An Evaluation of Six Synthetic Casting Materials: Strength of Cylinders in Bending

Six fiberglass casting tapes were evaluated in bending, using an unstable fracture model. Cylindrical casts were constructed and evaluated in bending at 2, 3, and 24 hours after application. Scotchcast Plus (3M, St. Paul, MN), Vet Cast II (3M), and Zim-Flex (Zimmer, Warsaw, IN) were significantly stronger than other materials at 2 hours; however, by 24 hours, casts constructed from Delta-Lite (Johnson & Johnson Products, New Brunswick, NJ) were strongest. Delta-Lite Conformable casts were significantly weaker at all times.     

Ex Vivo Biomechanics of Kirschner-Ehmer External Skeletal Fixation Applied to Canine Tibiae

The purpose of this study was to determine the respective contribution of each of the following parameters to the compressive, bending, and torsional rigidity of the Kirschner-Ehmer (KE) external fixation splint as applied to canine tibiae with an osteotomy gap: bilateral versus unilateral splints; increasing the number of fixation pins; altering the diameter of fixation pins and side bars; decreasing side bar distances from the bone; increasing pin separation distances in each pin group; decreasing distances between pin groups; altering pin clamp orientation; and altering side bar conformation. Bilateral splints were 100% (mean) stiffer than unilateral splints, with stiffness enhanced to the greatest extent in mediolateral bending and torsion. Increasing pin numbers stiffened both bilateral (mean, 41%; 8 versus 4) and unilateral splints (mean, 14%; 8 versus 4). Medium KE splints were 85% (mean) stiffer than small KE splints. Decreasing side bar distances to the bone from 1.5 cm to 1.0 cm to 0.5 cm increased stiffness of both bilateral and unilateral splints by a mean of 13% to 35%. Widening pin spacing from 1.67 cm to 2.5 cm increased stiffness in craniocaudal bending only (56% increase, bilateral splints; 73% increase, unilateral splints). Decreasing the distance between pin groups from 5.84 cm to 2.5 cm increased stiffness in torsion between 23% (unilateral splints) and 45% (bilateral splints) and decreased stiffness of unilateral splints by 29% in craniocaudal bending. Altering pin clamp configuration so that the bolts of the clamp were inside the side bar rather than outside the side bar increased stiffness in axial compression only (73% increase, bilateral splints; 54% increase, unilateral splints). Conforming the lateral side bar to the tibiae increased only axial compressive stiffness by 77% but was no different than placing the clamps inside the side bars of an unconformed bilateral splint. These results quantify the relative importance of specific parameters affecting KE splint rigidity as applied to unstable fractures in the dog.     

Fracture repair with transfixation pins and fiberglass cast in llamas and small ruminants

Transfixation pinning with fiberglass casting is an effective and adaptable method of longbone fracture fixation in llamas and small ruminants. Treatment of fractures in 7 limbs of 4 llamas and 2 small ruminants with this technique are described. Steinmann pins are placed transcortically proximal, and if necessary, distal to the fracture. The pin ends and limb are encased in fiberglass cast material. The cast is strong enough in animals of this size to eliminate the need for external frames or connecting bars. Severely comminuted fractures and fractures near joints are especially suited to fixation with this technique. Complications encountered in these cases included loosening of pins and one delayed union. All fractures healed to permit full use of the limb.     

Bone strain in the equine tibia: an in vivo strain gauge analysis

Rosette strain gauges were bonded to the cranial, caudal, and medial surfaces of the tibia in the middiaphyseal region of 6 adult ponies. While the ponies were walking, the cranial side was mainly subjected to tension, and the caudal side, to compression. The compression strain on the caudal side was 1.5 times greater than the tension strain on the cranial side. None of these principal strains was aligned along the long axis of the bone; both deviated laterally from the long axis. On the medial surface, the principal strain deviated caudally about 40 degrees from the long axis. From analysis of the strain patterns on the 3 sides of the bone, it could be concluded that during loading of the tibia, torsion was superimposed on craniocaudal bending. The strain pattern was not affected after transection of the cranial tibial muscle, as determined by measuring with the same gauges before and after surgical interference. The contribution of the cranial tibial muscle in reducing the strain in the tibial cortex was therefore very small.     

The Mesh Expansion Method of Suturing Wounds on the Legs of Horses

Wound closure utilizing tension-relieving incisions located in the skin adjacent to the wound of horses was evaluated in three experiments. Healing of lower limb wounds was compared in four treatment groups; wounds sutured under tension, wounds sutured with 7 mm and 10 mm tension relieving incisions, and unsutured controls. The wounds sutured using 10 mm tension relieving incisions healed significantly faster than the other three groups (p > 0.05). The mesh expansion technique was further evaluated in four-week-old granulating wounds. The technique was found to be unsuccessful because the tension relieving incisions that were used were too small and postoperative support was inadequate. The technique was evaluated in two clinical patients, both of which had large metatarsal lacerations. Tension relieving incisions of approximately 15 mm were made and full leg walking bar casts were applied. Both wounds had healed almost completely on removal of the casts four weeks postoperatively.     

The biomechanical properties of the feline femur

The purpose of this study was to determine the biomechanical properties of feline long bone by testing cadaver bone from mature cats in compression, three-point bending, notch sensitivity and screw pull-out strength. The determination of these properties is of clinical relevance with regard to the forces resulting in long bone fractures in cats as well as the behaviour and failure mode of surgical implants utilized for fracture stabilization and repair in the cat. Cadaveric cat femurs were tested in compression, three-point bending and in three-point bending after the addition of a 2.0 mm screw hole. Cortical screws, 2.7 mm in diameter, were inserted in cadaveric cat femur samples for screw pull-out testing. The mean maximum load to failure of mid diaphyseal feline femurs tested in compression was 4201+/-1218 N. Statistical analysis of the parameter of maximum load tested in compression revealed a statistical difference between sides (p=0.02), but not location (p=0.07), or location by side (p=0.12). The maximum strength of mid diaphyseal feline femurs tested in compression was 110.6+/-26.6 MPa. The modulus of elasticity of mid-diaphyseal cat femurs tested in compression was determined to be 5.004+/-0.970 GPa. The mean maximum load to failure of feline femurs tested in three-point bending was 443+/-98 N. The mean maximum load to failure of feline femurs tested in three-point bending after a 2.0 mm diameter hole was drilled in the mid-diaphyseal region of each sample through both cortices was 471+/-52 N. The mean maximum load required for screw pull-out of 2.7 mm cortical screws placed in feline femurs tested in tension was 886+/-221 N. This data should be suitable for investigating fracture biomechanics and the testing of orthopaedic constructs commonly used for fracture stabilization in the feline patient.     

Kirschner-Ehmer Apparatus Immobilization Following Achilles Tendon Repair in Six Dogs

Postoperative immobilization is an essential part of the management of Achilles tendon injuries. Results are reported in six dogs managed with the Kirschner-Ehmer apparatus for immobilization of the tarsus as an alternative to the use of casts or splints. In all six dogs, good to excellent function was restored to the limbs after removal of the Kirschner-Ehmer apparatus. There were no immobilization or tenorraphy failures.     

Forces loading the tarsal joint in the hind limb of the horse, determined from in vivo strain measurements of the third metatarsal bone

Strain gauge rosettes were bonded to the dorsal, lateral, medial, and plantar aspects of the third metatarsal bone in the hind limbs of 6 ponies. The maximal compressive principal strain was approximately -600 X 10(-6) m/m, and exceeded the amplitudes of the tensile strains at all aspects of the bone. After transformation, the shear strain and the principal strains parallel and perpendicular to the bone were obtained. The first peak in the bending strain was higher in the dorsal and lateral aspects, and the second peak was higher in the medial and plantar aspects. Young modulus of elasticity was determined in a 4-point bending test at the dorsal and plantar sides; it averaged 19.5 GPa in tension and compression. Applying linear bending theory, the eccentricity of an axial force parallel or a bending force perpendicular to the bone were calculated. The position where the total force penetrated the tarsometatarsal joint surface was largely within the joint surface, indicating that the joint is merely loaded in (eccentric) compression.     

Comparison of double dynamic compression plating versus two configurations of an internal veterinary fixation device: Results of in vitro mechanical testing using a bone substitute

OBJECTIVE: To compare the mechanical properties of 2 configurations of a veterinary fixation system (VFS) for large animal long bones with dynamic compression plating (DCP). SAMPLE POPULATION: Eighteen pairs of Canevasit tubes (Canevasit; Amsler und Frei, Schinznach Dorf, Switzerland) (length, 170 mm; diameter, 47.5 mm; cortex thickness, 10 mm), aligned with a 10-mm gap, and stabilized with 2 DCP or 2 VFS implants. METHODS: Three groups (n = 6) were compared. Group 1 Canevasit tubes were stabilized with two 10-hole, broad 4.5-mm stainless steel DCP applied with both plates centered over the gap, in orthogonal planes parallel to the long axis of the tubes and staggered to allow bicortical fixation with ten 4.5-mm, 52-mm-long cortex screws each. Group 2 tubes were stabilized similarly with 2 VFS implants, each composed of a stainless steel rod (length, 167 mm; diameter, 8 mm), and 10 clamps were applied in alternating fashion left and right on the rod and fixed bicortically with ten 4.5-mm, 52-mm-long, cortex screws. Group 3 tubes were stabilized similarly, but using only 6 clamps/rod. All groups were tested initially in torsion within elastic limits and subsequently in 4-point bending, with 1 implant on the tension side, until gap closure occurred. RESULTS: None of the constructs failed, but all had plastic deformation after 4-point bending. No statistically significant differences were found among the 3 groups in torsional stiffness. Double DCP fixation was significantly stiffer and stronger in 4-point bending, compared with both configurations of double VFS fixation. CONCLUSIONS: The plate design was favored in this study. The VFS system may have to be adapted before further tests are conducted. Test modalities have to be chosen closer to clinical conditions (real bone, cyclic loading, closed gap). CLINICAL RELEVANCE: The veterinary fixation system has not yet proven its advantages for large animal long bone fracture repair. From the pure mechanical point of view, double DCP is the favored method for the treatment mentioned.     

Arthrodesis of the Equine Proximal Interphalangeal Joint: A Biomechanical Comparison of Two Parallel Headless, Tapered, Variable-Pitched, Titanium Compression Screws and Two Parallel 5.5 mm Stainless-Steel Cortical Screws

Objective— To compare the biomechanical characteristics, failure mode, and effects of side (left or right limb) and end (forelimb or hindlimb) of different screws in 2-screw, parallel-screw proximal interphalangeal joint arthrodesis constructs in horses.
Study Design— In vitro experimental study.
Sample Population— Twenty limbs from 6 cadavers (4 complete limb sets, 2 partial sets—total of 4 forelimb and 6 hindlimb pairs).
Methods— Two parallel 5.5 mm cortical (AO) screws were inserted in lag fashion in 1 randomly allocated limb of a pair, and 2 parallel headless, tapered, variable-pitched, titanium compression screws (Acutrak-Plus^®) were inserted in the contralateral limb. Constructs were tested in 3-point bending in a dorsopalmar (plantar) direction using a materials-testing machine at a loading rate of 5.83 mm/s. Maximal bending moment at failure and composite stiffness were calculated from data generated on load–displacement curves. Data were analyzed using a Friedman 2-way analysis of variance and Wilcoxon's signed-rank tests.
Results— No significant difference was detected for bending moment or stiffness values in proximal interphalangeal joint arthrodesis constructs using 2 parallel Acutrak-Plus^® or AO screws for fixation. Mean stiffness values were significantly different between forelimb and hindlimb constructs.
Conclusions— Performance of 2 parallel Acutrak-Plus^® screws was biomechanically comparable with 2 parallel AO 5.5 mm cortical screws in in vitro pastern arthrodesis constructs.
Clinical Relevance— Acutrak-Plus^® screws may provide an alternative means of fixation for proximal interphalangeal joint arthrodesis.     

Corrosion casting in anatomy: Visualizing the architecture of hollow structures and surface details

Corrosion casting is the technique by which a solid, negative replica is created from a hollow anatomical structure and liberated from its surrounding tissues. For centuries, different types of hardening substances have been developed to create such casts, but nowadays, thermosetting polymers are mostly used as casting medium. Although the principle and initial set‐up are relatively easy, producing high‐quality casts that serve their intended purpose can be quite challenging. This paper evaluates some of the more popular casting resins that are currently available and provides a step‐by‐step overview of the corrosion casting procedure, including surface casts of anatomical structures. Hurdles and pitfalls are discussed, along with possible solutions to circumvent them, based on personal experience by the authors.     

An in vitro biomechanical comparison of interlocking nail constructs and double plating for fixation of diaphyseal femur fractures in immature horses

OBJECTIVE: To compare the biomechanical properties of intact immature horse femurs and 3 stabilization methods in ostectomized femurs. Animal or SAMPLE POPULATION: Eighteen pairs of femurs from immature horses aged 1 to 15 months, and weighing 68 to 236 kg. METHODS: Thirty-four immature horse femurs were randomly assigned to 1 of 5 test groups: 1) interlocking intramedullary nail (IIN) (n = 6); 2) IIN with a cranial dynamic compression plate (I/DCP) (n = 6); 3) 2 dynamic compression plates (2DCP) (n = 8); 4) intact femurs tested to failure in lateromedial (LM) bending (n = 6); and 5) intact femurs tested to failure in caudocranial (CaCr) bending (n = 8). Mid-diaphyseal ostectomies (1 cm) were performed in all fixation constructs. Biomechanical testing consisted of 4 nondestructive tests: CaCr bending, LM bending, compression, and torsion, followed by bending to failure. All groups were tested to failure in LM bending with the exception of 1 group of intact femurs tested to failure in CaCr bending. Stiffness and failure properties were compared among groups. RESULTS: The 2DCP-femur construct had greater structural stiffness in nondestructive bending than the IIN-femur construct in either LM or CaCr bending, and the I/DCP-femur construct in LM bending. Only the I/DCP and 2DCP fixations were similar to intact bone in nondestructive-bending tests. In addition, the 2DCP-femur construct had greater structural and gap torsional stiffness than the I/DCP-femur construct, and greater gap torsional stiffness than the IIN-femur construct. However, all of the fixation methods tested, including the 2DCP-femur construct, had lower structural stiffness in torsional loading compared with intact bone. No significant differences in structural stiffness were found between intact bones and femur constructs tested nondestructively in compression. In resistance to LM bending to failure, the 2DCP-femur construct was superior to the IIN-femur construct, yet similar to the I/DCP-femur construct. Also, evaluation of yield and failure loads revealed no significant differences between intact bone and any of the femur constructs tested to failure in LM bending. CONCLUSIONS: In general, the 2DCP-femur construct provided superior strength and stiffness compared with the IIN and I/DCP-femur constructs under bending and torsion. CLINICAL RELEVANCE: Double plating of diaphyseal comminuted femoral fractures in immature horses may be the best method of repair, because in general, it provides the greatest strength and stiffness in bending and torsion.     

Transfixation pinning and casting of tibial fractures in calves: five cases (1985-1989)

Medical records of 5 calves with tibial fractures that were reduced and stabilized by transfixation pinning and casting were reviewed. Multiple Steinmann pins were placed transversely through proximal and distal fracture fragments, and the pin ends were incorporated in fiberglass cast material after fracture reduction. Cast material serves as an external frame to maintain pin position and fracture reduction. Calves were between 2 weeks and 6 months old and weighed between 40 and 180 kg. Three fractures were spiral in configuration and 2 were comminuted. One tibial fracture was open. After surgery, all calves were ambulatory within 24 hours. To improve tarsal flexion and achieve normal stance in 3 calves, cast revision was required on the caudal aspect of the limb. Good radiographic and clinical evidence of stability was observed in 5 to 10 weeks (mean 8 weeks), at which time the pis and cast were removed. Return to normal function was rapid and judged to be excellent at follow-up evaluation 3 to 12 months later. Advantages of transfixation pinning and casting in management of tibial fractures include flexibility in pin positioning, adequate maintenance of reduction, early return to weight-bearing status, joint mobility, and ease of ambulation. The inability to adjust fixation and alignment after cast application is a disadvantage of this technique compared with other external fixators.     

Vascular perfusion in horses with chronic laminitis

Vascular perfusion casts were used to define and characterise the macroscopic perfusion defects present in the distal digit of 11 horses affected by chronic laminitis. Five clinically normal horses were used as controls. Based on clinical history and clinical status, horses with chronic laminitis were classified as being potentially treatable or clinically refractory. Eleven macroscopic vascular defects were noted in the casts from horses with laminitis. Four types of lesions were identified in the submural laminar circulation, 3 in the coronary bed and 4 were associated with the solar circulation. Multiple defects were present and a definite trend was noted for the perfusion defects to be worse in the casts of clinically refractory subjects than in those considered treatable. This information suggests that evaluation of circulatory status should add significantly to the ability to separate treatable from clinically refractory patients. Results also indicated that ventral displacement of the third phalanx (sinkers) and compression of the solar vasculature are more prevalent than is presently thought.     

Arthrodesis of the Equine Proximal Interphalangeal Joint: A Biomechanical Comparison of Two 7-Hole 3.5-mm Broad and Two 5-hole 4.5-mm Narrow Dynamic Compression Plates

OBJECTIVE: To compare the biomechanical characteristics and mode of failure of two different dynamic compression plate (DCP) techniques for proximal interphalangeal joint (PIPJ) arthrodesis in horses. STUDY DESIGN: Randomized block-design blocking on horse (1-5), method of fixation (two 7-hole, 3.5-mm broad DCP vs two 5-hole, 4.5-mm narrow DCP), side (left, right), and end (front, hind). Constructs were loaded to failure in 3-point bending in a dorsal-to-palmar (plantar) direction. SAMPLE POPULATION: Ten paired limbs from 5 equine cadavers. METHODS: Two 7-hole, 3.5-mm broad dynamic compression plates (bDCP) were used in 1 limb of a pair, and two 5-hole 4.5-mm narrow dynamic compression plates (nDCP) were used on the contralateral limb. Plates were positioned abaxially across the dorsomedial and dorsolateral aspect of the PIPJ. Arthrodesis constructs were loaded (19 mm/s) in 3-point bending in a dorsal-to-palmar (plantar) direction using a materials-testing machine. Composite stiffness, yield point, and maximal bending moment at failure were obtained from bending moment-angular deformation curves. Data were analyzed using ANOVA, X(2) analysis, and Fisher's exact tests; the power of the test was calculated when differences were not significant. RESULTS: There were no significant differences in composite stiffness (P >.05; power = 0.8 @ delta = 21.9%), yield point (P >.05; power = 0.8 @ delta = 34.4%), or maximal bending moment (P >.05; power = 0.8 @ delta = 17.8%) between the two fixation techniques. For bDCP constructs, 11% (15 of 140) of the 3.5-mm screws were damaged; 7 of the screw heads pulled through plates where the plates bent, 1 screw head broke off, and 7 screws were bent or pulled out of the phalanx. For nDCP constructs, 8% (8 of 100) of the 4.5-mm screws were damaged; 1 screw head pulled through a plate, 1 screw head broke off, and 6 screws were bent or pulled out of the phalanx. CONCLUSIONS: There were no biomechanical or failure differences between bDCP and nDCP fixation of the PIPJ in horses when evaluated in single-cycle 3-point bending to failure. CLINICAL RELEVANCE: There is no biomechanical advantage to the use of two 7-hole, 3.5-mm bDCP in equine proximal interphalangeal arthrodesis compared with two 5-hole, 4.5-mm nDCP. Two 5-hole, 4.5-mm nDCP may be easier to place, whereas two 7-hole, 3.5-mm bDCP may provide more versatility in fracture repair.     

Comparison of Three Methods of Ulnar Fixation in Horses

Objective- This study compares the mechanical properties of three methods of equine ulnar fixation: dynamic compression plating, pins and wires tension band, and a prototype grip system.
Study Design- The mechanical properties of dynamic compression plating, pins and wires tension band, and a prototype grip system repair of equine ulnar fractures were evaluated in a cadaveric osteotomy model.
Animals or Sample Population- Fifteen pairs of the radius and ulna from equine cadavers.
Methods- The three repair techniques were evaluated to mimic the pull of the triceps brachii muscle in single cycle to failure and in cyclic fatigue loading. Single cycle results were evaluated as the axial and angular displacement. Cyclic fatigue results were evaluated as the number of cycles to failure.
Results- Dynamic compression plate fixation and pins and wires tension band had significantly less axial displacement of the proximal fragment than the grip system ( P <.05). No significant difference in angular rotation of the proximal fragment was present between the three techniques. Dynamic compression plating had significantly greater fatigue resistance than the grip system ( P <.05). Cyclic failure was characterized by screw loosening or breakage and wire breakage.
Conclusions- Dynamic compression plates were better than the other techniques at maintaining compression of a transverse ulnar osteotomy at the level of the anconeal process just proximal to the trochlear notch.
Clinical Relevance- Knowledge of fixation technique mechanical properties is essential for surgeons to select the proper method of fracture repair.     

External coaptation

External coaptation includes the use of casts, splints, bandages, or slings to help stabilize fractures or luxations, reduce postoperative swelling, or help to protect wounds. Although each of these can be highly effective, it is very important to understand the various types of devices available and the indications for each. Inappropriate use of an external coaptation device can lead to unsatisfactory results.     

In vitro cyclic biomechanical properties of an interlocking equine tibial nail

OBJECTIVE: To determine cyclic biomechanical properties of gap osteotomized adult equine tibiae stabilized with an equine interlocking nail (EIN). STUDY DESIGN: In vitro experimental biomechanical investigation. SAMPLE POPULATION: Thirteen adult equine cadaveric tibiae. METHODS: Adult equine tibiae with transverse, midshaft, 1-cm gap osteotomies, stabilized with an equine interlocking nail, underwent cyclic biomechanical testing in vitro under axial compression, 4-point bending, and torsion. Different specimens were subjected to different load levels that represented estimated in vivo loads at 2 Hz for 740,000 cycles. Fatigue life and gap strain were calculated. RESULTS: Compression and bending, but not torsional, fatigue life were longer than time necessary for bone healing. Compressive, but not bending or torsional, gap strains were small enough to be compatible with fracture healing by primary bone formation. Gap strains for compressive, bending, and torsional loads were compatible with indirect, or secondary, bone formation. CONCLUSIONS: Further modification should be made to the equine interlocking nail to increase bending stiffness and torsional fatigue life. CLINICAL RELEVANCE: The stainless steel equine intramedullary interlocking nail is unlikely to provide appropriate long-term stability for fracture healing in adult equine tibiae without modifications in the nail design and material.     

Stiffness of modified Type 1a linear external skeletal fixators.

Modifications of a Type 1a external skeletal fixator (ESF) frame were evaluated by alternately placing transfixation pins on opposite sides of the connecting rod (Type 1a-MOD) or by placing additional connecting rods on either of the two inside (Type 1a-INSIDE) or two outside (Type 1a-OUTSIDE) transfixation pins. The objective of this study was to evaluate the stiffness of these modifications in terms of axial compression (AC), cranial-caudal bending (CCB), and medial-lateral bending (MLB). We hypothesized that these designs would allow significant increase in unilateral frame stiffness, over Type 1a, without proportional increase in frame complexity or technical difficulty of application. All of the ESF frames were constructed using large IMEX SKtrade mark clamps, 3.2 mm threaded fixation pins, 9.5 mm carbon fibre connecting rods and Delrin rods as bone models. Nine, eight pin frames of each design were constructed, and subjected to repetitive non-destructive loading forces (AC, CCB, MLB) using a materials testing machine. Frame construct stiffness for each force (AC, CCB, MLB) was derived from load-deformation curve analysis and displayed in N/mm. Data revealed the 1a-MOD and 1a-OUTSIDE constructs had significantly increased stiffness in CCB and AC as compared to the Type 1a constructs while all of the modified constructs were significantly stiffer in MLB than the Type 1a constructs.     

The Lightcast system of limb immobilisation

Extract

Prior to the use of internal devices for reducing and immobilizing limb fractures, external splints and plaster casts were used. In such circumstances it was necessary to carefully assess the value of the animal and the nature of the problem, before deciding if treatment was warranted. Careful assessment is still important to-day; however, with modem internal fixation equipment, less favourable cases are attempted. In general most failures result from inadequate support during recovery from anaesthesia.