Management of equine skull fractures using fixation with polydioxanone sutures

Abstract

Ten horses presented with severe distortion of the facial contour, crepitus on palpation and mild to moderate epistaxis. Individual horses also showed ocular damage, ptosis, severe dyspnoea and movement of the facial bones concurrent with respiration. The fracture fragments were exposed using a large curvilinear incision and elevated using a retractor, periosteal elevator, chisel or Steinmann pin. The fracture fragments were unstable following reduction and fixation was necessary. Stabilisation was achieved with polydioxanone sutures placed through holes drilled in opposing sides of the fracture lines. Polydioxanone sutures provided good stability and had better handling properties than wire. There was good apposition of fracture edges and minimal complications. Use of polydioxanone sutures can also avoid the expense and complexity of plate fixation in selected cases, and should be considered as an alternative to fixation with stainless steel wire in any facial fracture that adjoins stable bone.

Intradiploic hematoma of the frontal bone with secondary exophthalmos in a mare

“…Facial fractures in horses associated with head trauma can lead to long‐term complications if not treated appropriately include chronic sinusitis, bone sequestra, nonhealing wounds, facial deformity, secondary nasal septal thickening, or necrosis . A possible head trauma had been reported several years prior the clinical presentation in this case although there was no evidence of previous skull fracture on radiography or CT.…”

Surgical repair of a depressed, comminuted fracture of the zygomatic process of the frontal bone using a locking compression plate in a Thoroughbred colt foal

“…Several surgical stabilization techniques have been reported for this fracture configuration. Tension‐band wiring is frequently used in periorbital fractures, but is unlikely to provide adequate support for comminuted fractures. Three previous reports have demonstrated successful cosmetic outcomes of periorbital fractures following plate fixation, using a cuttable bone plate, T‐plate, and resorbable plate and tissue expanders …”

“…Conservative management of this type of fracture would have resulted in a poor cosmetic outcome and potential exposure keratopathy. [1][2][3][4][5][6][7][8][9]12 Several surgical stabilization techniques have been reported for this fracture configuration. Tension-band wiring is frequently used in periorbital fractures, 2,5,7 but is unlikely to provide adequate support for comminuted fractures.…”

“…Surgical reduction and stabilization is often recommended for such cases. [1][2][3][4][5][6][7][8][9] To the authors' knowledge, there is no report documenting the use of an LCP in such a location.…”

Equine orbital fractures: a review of 18 cases (2006–2013)

“…Surgical reconstruction is indicated when orbital bones impinge on the globe, optic nerve, supraorbital nerve, or nasolacrimal duct, and to improve cosmesis . Surgical options include closed reduction, open exploration and reduction, and the use of internal fixation implants (bone plates, stainless steel wire, or polydioxanone suture) . Open exploration and reduction are most appropriate in cases where fractures are severely comminuted, open, or more than 60 h old .…”