenting signs
- Abnormal facial contours.
- Evidence of trauma.
- Instability or crepitus.
- Epistaxis.
- Bleeding from ear(s).
- Neurological signs.
- Blindness.
Acute presentation
- Variable degrees of post-trauma behavioral changes.
- Head carriage changes.
- Patient may have evidence of brain involvement:
- Alterations in mentation.
- Cranial nerve deficits.
- Unable/difficulty rising.
- Ataxia.
Age predisposition
- None, though younger horses being halter trained may be more likely to flip over and experience fractures associated with poll injuries.
Cost considerations
- Depends on area of trauma and involvement of other structures such as eyes, brain, nasal passages and sinus.
Special risks
- Considerable anesthetic risk if traumatic brain injury.
- Anesthetic recovery risk of fracture repair failure or worsening of original fracture.
Pathogenesis
Etiology
- Kicks.
- Impact with fence.
- Collison with another horse.
- Blow to head.
- Rearing and hitting poll.
- Falls.
Predisposing factors
General
- Management problems → violent interactions between horses, eg overcrowding.
Specific
- Several horses fed from a common trough.
- Competitions and training over jumps, etc.
- Horses competing against each other where collision could occur, ie Polo.
Pathophysiology
- Trauma → facial bone fractures:
- Frontal.
- Nasal.
- Lacrimal.
- Zygomatic.
- Cranial vault.
- Maxilla Mandible / maxilla: fracture.
- Orbit Orbit: trauma.
- Complications:
- Cosmetic damage.
- Paranasal sinus involvement.
- Nasal cavity involvement.
- Tooth damage.
- Loss of respiratory capacity.
- Eye injury Orbit: trauma.
- Neurologic injury CNS: brain trauma.
- Neurological signs depend on site of injury:
- Frontal or parietal injury → cerebral laceration, hemorrhage → coma → cerebral edema → other signs of cerebral damage (depression, circling, blindness).
- Midbrain injury (often due to severe cerebral edema +/- skull fractures) → coma → depression, recumbency or ataxia/weakness and other varied signs.
- Injury to back of skull → fractures of occipital, petrosal bones, basioccipital, basisphenoid bones → usually asymmetric signs:
- Middle, inner ear hemorrhage → vestibular, facial nerve signs → head tilt
, circling 
, facial paralysis 
, nystagmus. Blood seen at external auditory meatus = a grave sign.
- Middle, inner ear hemorrhage → vestibular, facial nerve signs → head tilt
- Injury to medulla, eg blow to poll → hemorrhage → depression, recumbency, acute vestibular signs may → violent struggles to stand; nodding or tremor.
Timecourse
- Most signs are instant following trauma, though soft tissue involvement (brain, eye, nasal passage) may have worsening signs over the first 24-48 h as swelling and inflammation ensues.
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Gerding J C, Clode A, Gilger B C & Montgomery K W (2014) Equine orbital fractures: a review of 18 cases (2006-2013). Vet Ophthalmol 17 (1), 97-106 PubMed.
- Dunkel B, Corley K T, Johnson A L et al (2013) Pneumocephalus in five horses. Equine Vet J 45 (3), 367-71 PubMed.
- Avella C S & Perkins J D (2011) Computed tomography in the investigation of trauma to the ventral cranium. Equine Vet Educ 23 (7), 333-338 VetMedResource.
- Beccati F et al (2011) Comminuted basilar skull fracture in a colt: Use of computed tomography to aid the diagnosis. Equine Vet Educ 23 (7), 327-332 VetMedResource.
- Vos N J, Pollock P J, Harty M et al (2008) Fractures of the cervical certebral odontoid in four horses and one pony. Vet Rec 162 (4), 116-119 PubMed.
- Reed S M (2007) Head trauma: a neurological emergency. Equine Vet Educ 19 (7), 365-367 VetMedResource.
- Tremaine H (2004) Management of skull fractures in the horse. In Pract 26 (4), 214-222 VetMedResource.
- Ramirez O et al (1998) Imaging basilar skull fractures in the horse - a review. Vet Radiol Ultrasound 39 (5), 391-395 PubMed.
- Park R D (1993) Radiographic examination of the equine head. Vet Clin N Am 9 (1), 49 PubMed.
- Burbs D J & Collier M A (1991) T-plate repair of fracture of the nasal bones in a horse. JAVMA 199 (7), 909 PubMed.
- Caron J P et al (1986) Periorbital skull fractures in five horses. JAVMA 188 (3), 280 PubMed.
- Schumacher J et al (1985) Repair of facial defects with periosteal flaps in two horses. Vet Surg 14, 235 VetMedResource.
- Little C B et al (1985) A retrospective study of head fractures in 21 horses. Austr Vet J 62 (3), 89-91 PubMed.
- Blackford J T et al (1985) Non-invasive technique for reduction of zygomatic process fractures in the horse. Vet Surg 14, 21 Wiley Online Library.
- Campbell M L & Peyton L C (1984) Muscle flap closure of a frontocutaneous fistula in a horse. Vet Surg 13, 185 VetMedResource.
- Turner A S (1979) Surgical management of depression fractures of the equine skull. Vet Surg 8, 29 Wiley Online Library.
Other sources of information
- Easter J L & Watkins J P (1999) Facial Fractures. In: Equine Medicine and Surgery. 5th edn. Eds: Colahan P T, Merritt A M, Moore J N & Mayhew I G. Mosby, USA. pp 1673-1676.
- Beard W (1998) The Skull, Maxilla and Mandible. In: Equine Surgery. 2nd edn. Eds: Auer J A & Stick J A. W B Saunders Co, USA.