Wounds to the head accompanied by broken bone are relatively common in horses because of the speed and force with which horses collide with objects. A fractured skull usually does not mean brain injury. A horse's brain case is relatively small and inaccessible compared to the skull as a whole. Even severe head wounds usually do not involve the brain.

Injuries involving the large, air-filled, bone encased sinuses are common though. Head wounds accompanied by fracture can result in infection of the sinuses or bone of the skull (osteomyelitis). Bone or sinus infection can take weeks to become evident and can cause chronic wound drainage, swelling of the head, or chronic nasal discharge. For this reason, proper short term management is important.

Horses with brain damage may not be able to rise or even roll onto their chest. Others with less extensive injury may be depressed or be unstable on their feet or show other signs. But most horses with even severe head wounds and obvious fracture act surprisingly normal considering the apparent severity of their injuries.