New Concepts in Equine Skull Fracture Repair
Updated: Tuesday, November 27, 2012 11:00 AM
Posted: Wednesday, October 17, 2012 12:00 AM
Originally published on TheHorse.com
Editor's Note: This article is part of TheHorse.com's ongoing coverage of topics presented at the British Equine Veterinary Association's 51st annual Congress, held Sept. 12-15 in Birmingham, U.K.
Equine skull fractures are surprisingly common, comprising 12% of all fractures horses experience (Hug et al. 2009). These typically result from kicks and collisions, but thanks to surgical and technological advances, they are often possible to repair.
Anton Fürst, DVM, Dipl. ECVS, of the University of Zürich's Equine Department, in Switzerland, presented on these advancements in skull fracture repair at the British Equine Veterinary Association's 51st annual Congress, held Sept. 12-15, in Birmingham, UK.
Prognosis for most skull fractures is good to excellent because they are not affected by weight or laminitis, two factors that impede long-bone fracture healing, Fürst said.
Clinical signs that your horse might have a skull fracture include an obvious wound, facial disfiguration, and neurologic signs. Veterinarians can diagnose them using palpation, radiography (X ray) and computed tomography (CT).
Although it does require general anesthesia, "CT is much more precise (than other methods), takes 42 seconds, and helps show you where to put screws (during surgical repair)," said Fürst.
He then described the six common types of skull fracture and how veterinarians are now able to treat them:
Mandible (jaw) fractures are the most common and usually have a great prognosis, Fürst said. Historically, veterinarians have repaired these using figure-eight wire fixation. But "now we can use an interdental continuous wire-loop splint around the teeth," he added. "It allows the application of uniform tension between all the teeth that are engaged in the splint."
Interdental space fractures (on the jawbone between the incisors and pre-molars where there are no teeth) can be repaired using wire fixation, but Fürst recommends also using plates. "A locking compression plate in combination with wire provides excellent stability," he said.
He noted that while the pinless external fixator with titanium clamps was once a novel and useful repair method for interdental space fractures, this product is no longer made. It was produced for human surgeons, who now use other materials.
Fractured ramus (perpendicular portion) of the mandible can be repaired using plates and screws. "Dynamic compression plates can be used but locking compression plates are presently preferred because they provide better stability," said Fürst.
Facial fractures include those of the orbit, sinus, nasal cavity, and cerebral skull. These are usually open and often underestimated fractures; however, Fürst said prognosis is good. Repair is aimed at decompressing the brain or orbit, preventing infection, correcting any airway problems, and restoring cosmetic appearance. While veterinarians can use periosteal elevators (special dental instruments for lifting and maneuvering tissues or bone) to remove bone fragments within these fractures, a new technology to accomplish this comes from human medicine: a taplike rod that pulls fragments back into position. Veterinary surgeons can also employ the FlapFix System with titanium rosettes, which is also used in human fracture repair.
Orbital fractures can be particularly challenging because associated structures such as sensory and motor nerves might be involved. The surgeon can use wire or plates to fix and repair the solid bone outer parts of the orbit.
Cerebral skull fractures are more difficult to repair if located at the base of the skull vs. the roof, but veterinarians use plates and the FlapFix system for these cases.
Possible complications of these repair procedures include infection, bone sequestrum (disease/death), a broken fixation, or infected teeth requiring removal.
Other surgical developments include using cable, which is more stable and flexible than wire, for fixation, but this method is still in development, said Fürst.
So while equine skull fractures are frequently unsightly and alarming, don't panic if you encounter one in your own horse, Fürst said. Veterinary surgeons can often repair these injuries successfully, and most prognoses are excellent.
Disclaimer: Seek the advice of a qualified veterinarian before proceeding with any diagnosis, treatment, or therapy.
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