The effect of stem length on femoral component positioning in canine total hip arthroplasty

OBJECTIVE: To determine the effects of femoral prosthesis stem length on positioning of the femoral component within the canine femur. STUDY DESIGN: An in vitro experimental study. SAMPLE POPULATION: Eleven adult, mixed breed, canine cadaver femurs. METHODS: Polymethylmethacrylate centralized Biomedtrix size 5, 6, and 7 standard and 1cm shortened implants were placed in specimens, manipulated to achieve maximal displacements of the implant tip in each plane, and radiographed. Measurements of the implant angle, tip offset, and minimal tip to endosteal surface distance were obtained with image processing software. The effects of implant length and size on implant positioning were evaluated with the use of Student's t, chi(2) exact, and 2-way ANOVA testing. RESULTS: Statistically significant increases were noted in tip to caudal cortex distance in the sagittal plane, and available angle variability and tip offset variability in the transverse plane for shortened size 6 and 7 stems relative to the standard stems. No significant differences were noted in size 5 stems. Statistically significant increases in tip to caudal cortex distance and transverse plane available angle variability for standard 6 compared to standard 7 stems were noted. CONCLUSIONS: Shortened stems result in statistical improvement of several variables of femoral component positioning. However, the improvement appears to be clinically negligible. CLINICAL RELEVANCE: Alteration of current stem lengths is not recommended. The use of undersized standard implants may improve femoral component positioning in total hip arthroplasty.     

Comparison of the fit and geometry of reconstruction of femoral components of four cemented canine total hip replacement implants

OBJECTIVE: To compare fit and geometry of reconstruction of femoral components of 4 canine cemented total hip replacement implants and determine which implants are most compatible with current principles of cemented arthroplasty. SAMPLE POPULATION: Paired femurs from 16 adult mixed-breed dogs. PROCEDURE: Femurs were prepared for femoral stem implantation of either the Bardet, BioMedtrix, Mathys, or Richards II implant. Mediolateral and craniocaudal radiographs were obtained with femoral components in situ. Cross-sectional analysis of implant fit was performed on transected cemented specimens. Computer-aided analyses of digitized images were performed. RESULTS: The Bardet and Richards II implants reconstructed the original femoral head position significantly better than the other 2 implants. None of the implants allowed neutralization of the implant axis in the sagittal plane or were routinely centralized in the femoral canal.The Bardet implant had the smallest minimum distal tip offset in the sagittal plane. Greatest tip to cortex distance was provided by the Richards II implant in the transverse plane and the Mathys implant in the sagittal plane. The thinnest cement mantle regions for all implants were in the central longitudinal third of the femoral stem. CONCLUSIONS AND CLINICAL RELEVANCE: The Bardet and BioMedtrix implants had stem design characteristics that were most compatible with principles of cemented stem fixation. None of the implants completely satisfied the theoretically optimal conditions of centralization and neutralization of the femoral stem. Innovative design modifications, therefore, may be needed if these conditions are important to the long-term success of canine total hip replacement.     

Effect of surgical technique and use of a rigid centralizing device on stem positioning and geometric reconstruction in the sagittal plane during total hip replacement in canine cadavers

OBJECTIVE: To determine the effect of surgical technique and use of a rigid centralizing device on stem positioning and geometric reconstruction in the sagittal plane during total hip replacement in dogs. SAMPLE POPULATION: Bilateral femurs from 8 adult mixed-breed canine cadavers. PROCEDURE: Femurs were prepared for femoral stem implantation, using 4 variations in technique. Proximal femoral reconstruction and femoral stem positioning were evaluated on radiographs. RESULTS: Implants evaluated in this study accurately reconstructed displacement of the femoral head of the intact canine femur in the sagittal plane. Centralization of the distal aspect of the stem was optimized by use of an undersized femoral stem. Ostectomy at the level of the lesser trochanter resulted in the smallest diaphysis-to-implant angle. Anteversion and retroversion of implants significantly decreased the distance between the distal tip of the implant and the adjacent cortex, compared with normoversion. The centralizing device significantly increased the minimum distance between the distal tip of the implant and adjacent cortex but did not improve the odds of actually centralizing the tip of the implant. CONCLUSIONS AND CLINICAL RELEVANCE: Malpositioning of implants in the sagittal plane may be minimized through ostectomy at the lesser trochanter and use of an undersized implant positioned in normoversion. Use of a polymethylmethacrylate centralizing device will help eliminate contact between the implant tip and adjacent cortex. Implantation of an undersized femoral component, avoidance of substantial anteversion or retroversion, and use of a rigid centralizing device are recommended when using the prosthesis described-for total hip replacement of dogs.     

The effects of femur and implant position on the radiographic assessment of total hip femoral implants in dogs

OBJECTIVE: To determine the effect of femur positioning and femoral implant placement on the radiographic assessment of total hip femoral implants in dogs. STUDY DESIGN: Cadaveric study. ANIMALS: Five canine femurs. METHODS: Five canine femurs were fitted with total hip implants, in predetermined locations, postmortem. Each femur was moved through a defined range of motion and radiographed at specific intervals. Radiographs were then digitized, and implant position was measured using previously described methods. Regression analysis was conducted to determine whether varied femoral position resulted in a consistent (linear) pattern of change in the value of each particular measurement. RESULTS: Change in the position of the femur relative to the film cassette caused significant variation in the perceived position of the implant. The placement of the implant within the femur determined which measurements were affected and to what degree. CONCLUSIONS: The information obtained from standard clinical radiographs and conventional methods of quantitative analysis does not consistently provide an accurate assessment of the placement of the femoral implant within the femoral canal. Such data cannot be used to correlate implant position with implant failure.     

Coxofemoral arthroscopy and total hip arthroplasty for management of intermediate grade fibrosarcoma in a dog

OBJECTIVE: To report the use of arthroscopy and total hip arthroplasty (THA) for management of intermediate grade fibrosarcoma of the femoral head in a dog. STUDY DESIGN: Clinical case report. ANIMAL: A 6-year-old spayed female Rottweiler presented for evaluation of acute-onset of lameness of the right pelvic limb of approximately 10 days duration. METHODS: Coxofemoral arthroscopy was performed to obtain fine needle aspiration and Jamshidi biopsy of a lytic lesion of the femoral head. A cemented THA was performed removing as much of the femoral neck and proximal femur as possible while not compromising implant or joint stability. RESULTS: Histologic evaluation of specimens from the femoral head and neck remnants confirmed an intermediate grade fibrosarcoma. Fifteen months after THA, subjectively there was normal use of the right limb with only limited decrease in range of motion and mild muscular atrophy. Radiographs demonstrated stationary positioning of the THA implants. CONCLUSIONS: Arthroscopy of the coxofemoral joint is an effective diagnostic tool for evaluation of disease of the articular structures and canine total hip replacement may be an appropriate means of limb salvage in rare cases of disease of the femoral head. CLINICAL RELEVANCE: This case provides support for the use of coxofemoral arthroscopy as a diagnostic tool as well as an aid in acquiring representative intraarticular tissue samples. Additionally, the case presented demonstrates the potential use of THA as a limb sparing technique in cases of disease affecting the femoral head of dogs.     

Segmentation of the canine population in different femoral morphological groups

ObjectiveThe incidence of femoral traumatology and hip dysplasia shows the need to design canine specific femoral implants in veterinary surgery. A good knowledge of femoral morphology, and particularly of intra-species variability, is required to develop a well-adapted canine femoral intramedullary implant. The aim of this study is to evaluate the morphological variability of the canine femur and to propose a segmentation of this population.ProcedureThis study proposes different possibilities for the segmentation of a canine population of 103 dogs of various common breeds in relation to their femoral morphology. These segmentations were obtained with a statistical methodology, which takes into account 24 measured and calculated morphological parameters of 206 canine femurs.ResultsThe segmentation of this canine population into four or six homogeneous groups related to the femoral morphology were the two most relevant solutions. The total length of the femur and the femoral head diameter were the best discriminant parameters for this segmentation.ConclusionKnowledge of the variability of the femoral morphology in the canine species and the possibility of splitting the canine population into homogeneous morphological groups are useful for the design of specific canine femoral implants. The femoral morphological profiles of each group constitute an essential database for fitting the best orthopedic implant to the bone.     

Segmentation of the canine population in different femoral morphological groups

ObjectiveThe incidence of femoral traumatology and hip dysplasia shows the need to design canine specific femoral implants in veterinary surgery. A good knowledge of femoral morphology, and particularly of intra-species variability, is required to develop a well-adapted canine femoral intramedullary implant. The aim of this study is to evaluate the morphological variability of the canine femur and to propose a segmentation of this population.ProcedureThis study proposes different possibilities for the segmentation of a canine population of 103 dogs of various common breeds in relation to their femoral morphology. These segmentations were obtained with a statistical methodology, which takes into account 24 measured and calculated morphological parameters of 206 canine femurs.ResultsThe segmentation of this canine population into four or six homogeneous groups related to the femoral morphology were the two most relevant solutions. The total length of the femur and the femoral head diameter were the best discriminant parameters for this segmentation.ConclusionKnowledge of the variability of the femoral morphology in the canine species and the possibility of splitting the canine population into homogeneous morphological groups are useful for the design of specific canine femoral implants. The femoral morphological profiles of each group constitute an essential database for fitting the best orthopedic implant to the bone.     

Femoral Strain Distribution and Subsidence After Physiological Loading of a Cementless Canine Femoral Prosthesis: The Effects of Implant Orientation, Canal Fill, and Implant Fit

Twelve normal greyhound femora were divided into three groups. In group one, femoral stems were placed in neutral position with maximal fill. Group two had undersized femoral stems placed in neutral position. Group three had undersized femoral stems placed in varus position. Intact and implanted femora were loaded from 10 newtons (N) to 300 N in axial compression at a rate of 25 N/s for 10 replications. A strain gauge analysis showed that the strain distribution of all implanted femora were substantially different from intact femora, but femora with large implants placed in neutral position had the least amount of deviation from normal. An undersized stem in neutral position had significantly less compressive longitudinal strains along the proximomedial and proximocranial cortices. An undersized stem in varus position improved implant fit along the proximomedial and distolateral cortices, which resulted in increased tensile hoop strains. There were multiple significant correlations between the strain data and implantation variables (implant alignment, canal fill, and implant fit). Subsidence was significantly greater for the undersized implant in neutral position. There was not a difference in subsidence between the large neutral and varus groups. The most important variable that decreased subsidence was increased lateral implant fit ( r = -0.86, P = .0003).     

Influence of femoral head and neck conformation on hip dysplasia in the German Shepherd dog.

We investigated the prevalence of an anatomic variant of the proximal femur, termed the broomstick-like femoral head and neck formation, and its influence on the Féderation Cynologique Internationale (FCI) hip dysplasia score in 294 German Shepherd dogs. One-hundred and eighty (61%) of the 294 dogs in our study had this anatomic variant. The calculated area of the femoral heads in dogs with a broomstick-like conformation was 4.5 +/- 0.6 cm2 on the hip-extended view. In dogs with a normal femoral head, the calculated area of the femoral head was significantly larger at 4.8 +/- 0.6 cm2 (P < 0.05). In the frog-leg view, there was no significant difference in femoral head area between dogs with the broomstick-like conformation and normal dogs. There was no difference in the antetorsion angle between dogs with broomstick-like conformation and normal dogs. There was also no difference in the distraction ratio between the two phenotypes. The official FCI hip score was similar in dogs with and without the broomstick-like conformation. The average heritability of the broomstick-like conformation was 0.3 +/- 0.1, suggesting heritable influence. We conclude that the broomstick-like conformation is a common finding in the German shepherd dog and has genetic base. The broomstick-like conformation does not appear to be associated with the presence of canine hip dysplasia and it can therefore be assumed to be a normal anatomic variant.     

Orthogonal view analysis for evaluating the femoral component position of total hip implants in dogs using postoperative radiographs

OBJECTIVE: To show the ability to obtain repeatable, accurate, quantitative data to assess the position of the femoral component of canine total hip implants using postoperative radiographs. STUDY DESIGN: Cadaveric study and clinical trial. ANIMALS: Five cadaveric canine femurs and 4 patients. METHODS: Femoral implants were placed into 5 cadaveric canine femurs in predetermined locations. Orthogonal radiographs were taken of each femur at 10 degrees intervals as they were moved through a natural range of hip motion. An assessment of implant position was made with each set of radiographs and analyzed to observe significant inconsistencies in the values obtained when the femur was repositioned. Three investigators positioned and radiographed the hips of 4 client-owned dogs that had total hip arthroplasty (THA). Each investigator obtained a set of orthogonal radiographic views from which implant position was measured. The measurements obtained from each investigator's set of radiographs were statistically analyzed to evaluate for interobserver differences. RESULTS: The methods described indicate that consistent data regarding femoral implant placement can be obtained from postoperative radiographs of THA patients. Under most circumstances, change in position of the femur did not significantly affect femoral implant measurements. There were no significant differences noted among values obtained by different investigators. CONCLUSIONS: Measurements based on the femoral and implant axes obtained from orthogonal radiographic views of the femur provide a means for obtaining accurate and consistent quantitative data regarding femoral implant position using postoperative radiographs of canine THA patients. CLINICAL RELEVANCE: Acquisition of quantitative information about femoral implant position using postoperative radiographs will facilitate development of a readily available data source. This information, attainable in a clinical setting, may help identify elements of implant position that are important in determining the clinical outcome of THA in dogs.     

A radiographic stress technique for evaluation of coxofemoral joint laxity in dogs

OBJECTIVE: To develop a radiographic stress technique to quantify hip joint laxity in dogs. STUDY DESIGN: Prospective study on client-owned dogs presented for hip dysplasia screening. ANIMAL POPULATION: 302 nonselected dogs (63 breeds). METHODS: Dogs were sedated and placed in dorsal recumbency. During pelvic radiography, the femoral heads were displaced manually in a craniodorsal direction. On these stress radiographs, the degree of lateral displacement of the femoral heads was assessed in terms of a subluxation index (SI) and compared with the degree of femoral head subluxation and the severity of hip dysplasia found on conventional extended hindlimb radiographs. RESULTS: The degree of subluxation on stress radiographs was significantly greater than on conventional radiographs. Correlation between the severity of canine hip dysplasia (CHD), graded according to conventional techniques, and the degree of subluxation, induced by radiographic stress technique, was positive (r = .57; P<.0001). Two critical SI values were noted. Of the dogs with an SI value of 0.3 or less, 99% were classified as CHD grade normal, borderline, or mildly dysplastic. In dogs with an SI value between 0.3 and 0.5, CHD grading ranged from normal to severely dysplastic. Of the dogs with an SI value greater than 0.5, 95% had dysplastic hip joints. CONCLUSIONS: Hip joint laxity cannot be quantified precisely on standard position radiographs. The proposed stress technique yields significantly higher degrees of femoral head subluxation than the standard position.     

PUPPY LINE, METAPHYSEAL SCLEROSIS, AND CAUDOLATERAL CURVILINEAR AND CIRCUMFERENTIAL FEMORAL HEAD OSTEOPHYTES IN EARLY DETECTION OF CANINE HIP DYSPLASIA

Ventrodorsal extended hip radiographs were analyzed from Foxhounds, Irish setters, Greyhounds, and Labrador retrievers radiographed four to seven times between 8 and 110 weeks of age. Occurrence in these 91 dogs of a puppy line, an ill-defined zone of proximal femoral metaphyseal sclerosis, a femoral neck linear sclerosis, or circumferential linear femoral head osteophytosis at 15–17 weeks of age were compared with hip joint laxity, as measured by distraction index, and to later findings of caudal curvilinear femoral neck osteophytes, circumferential femoral head osteophytes, hip incongruity consistent with hip dysplasia and degenerative joint disease by 52 weeks of age. A puppy line and/or femoral metaphyseal sclerosis was common at 15–17 weeks of age for dogs at mimimal risk (Greyhounds) and high risk (Foxhounds) of developing early degenerative joint disease associated with canine hip dysplasia. Though 44% of Greyhound hips had puppy lines and 28% had femoral metaphyseal sclerosis at 15–17 weeks of age, no Greyhound had a caudolateral curvilinear osteophyte or circumferential femoral head osteophyte at 24–27 or 52 weeks of age. No significant relationship was found between occurrence of a puppy line, a circumferential femoral head osteophyte or femoral metaphyseal sclerosis at 15–17 weeks and canine hip dysplasia or degenerative joint disease incidence at 42–52 weeks. Presence of a caudolateral curvilinear osteophyte in at least one hip at 24–27 weeks was significantly related to the diagnosis of canine hip dysplasia by 42–52 weeks. When both a caudolateral curvilinear osteophyte and a circumferential femoral head osteophyte were present in a hip at 24–27 weeks, degenerative joint disease was evident in all such hips by 42–52 weeks of age.     

Subsidence of an Uncemented Canine Femoral Stem

Factors contributing to subsidence were analyzed by radiographic evaluation and mechanical testing of 36 canine cadaver femora during and after insertion of an uncemented porous-coated femoral stem and by radiographic evaluation of 35 canine total hip arthroplasties. Mean percentage of canal fill in immediate postoperative radiographs, and percentage of canal fill at midimplant and distal implant locations, were accurate predictors of subsidence. Force required to implant the femoral stem was strongly correlated with force required for implant subsidence. Femoral morphology and percentage of canal fill at the middle and distal sites were accurate predictors of subsidence. Implants in femora with a stovepipe morphology (canal flare index ≤ 1.8) were six times more likely to subside than implants in femora that had a normal appearance (canal flare index 1.8 to 2.5), and 72 times more likely to subside than implants in champagne-fluted femora (canal flare index ≥ 2.5). Femora with more than 85% mean, middle, or distal canal fill were less likely to subside.     

Venous drainage of the femoral neck in Legg Perthes disease and in hip dysplasia. A clinical and experimental study in the dog and pig

Three clinical cases of canine avascular femoral head necrosis and 4 cases of hip dysplasia were examined using intraosseus femoral neck venography. The contrast medium passed initio the diaphyseal bone marrow in all cases. Three growing dogs and 7 growing pigs were examined with the same method, before and after experimental ligation of the femoral veins. Before the venous tamponade, no contrast medium was visible in the femoral neck. The venography performed immediately after ligation showed contrast flow into the femoral neck similar to that seen in the clinical cases of Legg Perthes disease or hip dysplasia. However, a collateral circulation developed within 7 weeks. No more contrast-flow into the diaphysis was observed after that time.Although osteomedullography shows that both in Perthes disease and in hip dysplasia venous drainage has failed, venous tamponade may not induce the onset of the disease.Key words: hip dysplasia, Legg Perthes disease, osteomedullography     

CANINE HIP DYSPLASIA

It is the purpose of this study to call attention to new bone production that often occurs early in the sequence of pathological changes associated with canine hip dysplasia. New bone production extending to bony remodeling, as well as femoral head subluxation, both occur in the sequence of pathologic changes associated with canine hip dysplasia. Subluxation is considered primary, while osteoarthrosis is a secondary feature, and both are used in the diagnosis of canine hip dysplasia. This report concerns the significance of the presence of a solitary bony osteophyte, or spur, that is frequently evident on the caudal aspect of the femoral neck as viewed on the conventional ventrodorsal projection. This report utilizes findings from pelvic radiographs of 605 dogs (five breeds). There was a greater frequency (54%)of this bony change in cases diagnosed radiographically as dysplastic than in cases diagnosed as normal(15%).Thus, it is suggested that this minimal radiographic change can be used as an indicator of early canine hip dysplasia, especially in the absence of subluxation of the femoral head.     

Retrospective analysis of canine miniature total hip prostheses

OBJECTIVE: To determine the practicality and clinical outcome of miniature total hip replacement (THR) in dogs. STUDY DESIGN: Retrospective study. Sample Population- Seventeen client-owned dogs that had miniature THR. METHODS: Patient data surveyed included signalment, body weight, diagnosis, implant size, surgical technique, and intraoperative and postoperative complications. Radiographic evaluation included angle of lateral opening of the acetabular component, implant positioning, cement mantle quality, and femoral displacement measurement and ratio. Client questionnaire and orthopedic examination were used to obtain long-term follow-up information. RESULTS: Miniature THR was performed to address hip dysplasia and secondary osteoarthritis. In 1 dog, a staged bilateral procedure was performed. Mean body weight was 19 kg (range, 12 to 25 kg). Penetration or fissure of the femoral cortex was the most common intraoperative complication and occurred in 3 dogs. In 3 dogs, there was excessive coxofemoral laxity after reduction of the prosthesis. This instability was addressed specifically in 2 dogs by capsulorrhaphy or capsular prosthesis. Postoperative convalescent complications (craniodorsal luxation, 2 dogs; acetabular cup displacement, 1 dog) were related to surgical errors. Aseptic loosening of the femoral implant was diagnosed in 1 dog at 18 months. Mean follow-up time was 17 months (range, 4 to 42 months). Fifteen of 18 (83%) miniature THRs had good or excellent outcomes. CONCLUSIONS: Miniature THR should be considered a satisfactory alternative to femoral head and neck ostectomy in medium-size dogs affected by hip dysplasia and secondary osteoarthritis. The population of medium-size dogs that might derive more benefit from THR than FHO has yet to be defined. CLINICAL RELEVANCE: Miniature THR is a viable treatment option in medium-size dogs with hip dysplasia.     

Short-term evaluation of dorsal acetabular augmentation in 10 canine total hip replacements

OBJECTIVE: To report the use of dorsal acetabular augmentation (DAA) in canine total hip arthroplasty (THA) and to evaluate the clinical and radiographic outcome after a minimum of 1 year follow-up. STUDY DESIGN: Clinical study. ANIMALS: Nine dogs that had THA. METHODS: Ten hips requiring acetabular augmentation for optimum acetabular cup implantation for THA were evaluated retrospectively. The excised femoral head and neck was used as the corticocancellous bone graft for index THA surgeries, and the dorsal crest of the ipsilateral ilial wing was used as the bone graft in 1 dog that had a revision surgery. Clinical and radiographic follow-up examinations were performed at approximately 8 weeks and 1 year postoperatively. Long-term radiographic examinations included use of a standing dorsal acetabular rim (DAR) projection for assessment of graft-recipient boundary. Functional clinical outcome was assessed using direct patient evaluation and telephone interview. RESULTS: One dog failed to regain limb function after surgery. Suspected aseptic loosening of the acetabular cup was observed on radiographs approximately 12 weeks postoperatively. Excluding this single explantation, follow-up physical and radiographic examinations indicated good implant and graft positioning and normal function for all dogs. CONCLUSIONS: Acetabular augmentation permitted implantation of an appropriately sized acetabular cup while maintaining complete DAR coverage of the prosthesis. Nine out of 10 hips had a successful outcome with minimal radiographic and no functional abnormalities. Further follow-up is necessary to determine the long-term outcome of DAR augmentation in canine THA. CLINICAL RELEVANCE: Acetabular augmentation with an autogenous corticocancellous bone graft constructed from the femoral head and neck can provide complete DAR coverage to permit use of an appropriately sized acetabular cup in THA.     

A Comparison of Standard Femoral Head and Neck Excision and Femoral Head and Neck Excision Using a Biceps Femoris Muscle Flap in the Dog

Sixteen normal 20 to 30 kg dogs had standard femoral head and neck excision (8 dogs) or femoral head and neck excision with interposition of a biceps muscle flap (8 dogs). Lameness lessened at week 6, and did not differ between groups; neither group returned to a completely normal gait. Weightbearing decreased on the operated pelvic limb compared to controls (forceplate analysis). Weightbearing force of the muscle flap dogs was significantly less at weeks 6 and 16 than that of the standard femoral head and neck excision dogs. The operated limb of both groups was shortened; shortening was significantly greater for the muscle flap group. Hip extension was limited in both groups. Both groups had decreased (more acute) hip, stifle, and hock angles measured in standing position. Thigh muscle atrophy was more pronounced in the muscle flap group at week 6. More soft tissue was interposed in the muscle flap group at necropsy compared to the group with standard femoral head and neck excision, but the difference was not statistically significant. Skeletal muscle fibers were present in the interposed fibrous connective tissue of the muscle flap group, and the healed surfaces were smoother than those of the standard femoral head and neck excision group.     

The Effects of Implant Orientation, Canal Fill, and Implant Fit on Femoral Strain Patterns and Implant Stability During Catastrophic Testing of a Canine Cementless Femoral Prosthesis

Cementless femoral stems were placed into 12 normal greyhound femora. The implanted femora were divided into three groups by stem orientation and implant size and loaded in axial compression at a rate of 25 newtons (N) per second until failure. Rosette strain gauges were used to measure femoral principal strains at 500 N, 1,000 N, 1,500 N, and at maximum load. During maximum load, varus orientation of the femoral stem had significantly higher tensile hoop strains in the proximomedial cortex, whereas neutral orientation had higher tensile hoop strains along the cranial cortex. Femoral fractures occurred in these areas of peak tensile strain. There was no difference in maximum load between groups, therefore varus orientation did not predispose to fracture. Maximizing canal fill and implant fit increased implant stability.     

Assessment of stiffness and strength of 4 different implants available for equine fracture treatment: a study on a 20 degrees oblique long-bone fracture model using a bone substitute

OBJECTIVE: To compare the mechanical properties of 4 stabilization methods for equine long-bone fractures: dynamic compression plate (DCP), limited contact-DCPlate (LC-DCP), locking compression plate (LCP), and the clamp-rod internal fixator (CRIF--formerly VetFix). STUDY DESIGN: In vitro mechanical study. SAMPLE POPULATION: Bone substitute material (24 tubes) was cut at 20 degrees to the long axis of the tube to simulate an oblique mid-shaft fracture. METHODS: Tubes were divided into 4 groups (n=6) and double plated in an orthogonal configuration, with 1 screw of 1 implant being inserted in lag fashion through the "fracture". Thus, the groups were: (1) 2 DCP implants (4.5, broad, 10 holes); (2) 2 LC-DCP implants (5.5, broad, 10 holes); (3) 2 LCP implants (4.5/5.0, broad, 10 holes) and 4 head locking screws/plate; and (4) 2 CRIF (4.5/5.0) and 10 clamps in alternating position left and right of the rod. All constructs were tested in 4-point bending with a quasi-static load until failure. The implant with the interfragmentary screw was always positioned on the tension side of the construct. Force, displacement, and angular displacement at the "fracture" line were determined. Construct stiffness under low and high loads, yield strength, ultimate strength, and maximum angular displacement were determined. RESULTS: None of the implants failed; the strength of the bone substitute was the limiting factor. At low loads, no differences in stiffness were found among groups, but LCP constructs were stiffer than other constructs under high loads (P=.004). Ultimate strength was lowest in the LCP group (P=.01), whereas yield strength was highest for LCP constructs (409 N m, P=.004). CRIF had the lowest yield strength (117 N m, P=.004); no differences in yield strength (250 N m) were found between DCP and LC-DCP constructs. Differences were found for maximum angular displacement at the "fracture" line, between groups: LPC相似文献