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.