A 15 year old Warmblood mare presented with a history of flipping over backwards at a show earlier that day. She had been evaluated by the referring DVM who found multiple lacerations and weakness in the pelvic limbs. She was treated with banamine and corticosteroids. Upon presentation to the large animal emergency service, she was tachycardic, tachypneic, dehydrated, and had several lacerations including one major wound over the poll. A neurological exam revealed no abnormalities other than dull mentation. Skull radiographs were obtained and two large fragments of the occipital bone were noted to be displaced caudally from the nuchal crest. She was treated with antibiotics, NSAIDS, mannitol, neuroprotectants, and fluid therapy. The following day a CT exam of that area was performed to rule out fractures of the cranial cavity. This proving negative, the horse was anesthetized, the wound was explored and the two large bone fragments were removed from the poll region. Post surgically, the incision became infected with Enterobacter cloacae, one of the most common nosocomial organisms in the large animal hospital. She continued to recover slowly until discharge one month later.