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Head: fractures

pequis

Introduction

  • Cause: trauma.
  • Signs: abnormal facial contours, evidence of trauma Head: trauma 01 - facial nerve- local pain, swelling Face: edema - fractured odontoid, epistaxis, bleeding from ear(s), instability or crepitus, eye Head: trauma 05 - fracture - zygomatic process Head: trauma 02 - fracture - zygomatic process, 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.

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:
  • 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 Head: tilt 03 - cranial trauma, circling Behavior: circling - box walking, facial paralysis Head: facial paralysis 02, nystagmus. Blood seen at external auditory meatus = a grave sign.
    • 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.

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