Authors of section

Author

Anton Fürst

Executive Editor

Jörg Auer

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Plate fixation

1. Principles

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

dorsal recumbency

2. Preparation and approach

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

approach to vertical ramus

3. Plate selection and preparation

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.

plate fixation

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.

plate fixation

4. Surgical technique

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

plate fixation

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.

mandible vertical ramus

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.

plate fixation

Closure

The skin is closed routinely with interrupted sutures.

plate fixation

5. 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.

Postoperative images at 2 months

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.

plate fixation