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34th Annual Scientific Meeting proceedings
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Session:
Date/Time: 30-11--0001 (00:00 - 00:00)
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Sequestration of the fracture margin as a complication following surgical fixation of mandibular fractures in 3 horses – description of the clinical, radiographical, computed tomographical and histological appearance.
Aßmann AD1, Donati B2, Geyer H3, Theiss F*1, Bischofberger A*2
1Equine Hospital, Zürich, Switzerland, 2Clinic for Diagnostic Imaging, Zürich, Switzerland, 3Institute of Veterinary Anatomy, Zürich, Switzerland.
Objectives:
This case-series aimed at describing the characteristic radiographical-, CT- and histological appearance of fracture margin sequestration as a complication of unilateral open mandibular fractures in horses including their treatment and outcome.
Methods:
Three horses with mandibular fractures (two chronic, one acute) were referred for fixation. Clinical signs, radiographical, CT appearance of fractures and complicating fracture margin sequestra were documented and histology performed where possible. The chronic fractures were treated with an external skeletal fixator type I (Horse 1) and an internally applied LCP (Horse 3). Horse 2 (acute fracture) was treated with an LCP applied as external fixator type I. All cases received Intraoral cerclage wiring.
Results:
All horses developed fracture margin sequestration visible radiographically and on CT, representing three parallel zigzagging radiolucent/hypoattenuating lines. Horses 1 and 2 were euthanized. Histology showed sequestra of the fracture margins, osteoclasts and inflammatory cells. In horse 3 the fracture healed and the implants were removed. Drainage persisted for 2.5 years post-operatively due to the non-accessible fracture margin sequestra.
Conclusions:
Fracture margin sequestration associated with mandibular fractures is a challenging complication with characteristic imaging findings consistent of a central fracture line, paralleled by two elongated sequestra and additional parallel demineralized lines separating the sequestra from the parent bone. This can be recognized radiographically and in CT. Possible etiology of fracture margin sequestration included motion in the region of the fracture, infection and disruption of the mandibular blood supply, but remains speculation. Management is difficult especially removal of the sequestra dorsally in the fracture.
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