Plates, Screws, and Locking Mechanics

What are the most important steps to take after the primary survey to avoid missed injuries and set facial fractures up for a safer repair? In this episode of Everyday Oral Surgery, Dr. Andrew Jenzer returns to break down practical trauma fundamentals for oral and maxillofacial surgeons. He explores the steps for secondary surveys, core fracture repair principles, evaluating facial trauma, and making surgical decisions under pressure. He explains haemorrhagic shock staging, the Glasgow Coma Scale, cervical spine considerations, and a systematic approach for assessing trauma. He discusses the distinction between rigid and semi-rigid fixation, load-bearing versus load-sharing constructs, and how locking screws can help reduce complications. He unpacks the red flags to look out for, like orbital compartment syndrome, muscle entrapment with the oculocardiac reflex, and CSF leaks. Dr. Jenzer also shares planning guidance to help prevent missed injuries and unpacks why thin-slice CT scan reformats are vital. Tune in now!

Key Points From This Episode:

• The four classes of hemorrhagic shock and the vital signs associated with each stage.
• Learn about the Glasgow Coma Scale and why a low score is a cause for concern.
• Understand penetrating neck trauma zones and why the zone determines the approach.
• Discover the difference between rigid fixation and semi-rigid fixation for fractures.
• Unpack the ‘ideal lines of osteosynthesis’ concept and the biomechanical advantage it offers.
• Find out how load-bearing fixation differs from load-sharing fixation for plates and screws.
• Locking screws versus non-locking screws, and when is the best time to use each. 
• Hear about the Advanced Trauma Life Support (ATLS) process and why it is important. 
• How to confirm cervical spine safety using NEXUS criteria before proceeding.
• Dr. Jenzer shares his top-down, systematic approach to assessing trauma.
• Examples of when existing injuries have been overlooked and why.
• Ways to spot orbital compartment syndrome and why vision loss can be a bad sign.
• What muscle entrapment and the oculocardiac reflex indicate, and how to navigate it.
• Why thin-slice CT scans should be requested over standard thicker cuts. 
• Explore why early airway and feeding strategies are vital to consider early on. 

Links Mentioned in Today’s Episode:

Dr. Andrew Jenzer — https://surgery.duke.edu/profile/andrew-clark-jenzer
Dr. Andrew Jenzer Email Address — andrew.jenzer@gmail.com 

ACOMS — https://www.acoms.org/

Everyday Oral Surgery Website — https://www.everydayoralsurgery.com/ 

Everyday Oral Surgery on Instagram — https://www.instagram.com/everydayoralsurgery/ 

Everyday Oral Surgery on Facebook — https://www.facebook.com/EverydayOralSurgery/

Dr. Grant Stucki Email — grantstucki@gmail.com

Dr. Grant Stucki Phone — 720-441-6059