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.     

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.     

In Vitro Biomechanical Comparison of a Modified 5.5 mm Locking Compression Plate Fixation with a 5.5 mm Locking Compression Plate Fixation of Osteotomized Equine Third Metacarpal Bones

Objectives: To compare number of cycles to failure for palmarodorsal 4‐point bending of a modified 5.5 mm broad locking compression plate (M5.5‐LCP) fixation with a 5.5 mm broad LCP (5.5‐LCP) fixation used to repair osteotomized equine third metacarpal (MC3) bones. Study Design: In vitro biomechanical testing. Animal Population: Adult equine cadaveric MC3 bones (n=6 pairs). Methods: An 8‐hole, M5.5‐LCP, obtained by having a 1.0 mm thickness removed from the bone contact portion of the 5.5‐LCP, was applied to the dorsal surface of 1 randomly selected MC3 from each pair, and an 8‐hole, 5.5‐LCP was applied dorsally to the contralateral bone from each pair using a combination of cortical and locking screws. Plates and screws were applied using standard ASIF techniques to MC3 bones with a mid‐diaphyseal osteotomy. MC3 constructs had palmarodorsal 4‐point bending cyclic fatigue testing. Mean cycles to failure for each method were compared using a paired t‐test within each group. Significance was set at P<.05. Results: Mean±SD cycles to failure of the M5.5‐LCP fixation (188,641±17,971) was significantly greater than that of the 5.5‐LCP fixation (166,497±15,539). Conclusion: M5.5‐LCP fixation was superior to 5.5‐LCP fixation of osteotomized equine MC3 bones in resisting cyclic fatigue under palmarodorsal 4‐point bending. Clinical Relevance: This suggests that biological plate fixation is not the ideal choice for osteotomized equine MC3 bones.     

An In Vitro Biomechanical Comparison of a 5.5 mm Locking Compression Plate Fixation with a 4.5 mm Locking Compression Plate Fixation of Osteotomized Equine Third Metacarpal Bones

Objectives: To compare the monotonic biomechanical properties and fatigue life of a 5.5‐mm‐broad locking compression plate (5.5 LCP) fixation with a 4.5‐mm‐broad locking compression plate (4.5 LCP) fixation to repair osteotomized equine 3rd metacarpal (MC3) bones. Study Design: In vitro biomechanical testing of paired cadaveric equine MC3 with a middiaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. Animal Population: Fifteen pairs of adult equine cadaveric MC3 bones. Methods: Fifteen pairs of equine MC3 were divided into 3 test groups (5 pairs each) for (1) 4‐point bending single cycle to failure testing, (2) 4‐point bending cyclic fatigue testing, and (3) torsional single cycle to failure testing. An 8‐hole, 5.5 LCP was applied to the dorsal surface of 1 randomly selected bone from each pair and an 8‐hole, 4.5 LCP was applied dorsally to the contralateral bone from each pair using a combination of cortical and locking screws. All plates and screws were applied using standard ASIF techniques. All MC3 bones had middiaphyseal osteotomies. Mean test variable values for each method were compared using a paired t‐test within each group with significance set at P<.05. Results: Mean yield load, yield bending moment, composite rigidity, failure load, and failure bending moment, under 4‐point bending, single cycle to failure, of the 5.5 LCP fixation were significantly greater than those of the 4.5 LCP fixation. Mean cycles to failure in 4‐point bending of the 5.5 LCP fixation (170,535±19,166) was significantly greater than that of the 4.5 LCP fixation (129,629±14,054). Mean yield load, mean composite rigidity, and mean failure load under torsional testing, single cycle to failure was significantly greater for the broad 5.5 LCP fixation compared with the 4.5 LCP fixation. In single cycle to failure under torsion, the mean±SD values for the 5.5 LCP and the 4.5 LCP fixation techniques, respectively, were: yield load, 151.4±19.6 and 97.6±12.1 N m; composite rigidity, 790.3±58.1 and 412.3±28.1 N m/rad; and failure load: 162.1±20.2 and 117.9±14.6 N m. Conclusion: The 5.5 LCP was superior to the 4.5 LCP in resisting static overload forces (palmarodorsal 4‐point bending and torsional) and in resisting cyclic fatigue under palmarodorsal 4‐point bending. Clinical Relevance: These in vitro study results may provide information to aid in selection of an LCP for repair of equine long bone fractures.     

Mechanical Comparison of 3.5 mm Broad Dynamic Compression Plate,Broad Limited‐Contact Dynamic Compression Plate,and Narrow Locking Compression Plate Systems Using Interfragmentary Gap Models

Objectives— To compare (1) pullout properties between 3.5 mm cortical and locking screws, and (2) mechanical properties and gap displacements between the 3.5 mm broad limited‐contact dynamic compression plate (LC‐DCP), broad dynamic compression plate (DCP), and narrow locking compression plate (LCP), during axial loading of plate‐stabilized diaphyseal fragments with an interfragmentary gap. Study Design— In vitro mechanical testing of implanted polyurethane foam (PUF) hollow cylinders that simulated compact or osteopenic diaphyseal bone. Sample Population— (1) Five cortical and locking screws and (2) 4 PUF‐plate constructs for each plate type; using high‐ and low‐density (0.8 and 0.32 g/cm³) cylinders. Methods— (1) Screws were completely extracted at 5 mm/min. (2) Plated constructs were axially compressed at 300 N/s for 10 cycles from 5 to 355 N to determine gap displacement during physiologic loading, followed by single cycle increasing load to failure. Results— Pullout properties were not different between screw types. All plate constructs had yield loads over 3 times trotting loads. Gap closure occurred with LC‐DCP and DCP constructs, but not LCP constructs. LCP construct properties were most similar to LC‐DCP and DCP construct properties in the low‐density model. Conclusion— All plate systems sustained physiologic limb loads. Only LCP constructs maintained some gap integrity, although LC‐DCP and DCP screws were placed in neutral position. Clinical Relevance— The LCP system is more likely than LC‐DCP and DCP systems, with neutrally positioned screws, to maintain a planned interfragmentary gap, although gap strains range from 0% to 15% across the 2 mm gap during a trot load.     

Combination of a Corticai Allograft With a Cancellous Autograft in the Canine Tibia

This study was undertaken to determine what difference, if any, occurred when autogenous cancellous bone was placed in the medullary canal of a fresh, 4-cm cortical allograft compared to a fresh cortical allograft alone. Twelve mature dogs were used. A tubular cortical graft was placed in the midshaft of both tibias. The right tibia received the combination graft while the left tibia received a fresh cortical allograft only. Study periods ranged from one week to 17 weeks. The progress of the grafts was assessed by technetium-99m radionuclide bone scans, radiographs, gross and histological examination, and tetracycline labeling. Results indicate that autogenous cancellous bone placed in the medullary canal of a fresh cortical allograft was beneficial to the ingrowth of new blood vessels and incorporation of the cortical graft.     

Radiographic, Densitometric, and Biomechanical Effects of Recombinant Canine Somatotropin in an Unstable Ostectomy Gap Model of Bone Healing in Dogs

Objective —To determine the effect of recombinant canine somatotropin (STH) on radiographic, densitometric, and biomechanical aspects of bone healing using an unstable ostectomy gap model.
Study Design —After an ostectomy of the midshaft radius, bone healing was evaluated over an 8–week period in control dogs (n = 4) and dogs receiving recombinant canine STH (n = 4).
Animals or Sample Population—Eight sexually intact female Beagle dogs, 4 to 5 years old. Methods—Bone healing was evaluated by qualitative and quantitative evaluation of serial radiographs every 2 weeks. Terminal dual-energy x-ray absorptiometry and three-point bending biomechanical testing were also performed.
Results —Dogs receiving STH had more advanced radiographic healing of ostectomy sites. Bone area, bone mineral content, and bone density were two to five times greater at the ostectomy sites of treated dogs. Ultimate load at failure and stiffness were three and five times greater in dogs receiving STH.
Conclusions —Using the ostectomy gap model, recombinant canine STH enhanced the radiographic, densitometric, and biomechanical aspects of bone healing in dogs. Clinical Relevance—Dogs at risk for delayed healing of fractures may benefit from treatment with recombinant canine STH.