Introduction
Cranial mid-body fractures of the axis in horses result from hyperflexion of the neck and are associated with lateral bending falls or impact into fixed objects (Nixon 2020). These fractures propagate transversely through the body of the axis, at the level of the cranial physis, and enter the vertebral canal near the cranial vertebral foramen. Dorsal displacement of the body of the axis in relation to the cranial fracture fragment and mild lateromedial displacement are common (Nixon 2020). The literature on management of equine cranial mid-body axis fractures is scarce. One case series reports successful conservative treatment in four of five horses diagnosed with odontoid process fractures (Vos et al. 2008). The four horses that returned to athletic activity presented with a cranial mid-body fracture of the axis, referred to in the case series as a Type II odontoid fracture (Anderson and D’Alonzo 1974), whereas the fifth horse, euthanized several hours after admission, due to severe and deteriorating neurological symptoms, was diagnosed with an avulsion fracture of the odontoid process, also referred to as a Type I odontoid fracture (Anderson and D’Alonzo 1974,Vos et al.2008). All horses but one showed swelling at the level of the axis, signs of neck pain and neurological compromise upon presentation (Voset al. 2008). In the authors experience, conservative treatment of mild to moderately displaced cranial mid-body axis fractures has been unsuccessful. Out of three cases, one case was clinically sound but was retired eight months after initial presentation because of persisting severe neck stiffness, one case was euthanized three and a half months after injury because of acute neurological deterioration, and another became tetraplegic four days after fracture diagnosis and was euthanized. Following this personal experience, the authors recommended surgical treatment for an 8-year-old warmblood gelding admitted to the hospital with a cranial mid-body axis fracture. The authors report successful reduction and stabilization of the fracture using a 4.5mm locking compression T-plate.