Plate fixation

The use of intraoperative imaging is highly recommended to monitor correct placement of the screws.

This procedure is performed with the patient placed in dorsal recumbency or lateral recumbency through the approach to the vertical ramus.

Dynamic compression plates (DCPs) can be used but locking compression plates (LCPs) are preferred, because they provide better stability. In areas with only one cortex and a predominance of spongy bone, locking head screws provide good stability.
Depending on the size of the horse, narrow 3.5 or 4.5 mm LCPs are used, usually as 12-22 hole plates.

The plate is contoured, with the help of a soft aluminum template, to the caudal and ventral aspect of the ramus. This part contains good bone and a good surface to accept perfectly the plate.

The fracture is evaluated and reduction achieved with pointed reduction forceps or the inserted drill sleeve.

Plate application is accomplished by standard techniques.
Screw length in the horizontal part of the mandible must be determined precisely, so they do not engage the teeth roots.

Not all screw holes have to be filled in with screws. Generally longer plates are preferred.

Note: Plating the ventral and caudal aspect of the vertical ramus can be difficult because access for drilling and screw placement is limited by the parotid area and the wing of the atlas. Severe extension of the head improves access to the caudal aspect of the vertical ramus.

The skin is closed routinely with interrupted sutures.

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.

After the fracture has healed the plate can be removed, especially in cases where persistent drainage is present.