Authors of section


Anton Fürst

Executive Editor

Jörg Auer

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Flap fix

1. Principles

Open fractures of the parietal or interparietal bone may lead to meningitis. Therefore antibiotic treatment for at least 5 days is recommended.

2. Preparation and approach

This procedure is performed with the patient placed in lateral recumbency through the approach to the parietal bone.

approach to the parietal bone

3. Reduction

The fracture is reduced with a specially designed reduction instrument. It consists of a horizontal cross handle, connected to a tap-like rod that is twisted into the bone fragment and is manufactured in two sizes (2.4 mm and 3.5 mm),
Depending on the size of the fragment a 1.8 or 2.4 mm drill hole is initially prepared and the instrument inserted into the bone fragment with the help of its self-tapping tip. The fragments are brought back into normal position by pulling on the handle.

flap fix

4. Fixation

Implant selection

The titanium implants are available textured or smooth in four different sizes: 11, 13, 18 and 22 mm. The clover-leaf design allows the implant to adapt to the shape of the bone.

flap fix

Application of the flapfix

The top disk is slid towards the upper end of the tube until it locks in place.

flap fix

The bottom disk is placed through the fracture gab and placed under the intact and fractured bone. Following anatomic reduction of the fragment the top disc is slid distally until it it comes to lie on top of the fragment and adjacent intact bone.

flap fix

The application forceps is subsequently slid over the vertical bar. Tightening of the main handle applies tension to the vertical bar and in doing so squeezes the fragment and adjacent intact bone between the two rosettes. By tightening the most distal handle, the vertical bar is cut on top of the proximal clover-leaf rosette.

flap fix

Usually, 2-3 rosettes are sufficient for stable fixation.

cerebral skull parietal bone

Fixation with flap fixes in a multifragment fracture of the parietal bone.

flap fix

5. Closure

The incision is closed routinely.

flap fix

6. Aftercare

A head bandage and padded head protection are applied to the patient during recovery from anesthesia.

The horse is maintained in stall rest for about two weeks followed by small paddock exercises for another two weeks.

Depending on the extent of the neurological injury and healing progress, medical treatment is continued.

In most cases implants do not need to be removed provided that wound healing is normal and no persistent draining tracts develop.