Gunning splints anyone?

[tx oms]

Advertisement - Members don't see this ad

We've got a guy in the house right now with a edentulous mandible and bilateral body fractures. He's got a few snags up top. The problem is he's waiting for the VA to give him a CABG. Cardiology says he's high risk (duh). How would you treat him?

We're trying to bus him out to the Houston VA for his CABG ASAP, hopefully to be followed by an ORIF from our friends in the Houston program. The issue is what to do if the transfer doesn't work out. Anesthesia won't sleep the guy.

 

[omfsres]

We've got a guy in the house right now with a edentulous mandible and bilateral body fractures. He's got a few snags up top. The problem is he's waiting for the VA to give him a CABG. Cardiology says he's high risk (duh). How would you treat him?

We're trying to bus him out to the Houston VA for his CABG ASAP, hopefully to be followed by an ORIF from our friends in the Houston program. The issue is what to do if the transfer doesn't work out. Anesthesia won't sleep the guy.

Ex fix under local or MAC.

If I ever hear the G word come from your mouth again, I will throw my girly coffee all over your face.

 

[scalpel2008]

We've got a guy in the house right now with a edentulous mandible and bilateral body fractures. He's got a few snags up top. The problem is he's waiting for the VA to give him a CABG. Cardiology says he's high risk (duh). How would you treat him?

We're trying to bus him out to the Houston VA for his CABG ASAP, hopefully to be followed by an ORIF from our friends in the Houston program. The issue is what to do if the transfer doesn't work out. Anesthesia won't sleep the guy.

I think the ex fix is a decent option, provided this isn't an atrophic mandible. Consideration should also be given to no treatment at all at this time with a non chew diet as long as the bucket handle fracture is not an airway issue. He will probably end up with a fibrous union that can be secondarily treated once his CV status is optimized. Since he is a candidate for a CABG (as opposed to a PTCA or other less invasive revascularization techniques) we know his CAD/IHD is bad bad bad. I would not want him to crump in my chair, and the odds of him crumping either from the stress of an ex fix under local or hypotension/hypopnea of a MAC are far greater than your average patient....all for an edentulous mandible.

Call Houston OMS and formulate a plan since it sounds like they might be the ones dealing with him. I think a gunning splint would be difficult because 1) its efficacy is very dependent on fracture location i.e. if the fracture is proximal to the splint or if the fracture is near the circummandibular wire it isn't going to work.

 

[omfsres]

I think the ex fix is a decent option, provided this isn't an atrophic mandible. Consideration should also be given to no treatment at all at this time with a non chew diet as long as the bucket handle fracture is not an airway issue. He will probably end up with a fibrous union that can be secondarily treated once his CV status is optimized. Since he is a candidate for a CABG (as opposed to a PTCA or other less invasive revascularization techniques) we know his CAD/IHD is bad bad bad. I would not want him to crump in my chair, and the odds of him crumping either from the stress of an ex fix under local or hypotension/hypopnea of a MAC are far greater than your average patient....all for an edentulous mandible.

Call Houston OMS and formulate a plan since it sounds like they might be the ones dealing with him. I don't think a gunning splint would be difficult because 1) its efficacy is very dependent on fracture location i.e. if the fracture is proximal to the splint or if the fracture is near the circummandibular wire it isn't going to work.

I agree waiting might be prudent but from what I understand of this patients fracture, it is fairly displaced and would not likely heal with a fibrous union without some sort of manipulation and stabilization. In terms of gunning splints verses an ex fix, a GS application in my opinion would probably be as equally taxing on this patient as an ex fix. If you have ever placed circum max or mand wires you know that this is not like knitting a sweater. It takes some force. you also have to take impressions and remove the remaing teeth. I guess you could always secure the splints with screws instead of wires, but you still left with making the splints. So my vote is still for the ex fix with beta blockade, done in the OR for monitoring/intervention purposes(if it has to be done).

 

[tx oms]

I agree waiting might be prudent but from what I understand of this patients fracture, it is fairly displaced and would not likely heal with a fibrous union without some sort of manipulation and stabilization.

Are you saying that cortical bone touching cortical bone won't heal? Weren't you at the same orthognathic meeting as me?

 

[omfsres]

Are you saying that cortical bone touching cortical bone won't heal? Weren't you at the same orthognathic meeting as me?

I'm saying that a displaced fracture with significant continuity defect(from the displacement) couple with a signif amount of mobility wont likely heal with a bony or a fibrous union. Whenever we treat a non union with a bony defect greater than 5 mm after debridement, those will usually require an immediate or secondary bone graft to restore continuity. At least that is what your mom told me in the shower this morning.

 

[tx oms]

I'm saying that a displaced fracture with significant continuity defect(from the displacement) couple with a signif amount of mobility wont likely heal with a bony or a fibrous union. Whenever we treat a non union with a bony defect greater than 5 mm after debridement, those will usually require an immediate or secondary bone graft to restore continuity. At least that is what your mom told me in the shower this morning.

Comb your beard, bitch!