Holding Power of Different Pin Designs and Pin Insertion Methods in Avian Cortical Bone

Objective —To measure pullout strength of four pin types in avian humeri and tibiotarsi bones and to compare slow-speed power and hand insertion methods.
Study Design —Axial pin extraction was measured in vitro in avian bones.
Animal Population —Four cadaver red-tailed hawks and 12 live red-tailed hawks.
Methods —The pullout strength of four fixator pin designs was measured: smooth, negative profile threaded pins engaging one or two cortices and positive profile threaded pins. Part 1: Pins were placed in humeri and tibiotarsi after soft tissue removal. Part 2: Pins were placed in tibiotarsi in anesthetized hawks using slow-speed power or hand insertion.
Results —All threaded pins, regardless of pin design, had greater pullout strength than smooth pins in all parts of the study ( P < .0001). The cortices of tibiotarsi were thicker than the cortices of humeri ( P < .0001). There were few differences in pin pullout strengths between threaded pin types within or between bone groups. There were no differences between the pullout strength of pins placed by slow-speed power or by hand.
Conclusions —There is little advantage of one threaded pin type over another in avian humeri and tibiotarsi using currently available pin designs. There were few differences in pin pullout strengths between humeri and tibiotarsi bones. It is possible that the ease of hand insertion in thin cortices minimizes the potential for wobbling and therefore minimizes the difference between slow-speed drill and hand insertion methods.
Clinical Relevance —Threaded pins have superior bone holding strength in avian cortices and may be beneficial for use with external fixation devices in birds.     

Ellis Pin Complications in Seven Dogs

Complications developed with the clinical use of Ellis pins in external skeletal fixation in seven dogs weighing 11 to 24 kg. Pins broke at the threaded-nonthreaded shaft junction in six dogs, and there was radiographic evidence of pin loosening six dogs. One pin pulled out causing loss of fixation in one dog. These complications with the recently introduced Ellis pin emphasize a need for further evaluation of its proper use.     

Effect of Fixation Pin Insertion on the Bone-Pin Interface

Smooth and partially threaded 3.12 mm (1/8 inch) trochar-tipped Steinmann pins were inserted transversely through both diaphyseal cortices of eight mature canine tibias using five methods. Angular velocity (revolutions per minute) during insertion and temperature elevation due to friction during penetration of the second cortex were recorded. The force required for extraction of the pins from the bone and the histologic appearance of the bone-pin interface were determined for one-half of the pins 2 days after insertion and for one-half of the pins 56 days after insertion. The increase in temperature was similar for all methods of insertion except high speed power, which was significantly greater (p < 0.05). The force required for axial pin extraction was similar for pins inserted by hand chuck, predrilled, and low speed power methods after both 2 and 56 days. Pins inserted by high speed power and hand drill required force similar to the others for extraction after 2 days but significantly less force (p < 0.05) for extraction after 56 days. The partially threaded pins required significantly greater force (p < 0.01) extraction after both 2 and 56 days. Histologic examination revealed increased mechanical bone damage surrounding hand chuck inserted pins, increased bone necrosis surrounding high speed power inserted pins, and increased inflammatory changes surrounding hand drill inserted pins.     

Comparison of the Strength and Holding Power of 4 Pin Designs for Use with Half Pin (Type I) External Skeletal Fixation

The strength and holding power of four pin designs for use with half pin (type I) external skeletal fixation were evaluated. Pins that were tested were fully threaded, nonthreaded, two cortices partially threaded, and one cortex partially threaded. The study involved three parts: (1) resistance of the pins to axial extraction immediately after insertion; (2) resistance of the pins to axial extraction 8 weeks after being inserted into the tibiae of live dogs; and (3) resistance of the pins to bending load. Pins with threads engaging two cortices were more resistant to axial extraction than nonthreaded pins in both the acute (p less than 0.0001) and chronic (p less than 0.0001) studies. Nonthreaded pins were more resistant to bending than fully threaded and two cortices partially threaded pins (p less than 0.0005). One cortex partially threaded pins possessed similar bending strength to nonthreaded pins (p = 0.21) and had 5.3 times more resistance to axial extraction in the acute study (p less than 0.0001) and 6.9 times more in the chronic study (p less than 0.0001). Though one cortex partially threaded pins were not as resistant to axial extraction as pins with threads engaging two cortices (p less than 0.0001), they were more resistant to bending loads (p less than 0.0005). Loss of holding power and pin failure are two of the most serious problems associated with fracture stabilization using external skeletal fixation. The results of this study suggest that one cortex partially threaded pins are better at maintaining holding power and resisting bending and breaking than nonthreaded pins.(ABSTRACT TRUNCATED AT 250 WORDS)     

Reduction in Plate Strain by Addition of an Intramedullary Pin

Objective —The purpose of this study was to determine the strain sparing effect of a bone plate and rod system compared with a bone plate alone.
Study Design —Mathematical analysis and in vitro modeling of implant-bone constructs. Implants were instrumented with uniaxial strain gauges.
Animals or Sample Preparation —Five pairs of canine femurs.
Methods —Bone plates were instrumented with two 350-ohm strain gauges. The bone plates were used to bridge a simulated fracture gap in five pairs of canine femurs. In one femur of each pair, a bone plate alone was used to bridge the gap; in the opposite femur, a bone plate and intramedullary rod combination was used. Each specimen was mounted on a custom jig and loaded in an axial servohydraulic testing machine. A constantly increasing compressive load was applied at the rate of 0.7 cm/sec. Strains at 400.5 N were recorded and analyzed using Wilcoxon's signed rank test. Mathematical modeling was done using parallel beam theory.
Results —Stress reduction in the plate and rod system was twofold compared with the plate alone ( P = .059). As important, based on stress reduction in the plate, the fatigue life of the plate/rod system increased 10-fold over the plate system alone and was greater than 10-fold at higher absolute stress values. Mathematical analysis of the plate/rod system was similar to that seen with the in vitro analysis.
Conclusions —The combination of a bone plate and intramedullary pin was superior in reducing plate stress when compared with the plate alone and functioned as two beams acting in concert.
Clinical Relevance —Stabilization of comminuted fractures by bridging the zone of fragmentation with a bone plate without anatomic reduction of each fragment is a useful method of managing this type of injury. Addition of an intramedullary pin reduces the stress applied to the plate and thereby extends the fatigue life of the bone plate.     

Determination of Safe Depth of Pin Penetration for Repair of Distal Femoral Physeal Fractures in Immature Dogs: A Comparison of Normograde and Retrograde Pin Placement

Objective —The purpose of this study was to determine the depth that implants may be safely placed into the distal femoral epiphysis (DFE) for the repair of distal femoral physeal fractures.
Study Design —The depth of the DFE was related to the radiographic thickness of the patella in this experimental study.
Animals or Sample Population —Twenty immature canine cadavers.
Methods —Patella thicknesses were measured from lateral radiographs. Actual DFE depths were determined for pins driven in normograde fashion and for pins driven retrograde from the central depression between the metaphyseal pegs and from the cranial pegs. The association of DFE depth and patella thickness was evaluated using linear regression analysis. Using 95% confidence intervals, rules for estimating the safe depth of implant placement into the DFE were determined.
Results —DFE depth had significant correlation with patella thickness for pins placed in retrograde fashion from the central depression between the metaphyseal pegs (r²= .83) and from the cranial pegs (r²= .82) and for pins placed in normograde fashion (r²= .65).
Conclusions —Based on 95% confidence intervals, pins placed in retrograde fashion from the central depression between the metaphyseal pegs may be safely driven into the DFE a distance equal to 140% of patella thickness. Pins placed from the cranial metaphyseal pegs may be driven to a depth equal to 80% of patella thickness, and pins placed in normograde fashion may be driven to a depth equal to 30% of patella thickness.
Clinical Relevance —Measurement of patella thickness assists the surgeon in determining the approximate depth that pins may be driven into the DFE without penetrating the articular surface of the stifle joint.     

Healing of Mandibular Body Osteotomies after Plate and Intramedullary Pin Fixation

Osteotomies were created in the left body of the mandible of nine dogs and immediately stabilized with either a six hole dynamic compression bone plate or an intramedullary pin. Cortical bone healing and vascular supply were evaluated at weeks 2, 5, and 10 by microradiography, microangiography, and correlated histology of selected mandibular slices. Perforating arterioles from the buccal mucosa maintained vascular supply to rostral mandibular segments. The mandibular body rostral to the osteotomy site and caudal to the canine tooth suffered an interruption of vascular supply that was replaced by a temporary extraosseous supply during healing of the osteotomy. Intramedullary pin placement resulted in destruction of rostral teeth. There was an inflammatory response around the rostral portion of all intramedullary pins. Osteotomy sites involving tooth roots resulted in no disruption of the normal vascular or neural structures of the tooth pulp.     

Biomechanical Evaluation of a Toggle Pin Technique for Management of Coxofemoral Luxation

Toggle pin stabilization is an accepted technique for the management of coxofemoral (CF) luxation in dogs. The purpose of this study was to determine, in vitro, the respective contributions of several aspects of toggle pin repair to the overall stability of fixation. Factors evaluated were the manner and frequency with which toggle pins oriented on insertion, effect of orientation on toggle pin strength, effect of suture type on ligament prosthesis strength and load sustained by the fixation, and comparison of repair using a modified toggle design to that of capsulorrhaphy. When placed in cadavers using standard technique, conventional toggle pins were found to orient significantly more frequently in one of two possible positions. Mechanical testing of fixations performed in experimentally luxated cadaver hips demonstrated a high (12/20) incidence of toggle pin failure using the conventional implant in the most common orientation. When tested alone, toggle pins were weakest mechanically in this orientation. Rotating the implant 180° increased mean load to failure by 249%. There was no significant difference in load sustained by conventional toggle fixations using No. 2 braided polyester versus 50 lb test monofilament nylon as the suture ligament prosthesis. However, the higher stiffness of the polyester suture may be more favorable for use in this application. Fixation using a toggle rod designed to allow evaluation of construct stability when failure of the toggle is eliminated resulted in an increase in maximum load sustained before luxation (47% of the intact control hips). This load was not significantly different than the resistance to luxation afforded by capsulorrhaphy. This study suggests that when implanting conventional toggle pins, consideration should be given to ensuring placement in the strongest orientation.     

Ex Vivo Biomechanical Comparison of Pin Fixation Techniques for Canine Distal Femoral Physeal Fractures

Objective— To compare the biomechanical properties of five intramedullary (IM) pin fixation techniques for Salter-Harris type I fractures of the distal femur in dogs.
Study Design— Randomized, one-way factorial design composed of five treatment groups: (1) single IM pin, (2) dynamic IM crossed pins, (3) paired convergent pins, (4) crossed pins, and (5) crossed polyglycolic acid (PGA) rods.
Sample Population— Forty pairs of cadaver canine femurs.
Materials— One femur of each pair was manually fractured and subsequently repaired; the contralateral intact femur served as its control. Each femur was loaded in torsion until failure occurred and load-deformation curves were generated.
Results— The crossed-pin technique sustained the greatest load to failure (116.8%) followed by the paired convergent pins (104.8%), dynamic IM pins (90.6%), single IM pin (72.1%), and crossed PGA rods (71.9%). Statistically significant differences in strength at failure were detected between the crossed-pin and single IM pin and the crossed-pin and crossed PGA rod techniques. All fixation techniques underwent greater deformation (1.5 times as much) and had a lower stiffness (66% to 75%) compared with the intact controls; however, there was no significant difference between techniques. Failure in the paired convergent and crossed-pin techniques occurred by fracture of the bone; failure in the other techniques occurred by distraction at the fracture site.
Conclusion— The rotational stability of any of the fixation techniques appears to be primarily determined by the ability to prevent distraction and maintain interdigitation of the physis.
Clinical Relevance— When choosing a particular fixation technique for repair of a distal femoral physeal fracture, consideration should be given to the technique's relative biomechanical merits.     

A Novel Pin Distraction Device for Arthroscopic Assessment of the Medial Meniscus in Dogs

Objective— To describe an extra-articular joint distractor for meniscal examination and treatment during canine stifle arthroscopy.
Study Design— Case series.
Animals— Dogs ≥20 kg with suspected cranial cruciate ligament (CrCL) deficiency.
Methods— A custom designed linear side bar was constructed to allow invasive pin distraction of the stifle joint. Its design efficacy for distraction of the medial joint compartment, observation and probing of the medial meniscus, and value during meniscal surgery was evaluated by clinical use.
Results— Application of the stifle distractor medial to the stifle joint using 2 negative threaded pins was easily performed percutaneously without the need of power equipment; however, unintended intra-articular placement of 1 threaded pin occurred in 2 stifles, without appreciable consequence to joint function. Observation as well as thorough probing of the caudal horn of the medial meniscus, even in the presence of a prominent remnant of the CrCL or severe periarticular fibrosis, was possible. Partial meniscectomy was effectively performed as needed without apparent damage to the associated articular surfaces.
Conclusions— Distraction and translation of the medial compartment of the stifle joint using invasive pin distraction allowed observation and palpation of the caudal horn of the medial meniscus so that assessment and treatment were readily accomplished without apparent morbidity.
Clinical Relevance— With careful attention to accurate pin placement, invasive pin distraction of the medial compartment of the canine stifle joint may improve arthroscopic evaluation and treatment of meniscal pathology.     

Effects of Three Intramedullary Pinning Techniques on Proximal Pin Location and Articular Damage in the Canine Tibia

The effects of three different techniques of intramedullary (IM) pin placement on pin location and incidence of stifle joint injury were evaluated using 70 cadaver canine tibiae after middisphyseal osteotomy. In 50 tibiae, pins were placed retrograde in either a nondirected (group A) or a craniomedially directed fashion (group B) with 25 tibiae in each group. Pins were driven normograde (group N) in 20 tibiae. All the stifles were dissected to qualitatively evaluate pin interference with different joint structures. End-on radiographs of the tibial plateaus were used to quantitatively evaluate pin location. Interference with the caudal cruciate ligament, medial meniscus, lateral meniscus, or meniscal ligaments was not observed in any group. There was a significant association between pinning technique and incidence of involvement of the cranial cruciate ligament ( P < .005), patella ( P < .001), patellar ligament ( P < .005), and femoral condyle ( P < .01). Pin location for group A was significantly different from either other group in a cranial-caudal direction ( P = .003), and was significantly different from group N in a medial-lateral direction ( P = .005). No significant difference was observed between pin location for groups B and N in either plane. It was concluded that although nondirected retrograde pinning cannot be recommended, retrograde pins directed craniomedially may be an acceptable technique for the repair of proximal to mid-diaphyseal tibial fractures if care is taken to properly seat the pins.     

Mechanical Evaluation of Half-Pin (Type 1) External Skeletal Fixation in Combination with a Single Intramedullary Pin

Half-pin (type 1) external skeletal fixators with four, three, and two fixation pins and an intramedullary pin, and four-pin external skeletal fixators without an intramedullary pin were applied to prepared canine femurs. Load to failure, load to yield, safe load, and stiffness under compressive and torsional loads were calculated. When tested in compression, all measurements for the four-pin fixators with an intramedullary pin were significantly higher than for the two-pin fixators with an intramedullary pin. The values for all parameters except load to yield were significantly higher for the four-pin fixators with an intramedullary pin than for the four-pin fixators without an intramedullary pin. When tested in torsion, all measurements for the four-pin fixators with an intramedullary pin were significantly higher than for the two or three-pin fixators with an intramedullary pin.     

In Vitro Comparison of a Novel External Fixator and Traditional Full‐Limb Transfixation Pin Cast in Horses

Objective: To compare the mechanical properties and failure modes of a standardized short oblique distal radial metaphyseal osteotomy stabilized using either a transfixation pin cast (TPC), a modular‐sidebar external skeletal fixator (ESF), or a solid‐sidebar ESF (modular‐ or solid‐ESF, respectively) using static or cyclic axial loading to failure. Study Design: In vitro study. Animals: Equine cadaver forelimbs. Methods: A 30° oblique distal radial osteotomy was created and stabilized using 1 of the 3 fixation methods: (1) TPC, (2) modular‐ESF, or (3) solid‐ESF. Limbs were tested using static (TPC, modular‐ESF, and solid‐ESF) or cyclic (TPC and solid‐ESF) axial loading to failure. The stiffness, yield load, yield displacement, failure load, and failure displacement for static loading and the cycles to failure for cyclic loading at 75% failure load were obtained. Data were analyzed using a Kruskal–Wallis test. Level of significance was P<.05. Results: The solid‐ESF had a greater stiffness, higher yield and failure load and a lower yield and failure displacement than the TPC (P=.01) and the modular‐ESF (P=.02). TPC had a higher yield load, failure load, and yield displacement than the modular‐ESF (P=.01). Mean cycles to failure for TPC was 2996±657 at a load of 16,000 N and for solid‐ESF 6560±90 cycles at a load of 25,000 N. Conclusions: The solid‐ESF was stiffer and stronger than the TPC and modular‐ESF and failed at a greater number of cycles in axial loading compared with the TPC. Clinical Relevance: This study is an initial step in evaluating the solid‐ESF. Further testing needs to be performed, but this fixation may offer a viable alternative to the traditional TPC for stabilization of long bone fractures in adult horses.