After wound déebridement has been achieved and the trauma assessed, the fracture is reduced. The outer parts of the orbit (frontal, temporal and zygomatic bones) are typically displaced inwardly. They must be reduced to their normal position cautiously using one of several methods. Periosteal elevators or Langenbeck retractors are often necessary for complete fracture reduction.
In addition, a specially designed reduction instrument, manufactured in two sizes (2.4 mm and 3.5 mm), has recently become available. It consists of a horizontal cross handle, connected to a tap-like rod that is twisted into the bone fragment.
Of all the various instruments that are available, these are best suited for the use in horses. Depending on the size of the fragment a 1.8 or 2.4 mm drill hole is prepared and the instrument inserted into the bone fragment.
Occasionally it is necessary to trim the bone fragments to facilitate correct anatomic repositioning and fracture reduction.
Holes are drilled into the fragment and the intact parent bone close to the fragment with a 2 mm drill bit.
A cerclage wire of 0.8-1 mm diameter is pre-placed and twisted to tighten.
Note: Remember to protect the globe with a periosteal elevator while drilling the holes and placing the wires.
The skin incision is closed routinely.
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 healing progress, nonsteroidal anti-inflammatory drugs and antibiotics are given for 3 to 5 days, or longer if required.
In most cases implants do not need to be removed provided that wound healing is normal and no persistent draining tracts develop.