Advances in screw and plate technology are leading to improved clinical and aesthetic results in the treatment of even the most complicated jaw fractures, according to Swiss researchers.

By using the new locking compression plate (LCP) system, surgeons are able to provide a more stable repair system that aids complete healing with fewer and less severe complications compared to previous plate systems. According to Jan Kuemmerle, DVM, certified specialist of equine medicine and surgery at the University of Zurich, the difference is in the way the screws are attached to the plate and the bone. “Other plate systems rely on the principle that the screw compresses the plate onto the bone,” he said. “But the LCP screws are anchored firmly into the plate, and so the entire plate-screw construct is in itself stable.”

Top, the foal’s fractured jaw. Below, the same horse with the jaw repaired.

Guided by fluoroscopic X ray imaging of the fractured bone during surgery, surgeons are able to place LCP screws that are short enough to prevent damage to tooth roots, while ensuring mechanical stability.

“With LCP combined with fluoroscopic control, we are now getting optimal fixation with minimum collateral damage,” Kuemmerle said.

Horses treated with LCP were “comfortably eating” hay and mash within six hours following surgery due to the stability of the system, he said. This prevented any need to wire the jaw shut or provide nutrition through a nasogastric tube or IV infusion. Post-surgical complications were minimal and were primarily implant-related infections in open fracture cases. These were easily treated with antibiotics and drainage. There were no cases of reduced blood supply to bone fragments leading to sequestration, which is known to occur with conventional plate systems.

“The down side of the LCP is that it costs two to three times more than a conventional system,” Kuemmerle said. “But considering the improved healing and the reduced cost for postoperative care due to complications, it is an investment that is worthwhile for the owner.”

The same horse several years after surgery.

All the horses and ponies in the study had achieved stable healing within three months of surgery with excellent cosmetic results, according to the scientists’ article, which appeared in a recent issue of Veterinary and Comparative Orthopaedics and Traumatology