Polyaxial pedicle screw external fixation to stabilize oblique mandibular fractures in three standing, sedated horses.
Authors: Nelson Brad B, Easley Jack, Steward Sara K T, Smanik Lauren E, Koch Drew W, Rawlinson Jennifer E, Easley Jeremiah T
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Polyaxial Pedicle Screw External Fixation for Equine Mandibular Fractures Unstable oblique mandibular fractures in horses often fail conservative management, yet surgical repair typically requires general anaesthesia with its associated risks. This case series describes a novel standing surgical technique using polyaxial pedicle screw (PPS) external fixation combined with intraoral tension band wiring in three horses—two with unilateral fractures and one with bilateral involvement. Procedures were performed under sedation and regional nerve anesthesia, with PPS inserted under radiographic guidance to avoid tooth roots and intraoral wires secured either through lateral buccotomy or by drilling through the crown. All three horses achieved complete radiographic and clinical healing with implant removal at 6–10 weeks post-operatively, and owners confirmed continued soundness 12–18 months later. Complications (broken wires, bone sequestration, and infection in individual cases) were minor and did not compromise outcomes. This technique offers equine practitioners a valuable alternative for managing unstable mandibular fractures whilst avoiding the morbidity and mortality risks associated with general anaesthesia, though the small case series warrants further investigation of long-term functional and cosmetic outcomes across larger populations.
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Practical Takeaways
- •This technique allows treatment of unstable mandibular fractures in standing sedated horses, avoiding the risks associated with general anesthesia in this species
- •While minor complications can occur during healing, they do not necessarily compromise the final outcome; all three cases achieved full healing and functional recovery
- •This approach provides a viable alternative to conservative management for oblique mandibular fractures that are unstable or have failed previous conservative treatment
Key Findings
- •Polyaxial pedicle screw external fixation combined with intraoral wiring successfully stabilized unstable mandibular fractures in 3 horses, enabling healing without general anesthesia
- •All three horses achieved complete radiographic healing and returned to function, with implants removed at 6-10 weeks post-fracture
- •Complications (broken wires, bone sequestration, infection) occurred in 3/3 horses but did not prevent successful long-term outcomes at 12-18 month follow-up