Authors of section

Author

Anton Fürst

Executive Editor

Jörg Auer

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U-shaped splint

1. Principles

Open fractures

Fractures of the interdental space and horizontal ramus are almost always open fractures. Wound debridement and flushing is extremely important. Nevertheless, infections of soft tissues as well as the bone are common. Therefore establishment of ventral drainage is important.

u shaped splint

Challenges

Aluminum splints can easily be bent into a U-shape and attached to the labial aspect of the incisors and the buccal aspect of the cheek teeth using wire sutures. However, attachment of the splint to the caudal cheek teeth is difficult, time consuming, and presents a major limitation of this technique.

u shaped splint

2. Preparation and approach

This procedure is performed with the patient placed in dorsal recumbency through the approach to the interdental space.

fixation using pmma compounds

3. Reduction and fixation

Wound debridement

In older or infected fractures, wound débridement is important. All infected bone must be removed with a curette or rongeur.
Additional flushing is indicated.

u shaped splint

Reduction

The fracture is reduced manually.

u shaped splint

Application of the U-shaped splint

The pre-bent U-shaped splint is most often made of a malleable brass or of an aluminum rod. The bar has holes at different locations to allow for insertion of the wires.
It is placed on the labial surface of the incisors and spans the interdental space and most of the length of the dental arcade bilaterally.

u shaped splint

Stab incisions are prepared through the cheek (as described of the interdental wiring technique) and a drill bit is then introduced through a protective drill guide. Holes are prepared between the cheek teeth at the gum line.

u shaped splint

Holes are also prepared between the incisors, either with a cannula or with a drill bit.

u shaped splint

To increase stability, first intraoral wire fixation is applied in addition to the U-bar. For more details please see "Wire fixation".

These wires have to be placed prior to application of the U-bar.

u shaped splint

First the wires are introduced between the incisors and the cheek teeth and followed by insertion of the bar.

u shaped splint

The bar is fixed to the incisors and cheek teeth at multiple sites by cerclage wires encircling the teeth and passing through the holes in the bar.

u shaped splint

The wires are guided through the bar and tightened by twisting.

u shaped splint
mandible horizontal ramus interdental space bilateral

Pearl: Leaving the wires between the cheek teeth very long and exiting them through the mouth helps guiding them through the holes in the bars. The two wires encircling one cheek tooth are identified and twisted together. The corresponding wires are untwisted and one by one guided through the respective holes under visual control and twisted together again. Once all are placed through the intended holes the bar is placed in its final position and the corresponding wires exited through a stab incision, followed by tightening.

u shaped splint

Closure

The stab incisions are closed routinely. In old, infected or open fractures, a drainage should be placed.

u shaped splint

The image shows the interdental wiring applied initially to achieve reduction and the U bar that was added to the incisor and premolar teeth to increase stability.

u shaped splint

4. Aftercare

During the post-surgical period, the horse is confined to stall rest for one week and fed with soft fiber feed stuff; firm feed such as hay cubes, apples or carrots should not be fed. Antibiotics and anti-inflammatory drugs are given for 3 to 5 days or longer, if required, especially in open fractures. Intraoral cerclage and tension wires are cleaned once daily until their removal. The drainage sites are cleaned and flushed daily with antiseptic solutions.
After the fracture has healed the U-bar and wires can be removed under sedation and local anesthesia.

u shaped splint