History
An eight-year-old 550kg warmblood gelding was referred for surgical management of an axis fracture sustained during a 1.30m show-jumping course. The horse fell over a fence and landed on the ground with a hyperflexed neck. The owner reported that the horse shows signs of ataxia immediately after getting up. The animal was transported to the nearest equine hospital for further examination. At admission, the horse was depressed. Swelling, although more pronounced on the right side, was apparent on both sides of the neck, at the level of the first cervical vertebrae (C1-C3). Palpation of that region was painful. The horse held its head and neck in an extended position and was reluctant to turn to the left. When walked in a circle to the right, the horse showed uncoordinated movement of the hindlimbs. The observed ataxia was assigned a grade 3 (Mayhew system – Mayhew 1978). Further neurological tests were not performed. Following the clinical examination, latero-lateral radiographs of the cervical spine were obtained. A cranial mid-body axis fracture, propagating transversely through the body of the axis, at the level of the cranial physis, and entering the vertebral canal near the cranial vertebral foramen, was diagnosed. Mild ventral displacement of the cranial fracture fragment (odontoid process) was observed. A dorsoventral radiograph of the axis was obtained to evaluate latero-lateral displacement of the fracture. No obvious displacement was recorded in the latero-lateral plane (Figure 1) . Standing CT was considered for further diagnostics but was finally not performed as it was not available on site. The patient received anti-inflammatory medication (dexamethasone IV 0.1mg/kg and flunixin meglumine IV 1.1mg/kg) and was placed in a sling. Considering the authors’ disappointing results with conservative management, internal fixation was recommended. The horse remained in the sling for eight days before being transported to a referral hospital for surgical management. In the meantime, the anti-inflammatory medication was continued (flunixin meglumine IV 1.1mg/kg BID). Hay was fed loosely at shoulder height. The horse’s comfort improved significantly within the first two days. Neck stiffness remained but the horse did not show any signs of pain in the box. The patient was stabled in a sling and continued receiving anti-inflammatory medication (flunixin meglumine IV 1.1mg/kg BID) at the referral hospital before undergoing surgery.