Abstract
A fourteen-day-old warmblood colt presented with severe neurological signs of unknown origin. The foal was recumbent and comatose, and showed spastic motion of the head. Computed tomography (CT) examination revealed multiple impression fractures to the left parietal and temporal bones, as well as traumatic brain injury. Three fragments of the temporal bone were dislocated into the cranial vault. The foal was surgically treated within 24 hours of presentation: the fragments were elevated and the largest fragment was fixated with an L-shaped titanium MatrixMidface 0.8 mm reconstruction plate. The brain injury resolved with medical treatment and supportive care. Apart from a localized wound abscess that was drained, postoperative healing was uneventful and the foal regained the ability to ambulate 18 days after surgery. Follow-up CT imaging documented good fracture healing and a favorable development of the soft tissue injuries. Seven months after surgery, the foal was fully recovered and showed no neurological signs.
Highlights
Head trauma is common, especially in young horses
The foal was surgically treated within 24 hours of presentation: the fragments were elevated and the largest fragment was fixated with an L-shaped titanium MatrixMidface 0.8 mm reconstruction plate
Skull fractures are often underestimated on visual examination (Fürst, 2010) and impression fractures are especially hard to detect on palpation, because of the associated soft tissue swelling (Auer, 2019)
Summary
Especially in young horses. Fractures of the skull are caused by horses falling backwards, collision with solid objects, and kicks (Ramirez et al, 1998; Lim et al, 2013). The majority of fractures of the head involve the maxilla, mandibles, and frontal bones including the facial sinuses (Schaaf et al, 2008). Skull fractures are often underestimated on visual examination (Fürst, 2010) and impression fractures are especially hard to detect on palpation, because of the associated soft tissue swelling (Auer, 2019). Surgical treatment is warranted when the fracture is unstable or when fragments are displaced (Feary et al, 2007). Sutures or plates has been described for equine facial and skull fractures (Dowling et al, 2001; McMaster et al, 2016; Derham et al, 2019). To the authors’ knowledge, this is the first case report describing the successful surgical treatment of a parietal and temporal bone fracture with associated traumatic brain injury
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