CC BY 4.0 · VCOT Open 2020; 03(02): e90-e95
DOI: 10.1055/s-0040-1716351
Case Report

Internal Fixation of a Complicated Mandibular Fracture in a Filly Using a String-of-Pearls Locking Plate Assisted by a 3D Printed Model

1   Department of Clinical Sciences, Auburn University–College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital, Auburn, Alabama, United States
,
Kara Lascola
1   Department of Clinical Sciences, Auburn University–College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital, Auburn, Alabama, United States
,
Mariano Mora-Pereira
1   Department of Clinical Sciences, Auburn University–College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital, Auburn, Alabama, United States
,
Serena Ceriotti
1   Department of Clinical Sciences, Auburn University–College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital, Auburn, Alabama, United States
,
Lindsey Boone
1   Department of Clinical Sciences, Auburn University–College of Veterinary Medicine, JT Vaughan Large Animal Teaching Hospital, Auburn, Alabama, United States
› Institutsangaben

Abstract

Objective The aim of this study was to describe the successful surgical treatment of a complicated mandibular fracture with a 3.5 mm string-of-pearls (SOP) locking plate in a 5-month-old Appaloosa filly presenting with neurological signs.

Study Design This is a case report.

Results The neurological signs were due to severe head trauma and stabilized with medical treatment. Financial concerns initially prevented advanced imaging; radiographs identified a mandibular symphysis fracture, a fracture of the left vertical ramus that originated at the junction between the horizontal and vertical ramus and extended toward the coronoid process and rostral maxillary fractures. Following intra-dental wiring of the symphysis fracture, a lateral malocclusion developed. Computed tomography additionally identified fractures of the right wing of the basisphenoid bone, right zygomatic arch, left paracondylar process and the lateral body of the mandible. The vertical ramus fracture was repaired utilizing a 20-hole 3.5 mm SOP plate contoured to the ventral aspect of the angle of the mandible. A scaled (1:4) three-dimensional printed model aided pre- and intra-operative surgical planning. The filly was comfortable and eating well at the 4-week recheck. Radiographs showed good callus formation at the maxilla, healing of the mandibular symphysis and ramus. Just prior to the 10-week recheck, the filly suffered severe enterocolitis and was euthanatized.

Conclusion The locking function of the SOP plate provided adequate stability for the fracture to heal without the expense of locking screws. The three-dimensional printed model aided in navigation of the complex fracture without the availability of fluoroscopy.

Authors' Contributions

S. Boorman and L. Boone were responsible for study conception. All authors were responsible for study design, acquisition of data, data analysis and interpretation, revising of the manuscript and are publicly accountable for relevant content. All authors gave final approval of the submitted manuscript.




Publikationsverlauf

Eingereicht: 01. März 2020

Angenommen: 25. Juli 2020

Artikel online veröffentlicht:
30. August 2020

© 2020. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).

Georg Thieme Verlag KG
Stuttgart · New York

 
  • References

  • 1 Fürst AE, Auer JA. Craniomaxillofacial disorders. In: Auer JA, Stick JA. , ed. Equine Surgery. Fifth edition.. Philadelphia: W.B. Saunders Co.; 2018: 1794-1829
  • 2 Kuemmerle JM, Kummer M, Auer JA, Nitzl D, Fürst AE. Locking compression plate osteosynthesis of complicated mandibular fractures in six horses. Vet Comp Orthop Traumatol 2009; 22 (01) 54-58
  • 3 Peavey CL, Edwards III RB, Escarcega AJ, Vanderby Jr R, Markel MD. Fixation technique influences the monotonic properties of equine mandibular fracture constructs. Vet Surg 2003; 32 (04) 350-358
  • 4 Gardner MJ, Brophy RH, Campbell D. , et al. The mechanical behavior of locking compression plates compared with dynamic compression plates in a cadaver radius model. J Orthop Trauma 2005; 19 (09) 597-603
  • 5 Levine DG, Richardson DW. Clinical use of the locking compression plate (LCP) in horses: a retrospective study of 31 cases (2004-2006). Equine Vet J 2007; 39 (05) 401-406
  • 6 Richardson DW. Application of the locking compression plate (LCP). In: Nixon AJ. , ed. Equine Fracture Repair. Second edition.. Hoboken: John Wiley and Sons Inc.; 2019: 156-162
  • 7 Gallagher B, Silva MJ, Ricci WM. Effect of off-axis screw insertion, insertion torque, and plate contouring on locked screw strength. J Orthop Trauma 2014; 28 (07) 427-432
  • 8 Boulton CL, Kim H, Shah SB. , et al. Do locking screws work in plates bent at holes?. J Orthop Trauma 2014; 28 (04) 189-194
  • 9 Ness MG. The effect of bending and twisting on the stiffness and strength of the 3.5 SOP implant. Vet Comp Orthop Traumatol 2009; 22 (02) 132-136
  • 10 DePuy Synthes. Small fragment locking compression plate (LCP) system surgical technique guide. West Chester, PA; 2013
  • 11 Lin ASP, Fechter CM, Magill M, Wipf F, Moore T, Guldberg RE. The effect of contouring on fatigue resistance of three types of fracture fixation plates. J Orthop Surg Res 2016; 11 (01) 107
  • 12 Orthomed: SOP™ interlocking plate system. Standard Operating Procedure. West Yorkshire, UK; 2015
  • 13 Rutherford S, Demianiuk RM, Benamou J, Beckett C, Ness MG, Déjardin LM. Effect of intramedullary rod diameter on a string of pearls plate-rod construct in mediolateral bending: an in vitro mechanical study. Vet Surg 2015; 44 (06) 737-743
  • 14 Ogden NKE, Jukic CC, Zedler ST. Management of an extensive equine juvenile ossifying fibroma by rostral mandibulectomy and reconstruction of the mandibular symphysis using string of pearls plates with cortical and cancellous bone autografts. Vet Surg 2019; 48 (01) 105-111
  • 15 Donati B, Fürst AE, Hässig M, Jackson MA. Epidemiology of fractures: the role of kick injuries in equine fractures. Equine Vet J 2018; 50 (05) 580-586
  • 16 Jansson N. Conservative management of unilateral fractures of the mandibular rami in horses. Vet Surg 2016; 45 (08) 1063-1065
  • 17 Gonçalves R, Malalana F, McConnell JF, Maddox T. Anatomical study of cranial nerve emergence and skull foramina in the horse using magnetic resonance imaging and computed tomography. Vet Radiol Ultrasound 2015; 56 (04) 391-397
  • 18 Tanner J, Spriet M, Espinosa-Mur P, Estell KE, Aleman M. The prevalence of temporal bone fractures is high in horses with severe temporohyoid osteoarthropathy. Vet Radiol Ultrasound 2019; 60 (02) 159-166
  • 19 Walker AM, Sellon DC, Cornelisse CJ. , et al. Temporohyoid osteoarthropathy in 33 horses (1993-2000). J Vet Intern Med 2002; 16 (06) 697-703
  • 20 Boorman S, Scherrer NM, Stefanovski D, Johnson AL. Facial nerve paralysis in 64 equids: clinical variables, diagnosis, and outcome. J Vet Intern Med 2020; 34 (03) 1308-1320
  • 21 Feary DJ, Magdesian KG, Aleman MA, Rhodes DM. Traumatic brain injury in horses: 34 cases (1994-2004). J Am Vet Med Assoc 2007; 231 (02) 259-266
  • 22 Rizk A, Hamed M. The use of cerclage wire for surgical repair of unilateral rostral mandibular fracture in horses. Majallah-i Tahqiqat-i Dampizishki-i Iran 2018; 19 (02) 123-127
  • 23 Devine DV, Moll HD, Bahr RJ. Fracture, luxation, and chronic septic arthritis of the temporomandibular joint in a juvenile horse. J Vet Dent 2005; 22 (02) 96-99
  • 24 Bar-Am Y, Pollard RE, Kass PH, Verstraete FJM. The diagnostic yield of conventional radiographs and computed tomography in dogs and cats with maxillofacial trauma. Vet Surg 2008; 37 (03) 294-299
  • 25 Chae MP, Rozen WM, McMenamin PG, Findlay MW, Spychal RT, Hunter-Smith DJ. Emerging applications of bedside 3D printing in plastic surgery. Front Surg 2015; 2: 25
  • 26 Winer JN, Verstraete FJM, Cissell DD, Lucero S, Athanasiou KA, Arzi B. The application of 3-dimensional printing for preoperative planning in oral and maxillofacial surgery in dogs and cats. Vet Surg 2017; 46 (07) 942-951
  • 27 Belsito KA, Fischer AT. External skeletal fixation in the management of equine mandibular fractures: 16 cases (1988-1998). Equine Vet J 2001; 33 (02) 176-183
  • 28 Kääb MJ, Frenk A, Schmeling A, Schaser K, Schütz M, Haas NP. Locked internal fixator: sensitivity of screw/plate stability to the correct insertion angle of the screw. J Orthop Trauma 2004; 18 (08) 483-487