Page 265 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

240 CHAPTER 1

VetBooks.ir 1.451 FRACTURES

Definition/overview
Fractures of cervical vertebrae occur in many con-
figurations and may be displaced or non-displaced.

Aetiology/pathophysiology
A fracture may be traumatically induced, often as
the result of a fall or a collision with a solid object,
or is secondary to OA of the caudal cervical articular
process joints.

Clinical presentation
Fig. 1.451 A left-sided jugular vein thrombophlebitis Clinical signs depend on the site of the fracture and
following an intravenous catheter placed for a general its configuration and whether one or more vertebrae
anaesthesia. Note the enlarged, thickened and corded are involved. There may or may not be visible defor-
vein. (Photo courtesy Graham Munroe) mity of the neck (Fig. 1.453). There is usually neck
pain and stiffness. Dermatomal sweating can occur.
A catastrophic fracture may result in spinal cord
1.452
trauma and respiratory arrest. Occasionally, there is
an associated forelimb lameness.

Differential diagnosis
A neck abscess, jugular vein septic thrombophlebitis,
severe muscle injury or meningitis/meningoenceph-
alitis can cause severe neck stiffness and pain.

Diagnosis
Laterolateral (Fig. 1.454) and lateral ventral-lateral
dorsal oblique radiographic images are required
to identify most fractures and their laterality.
Ventrodorsal images may give additional informa-
tion in selected cases. Complete appraisal of fracture
configuration may require CT.

Management
Many fractures, in the absence of neurological signs,
can be managed conservatively with a reasonable
prognosis for return to full athletic function. Acute
neurological signs may progressively improve in
the first week after diagnosis, assuming that there
is no further trauma to the spinal cord. Persistence
of neurological signs warrants a guarded prognosis.
Fig. 1.452 Dorsal image of a 3-year-old Mangalarga It is conceivable that callus associated with fracture
Marchador with acquired torticollis of 3 months’ repair may result in later onset ataxia, but this is
duration. There is convexity of the neck to the left. unusual. Complex fractures resulting in visible neck
Parelaphostrongylus tenuis migration in the spinal cord deformity have a more guarded prognosis.
has been described as a cause.