Arthrodesis of the equine proximal interphalangeal joint: a biomechanical comparison of three 4.5-mm and two 5.5-mm cortical screws

OBJECTIVE--To compare the biomechanical characteristics and mode of failure of 2 parallel-screw techniques for proximal interphalangeal joint arthrodesis in horses. STUDY DESIGN--Randomized block design, blocking for horse (1-5), method of screw fixation (three 4.5-mm vs two 5.5-mm), side (left limb vs right limb), and end (front limb vs hind limb). Constructs were loaded to failure in 3-point bending in a dorsal-to-palmar (plantar) direction. SAMPLE POPULATION--Twenty limbs (10 limb pairs) from 5 equine cadavers. METHODS--A combined aiming device was used to facilitate consistent screw placement. Three parallel 4.5-mm cortical screws were placed in lag fashion in 1 limb of a pair, and 2 parallel 5.5-mm cortical screws were placed in lag fashion in the contralateral limb. Arthrodesis constructs were tested in 3-point bending in a dorsal-to-palmar (plantar) direction using a materials-testing machine. Loading rate was 19 mm/s. Maximal bending moment at failure and composite stiffness were obtained from bending moment-angular deformation curves. Data were analyzed using ANOVA and chi(2) analysis. RESULTS--There were no significant differences in bending moment (P >.05, power = 0.8 @ delta = 19%) or composite stiffness (P >.05, power = 0.8 @ delta = 19%) between the 2 fixation techniques. Higher maximal bending moment was found in front limbs than hind limbs, and front limbs with two 5.5-mm screws than hind limbs with two 5.5-mm screws. In all cases, constructs completely failed. A greater number of 4.5-mm cortical screws failed than 5.5-mm cortical screws. CONCLUSIONS-In pastern arthrodesis constructs loaded in 3-point bending, end (front limb vs hind limb) affected maximal bending moment at failure of constructs. There was no significant effect of horse, treatment, or side on maximal bending moment or stiffness. Two 5.5-mm cortical screws should provide a surgically simpler pastern arthrodesis than three 4.5-mm cortical screws while maintaining similar biomechanical characteristics. CLINICAL RELEVANCE--Three 4.5-mm screws or two 5.5-mm screws will provide similar biomechanical characteristics in bending when performing equine pastern arthrodesis.     

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.     

Arthrodesis of the Proximal Interphalangeal Joint in the Horse: A Cyclic Biomechanical Comparison of Two and Three Parallel Cortical Screws Inserted in Lag Fashion

Objective— To compare the biomechanical cyclic fatigue properties of 2 and 3 parallel transarticular 5.5 mm cortical screws used in arthrodesis of the proximal interphalangeal (PIP) joint.
Study Design— Randomized block design, for horse, fixation method (2 versus three 5.5 mm cortical screws), side (right, left) and end (front, hind) in cadaveric equine limbs.
Sample Population— Cadaveric adult equine fore- and hindlimbs (n=5 pairs each).
Methods— Two parallel 5.5 mm cortical screws were inserted in lag fashion, transarticularly through the PIP joint in 1 limb of a pair, and in the contralateral limb, three 5.5 mm cortical screws were inserted in similar fashion. Constructs were then tested in 3-point bending in a dorsal-to-palmar (plantar) direction using a materials testing machine using a cyclic load of −500 to −3500 N at a rate of 6 Hz.
Results— There was no significant difference in displacement at failure, force at failure or number of cycles between limbs. Forelimb constructs tended to fail at a greater mean displacement than hindlimb constructs but this difference was not significant ( P =.06). There was no statistical difference in any tested biomechanical variable between left- and right-sided limbs.
Conclusions— There was no significant difference in the number of cycles to failure for the 2 methods tested.
Clinical Relevance— Two 5.5 mm cortical screws inserted in parallel for PIP joint arthrodesis is surgically simpler, results in comparable biomechanical performance in the current model and should perform as well as three 5.5 mm screws under cyclic fatigue conditions.     

A mechanical comparison of equine proximal interphalangeal joint arthrodesis techniques: an axial locking compression plate and two abaxial transarticular cortical screws versus an axial dynamic compression plate and two abaxial transarticular cortical screws

Objectives: To compare in vitro monotonic biomechanical properties of an axial 3‐hole, 4.5 mm narrow locking compression plate (ELCP) using 5.0 mm locking screws and 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (ELCP–TLS) with an axial 3‐hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (DCP–TLS) for equine proximal interphalangeal (PIP) joint arthrodesis. Design: Experimental. Animal Population: Cadaveric adult equine forelimbs (n=18 pairs). Methods: For each forelimb pair, 1 PIP joint was stabilized with an axial ELCP using 5.0 mm locking screws and 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion and 1 PIP joint with an axial 3‐hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion. Six matching pairs of constructs were tested in single cycle to failure under axial compression, 6 construct pairs were tested for cyclic fatigue under axial compression, and 6 construct pairs were tested in single cycle to failure under torsional loading. Mean values for each fixation method were compared using a paired t‐test within each group with statistical significance set at P<.05. Results: Mean yield load, yield stiffness, and failure load under axial compression, single cycle to failure, of the DCP–TLS fixation were significantly greater than those of the LCP–TLS fixation. There was no significant difference between the mean number of cycles to failure in axial compression of the LCP–TLS and the DCP–TLS fixations. Mean yield load, yield stiffness, and failure load under torsion, single cycle to failure, of the LCP–TLS fixation were significantly greater than those of the DCP–TLS fixation. Conclusion: The DCP–TLS construct provided significantly greater stability under axial compression in single cycle to failure than the ELCP–TLS construct, the ELCP–TLS construct provided significantly greater stability under torsional loading in single cycle to failure than the DCP–TLS construct, and there was no significant difference in stability between the 2 constructs for cyclic loading under axial compression.     

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.     

Arthrodesis of the equine proximal interphalangeal joint: a biomechanical comparison of 3-hole 4.5 mm locking compression plate and 3-hole 4.5 mm narrow dynamic compression plate, with two transarticular 5.5 mm cortex screws

Objectives: To compare the biomechanical characteristics of 2 arthrodesis techniques for the equine proximal interphalangeal joint (PIP) using either a 3‐hole 4.5 mm locking compression plate (LCP) or 3‐hole 4.5 mm narrow dynamic compression plate (DCP), both with 2 transarticular 5.5 mm cortex screws. Study Design: Experimental. Sample Population: Cadaveric adult equine forelimbs (^*n=6 pairs). Methods: For each forelimb pair, 1 limb was randomly assigned to 1 of 2 treatment groups and the contralateral limb by default to the other treatment group. Construct stiffness, gap formation across the PIP joint, and rotation about the PIP joint were determined for each construct before cyclic axial loading and after each of four, 5000 cycle loading regimens. After the 20,000 cycle axial loading regimen, each construct was loaded to failure. Results: There were no significant differences in construct stiffness, gap formation, or sagittal plane rotation between the LCP and DCP treatment groups at any of the measured time points. Conclusion: Biomechanically, fixation of the equine PIP joint with a 3‐hole 4.5 mm LCP is equivalent to fixation with a 3‐hole 4.5 mm narrow DCP under the test conditions used.     

Comparison of a 3-hole 4.5-mm Dynamic Compression Plate and a 7-hole 5.5-mm Y Locking Compression Plate for Arthrodesis of the Proximal Interphalangeal Joint in Horses—an Ex Vivo Biomechanical Study

The objective of this study was to compare the biomechanical properties in a single cycle axial loading test and the types of failures in two constructs (a 3-hole 4.5-mm dynamic compression plate (DCP) and 7-hole 5.5-mm Y locking compression plate (Y-LCP)) in equine proximal interphalangeal joint (PIJ) arthrodesis. One limb in each pair was randomly assigned to PIJ arthrodesis using a 3-hole 4.5-mm DCP combined with two transarticular 5.5-mm cortical screws, whereas the contralateral limb was submitted to PIJ arthrodesis using a 7-hole Y-shaped 5.0-mm LCP in conjunction with one transarticular 4.5-mm cortical screw inserted through the central plate hole. Cortical screws were inserted in lag fashion. Constructs were submitted to a single axial load cycle to failure. Construct stiffness, load, and deformation were analyzed. Dynamic compression plate and Y-LCP arthrodesis constructs did not differ significantly and were equally resistant to axial loading under the conditions studied (DCP and Y-LCP group stiffness, 5685.22 N/mm and 6591.10 N/mm, respectively). Arthrodesis of the PIJ using a DCP and two transarticular 5.5-mm cortical screws or a Y-LCP yielded biomechanically equivalent outcomes under the test conditions considered. However, Y-LCP provides less impact in the palmar/plantar bone. Application of Y-LCP with unicortical screws has equivalent biomechanical characteristics of DCP and may be a safe option for PIJ arthrodesis, where potential trauma secondary to applying bicortical screws in the palmar/plantar aspect of the pastern can be avoided.     

An in vitro biomechanical comparison between prototype tapered shaft cortical bone screws and AO cortical bone screws for an equine metacarpal dynamic compression plate fixation of osteotomized equine third metacarpal bones

OBJECTIVES: To compare biomechanical properties of a prototype 5.5 mm tapered shaft cortical screw (TSS) and 5.5 mm AO cortical screw for an equine third metacarpal dynamic compression plate (EM-DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. STUDY DESIGN: Paired in vitro biomechanical testing of cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. ANIMAL POPULATION: Adult equine cadaveric MC3 bones (n=12 pairs). METHODS: Twelve pairs of equine MC3 were divided into 3 groups (4 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 EM-DCP (10-hole, 4.5 mm) was applied to the dorsal surface of each, mid-diaphyseal osteotomized, MC3 pair. For each MC3 bone pair, 1 was randomly chosen to have the EM-DCP secured with four 5.5 mm TSS (2 screws proximal and distal to the osteotomy; TSS construct), two 5.5 mm AO cortical screws (most proximal and distal holes in the plate) and four 4.5 mm AO cortical screws in the remaining holes. The control construct (AO construct) had four 5.5 mm AO cortical screws to secure the EM-DCP in the 2 holes proximal and distal to the osteotomy in the contralateral bone from each pair. The remaining holes of the EM-DCP were filled with two 5.5 mm AO cortical screws (most proximal and distal holes in the plate) and four 4.5 mm AO cortical screws. All plates and screws were applied using standard AO/ASIF techniques. Mean test variable values for each method were compared using a paired t-test within each group. Significance was set at P<.05. RESULTS: Mean 4-point bending yield load, yield bending moment, bending composite rigidity, failure load and failure bending moment of the TSS construct were significantly greater (P<.00004 for yield and P<.00001 for failure loads) than those of the AO construct. Mean cycles to failure in 4-point bending of the TSS construct was significantly greater (P<.0002) than that of the AO construct. The mean yield load and composite rigidity in torsion of the TSS construct were significantly greater (P<.0039 and P<.00003, respectively) than that of the AO construct. CONCLUSION: The TSS construct provides increased stability in both static overload testing and cyclic fatigue testing. CLINICAL RELEVANCE: The results of this in vitro study support the conclusion that the EM-DCP fixation using the prototype 5.5 mm TSS is biomechanically superior to the EM-DCP fixation using 5.5 mm AO cortical screws for the stabilization of osteotomized equine MC3.     

An in vitro biomechanical comparison of equine proximal interphalangeal joint arthrodesis techniques: two parallel transarticular headless tapered variable pitch screws versus two parallel transarticular AO cortical bone screws inserted in lag fashion

Objectives: To compare the mean number of cycles to failure under axial compression of equine proximal interphalangeal (PIP) joint arthrodesis constructs created by 2 parallel transarticular Acutrak Plus screws (AP‐TS) or 2 parallel transarticular 5.5 mm cortical screws inserted in lag fashion (AO‐TLS). Study Design: Paired in vitro biomechanical testing of 2 methods of stabilizing cadaveric adult equine forelimb PIP joints. Sample Population: Cadaveric adult equine forelimbs (n=5 pairs). Methods: For each forelimb pair, 1 PIP joint was stabilized with AP‐TS and 1 with AP‐TLS. The 5 construct pairs were tested for cyclic fatigue under axial compression. Mean number of cycles to failure for each fixation method were compared by a paired t‐test within each group with statistical significance set at P<.05. Results: The mean number of cycles to failure under axial compression for AO‐TLS fixation and AP‐TS fixation were 57,723±8488 and 35,322±4698, respectively. Conclusion: The AO‐TLS was superior to the AP‐TS in resisting cyclic fatigue under axial compression.     

In vitro biomechanical comparison of equine proximal interphalangeal joint arthrodesis techniques: prototype equine spoon plate versus axially positioned dynamic compression plate and two abaxial transarticular cortical screws inserted in lag fashion

Objectives— To compare in vitro monotonic biomechanical properties of an equine spoon plate (ESP) with an axial 3‐hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws (DCP‐TLS) inserted in lag fashion for equine proximal interphalangeal (PIP) joint arthrodesis. Study Design— Paired in vitro biomechanical testing of 2 methods of stabilizing cadaveric adult equine forelimb PIP joints. Animal Population— Cadaveric adult equine forelimbs (n=18 pairs). Methods— For each forelimb pair, 1 PIP joint was stabilized with an ESP (8 hole, 4.5 mm) and 1 with an axial 3‐hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion. Six matching pairs of constructs were tested in single cycle to failure under axial compression with load applied under displacement control at a constant rate of 5 cm/s. Six construct pairs were tested for cyclic fatigue under axial compression with cyclic load (0–7.5 kN) applied at 6 Hz; cycles to failure were recorded. Six construct pairs were tested in single cycle to failure under torsional loading applied at a constant displacement rate (0.17 radians/s) until rotation of 0.87 radians occurred. Mean values for each fixation method were compared using a paired t‐test within each group with statistical significance set at P<.05. Results— Mean yield load, yield stiffness, and failure load for ESP fixation were significantly greater (for axial compression and torsion) than for DCP‐TLS fixation. Mean (± SD) values for the ESP and DCP‐TLS fixation techniques, respectively, in single cycle to failure under axial compression were: yield load 123.9 ± 8.96 and 28.5 ± 3.32 kN; stiffness, 13.11 ± 0.242 and 2.60 ± 0.17 kN/cm; and failure load, 144.4 ± 13.6 and 31.4 ± 3.8 kN. In single cycle to failure under torsion, mean (± SD) values for ESP and DCP‐TLS, respectively, were: stiffness 2,022 ± 26.2 and 107.9 ± 11.1 N m/rad; and failure load: 256.4 ± 39.2 and 87.1 ± 11.5 N m. Mean cycles to failure in axial compression of ESP fixation (622,529 ± 65,468) was significantly greater than DCP‐TLS (95,418 ± 11,037). Conclusion— ESP was superior to an axial 3‐hole narrow DCP with 2 abaxial transarticular screws inserted in lag fashion in resisting static overload forces and cyclic fatigue. Clinical Relevance— In vitro results support further evaluation of ESP for PIP joint arthrodesis in horses. Its specific design may provide increased stability without need for external coaptation support.     

An In Vitro Biomechanical Comparison of Equine Proximal Interphalangeal Joint Arthrodesis Techniques: An Axial Positioned Dynamic Compression Plate and Two Abaxial Transarticular Cortical Screws Inserted in Lag Fashion Versus Three Parallel Transarticular Cortical Screws Inserted in Lag Fashion

Objectives— To compare in vitro monotonic biomechanical properties of an axial 3‐hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (DCP‐TLS) with 3 parallel transarticular 5.5 mm cortical screws inserted in lag fashion (3‐TLS) for the equine proximal interphalangeal (PIP) joint arthrodesis. Study Design— Paired in vitro biomechanical testing of 2 methods of stabilizing cadaveric adult equine forelimb PIP joints. Sample Population— Cadaveric adult equine forelimbs (n=15 pairs). Methods— For each forelimb pair, 1 PIP joint was stabilized with an axial 3‐hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion and 1 with 3 parallel transarticular 5.5 mm cortical screws inserted in lag fashion. Five matching pairs of constructs were tested in single cycle to failure under axial compression, 5 construct pairs were tested for cyclic fatigue under axial compression, and 5 construct pairs were tested in single cycle to failure under torsional loading. Mean values for each fixation method were compared using a paired t‐test within each group with statistical significance set at P<.05. Results— Mean yield load, yield stiffness, and failure load under axial compression and torsion, single cycle to failure, of the DCP‐TLS fixation were significantly greater than those of the 3‐TLS fixation. Mean cycles to failure in axial compression of the DCP‐TLS fixation was significantly greater than that of the 3‐TLS fixation. Conclusion— The DCP‐TLS was superior to the 3‐TLS in resisting the static overload forces and in resisting cyclic fatigue. Clinical Relevance— The results of this in vitro study may provide information to aid in the selection of a treatment modality for arthrodesis of the equine PIP joint.     

Proximal interphalangeal joint arthrodesis in 34 horses using two parallel 5.5-mm cortical bone screws

OBJECTIVE: To report clinical experience with arthrodesis of the proximal interphalangeal joint in horses using two parallel 5.5-mm cortical bone screws placed in lag fashion. STUDY DESIGN: Retrospective, clinical study. ANIMALS: Thirty-four horses, aged 1 to 19 years. METHODS: Medical records for all horses admitted (1991-1997) for pastern arthrodesis using two 5.5-mm ASIF cortical bone screws, in parallel orientation, and placed in lag fashion by use of a combined aiming device to facilitate accuracy were reviewed. Signalment, lameness diagnosis, duration of lameness, limb(s) involved, and outcome were recorded. Criteria for successful outcome were determined as return to previous level of function or future intended athletic use. RESULTS: Thirty-nine proximal interphalangeal joint arthrodeses were performed on 34 horses. One horse was euthanatized in the recovery room and was excluded from data analysis. Successful outcome occurred in 85% of frontlimbs and 89% of hindlimbs. Failure occurred in 5 joints; 1 horse had lameness directly associated with surgery, whereas 4 horses had unrelated lameness. CONCLUSION AND CLINICAL RELEVANCE: Age, breed, and initial disease did not affect outcome. Arthrodesis of the proximal interphalangeal joint by use of two 5.5-mm ASIF cortical bone screws, in parallel orientation, placed in lag fashion by use of a combined aiming device, resulted in sound use of the limb in >85% of the joints with shortened postoperative coaptation.     

Effect of bone diameter and eccentric loading on fatigue life of cortical screws used with interlocking nails

OBJECTIVE: To test the effects of bone diameter and eccentric loading on fatigue life of 2.7-mm-diameter cortical bone screws used for locking a 6-mm-diameter interlocking nail. SAMPLE POPULATION: Eighteen 2.7-mm-diameter cortical bone screws. PROCEDURE: A simulated bone model with aluminum tubing and a 6-mm-diameter interlocking nail was used to load screws in cyclic 3-point bending. Group 1 included 6 screws that were centrally loaded within 19-mm-diameter aluminum tubing. Group 2 included 6 screws that were centrally loaded within 31.8-mm-diameter aluminum tubing. Group 3 included 6 screws that were eccentrically loaded (5.5 mm from center) within 31.8-mm-diameter aluminum tubing. The number of cycles until screw failure and the mode of failure were recorded. RESULTS: An increase in the diameter of the aluminum tubing from 19 to 31.8 mm resulted in a significant decrease in the number of cycles to failure (mean +/- SD, 761,215 +/- 239,853 to 16,941 +/- 2,829 cycles, respectively). Within 31.8-mm tubing, the number of cycles of failure of eccentrically loaded screws (43,068 +/- 14,073 cycles) was significantly greater than that of centrally loaded screws (16,941 +/- 2,829 cycles). CONCLUSIONS AND CLINICAL RELEVANCE: Within a bone, locking screws are subjected to different loading conditions depending on location (diaphyseal vs metaphyseal). The fatigue life of a locking screw centrally loaded in the metaphyseal region of bone may be shorter than in the diaphysis. Eccentric loading of the locking screw in the metaphysis may help to improve its fatigue life.     

A Biomechanical Comparison of 7-Hole 3.5 mm Broad and 5-Hole 4.5 mm Narrow Dynamic Compression Plates

Seven-hole 3.5 mm broad and 5-hole 4.5 mm narrow dynamic compression plates were applied to paired canine cadaveric tibias in a stable fracture model. Paired tibias were tested to acute failure in rotation and four-point bending, and to fatigue failure in four-point bending. Resistance to screw pullout was measured for three 3.5 mm cortical screws and two 4.5 mm cortical screws inserted in the configurations of the bone plates. All plate-bone systems failed by fracture of the bone through a screw hole. The 3.5 mm plate-bone system was stronger in acute failure in rotation and in four-point bending. There was no difference in stiffness, and no difference in the number of cycles to failure in fatigue testing. Three 3.5 mm screws had greater resistance to pullout than two 4.5 mm screws. Results indicate that the 7-hole 3.5 mm broad dynamic compression plate has a biomechanical advantage over the 5-hole 4.5 mm narrow dynamic compression plate.     

A mechanical comparison of 4.5 mm narrow and 3.5 mm broad plating systems for stabilization of gapped fracture models

OBJECTIVE: To evaluate and compare the mechanical properties of 4.5 narrow and 3.5 broad plating systems using their respective cortical and cancellous screws in unstable, central, and eccentric gap fracture models. STUDY DESIGN: Mechanical evaluation and comparison of 2 dynamic compression plate (DCP) systems. SAMPLE POPULATION: Eighteen cortical and 30 cancellous gapped fracture models. METHODS: DCP (4.5 mm narrow, 3.5 mm broad) with their respective cortical screws were applied to cortical bone density polyurethane foam blocks to construct center gap cortical fracture models that were tested in gap closing monotonic 4-point bending. DCP (4.5 mm narrow, 3.5 mm broad) with their respective cancellous screws were applied to cancellous bone density polyurethane foam blocks to construct eccentric gap cancellous fracture models. The cancellous constructs were tested in monotonic gap opening and gap closing cantilever bending and in cyclic axial loading. Univariate and multivariate repeated measures ANOVA were used to compare the maximum loads at failure of the 4.5 mm constructs and 3.5 mm constructs. RESULTS: The 4.5 mm narrow plating system withstood significantly higher loads at failure than the 3.5 mm broad plating system in 4-point bending (P<.0001) and gap opening cantilever bending (P<.0001). The 4.5 mm system failed in gap closing cantilever bending by plastic deformation of the plate, whereas the 3.5 mm system failed by screw pullout. There was no difference between the 2 systems in cyclic axial loading. CONCLUSION: Results indicate that the 4.5 mm narrow plating system has a mechanical advantage over the 3.5 mm broad plating system for stabilization of gapped fracture models. CLINICAL RELEVANCE: The 4.5 mm narrow plating system may be mechanically advantageous compared with the 3.5 mm broad plating system for stabilizing unreconstructed comminuted long bone fractures in large dogs.     

Effect of a collateral ligament sparing surgical approach on mechanical properties of equine proximal interphalangeal joint arthrodesis constructs

Objective: To (1) compare the effect of a collateral ligament sparing surgical approach with an open surgical approach on mechanical properties of proximal interphalangeal joint (PIPJ) arthrodesis, and (2) to determine the percentage of articular cartilage surface removed by transarticular (TA) drilling with different diameter drill bits. Study Design: Randomized paired limb design. Sample Population: Cadaveric equine limbs (n=76). Methods: Cadaveric PIPJ were drilled using a 3.5, 4.5, or 5.5 mm drill bit at 80–84° to the dorsal plane to remove articular cartilage and subchondral bone from the distal articular surface of the proximal phalanx (P1) and the proximal articular surface of the middle phalanx (P2). Bone ends were photographed and the percentage of the projected surface area that was denuded of cartilage was measured. PIPJ arthrodesis constructs (3‐hole dynamic compression plate [DCP], two 5.5 mm TA screws inserted in lag fashion, medial and lateral to the DCP; DCP‐TA) were created using 2 surgical approaches in paired limbs. A conventional open approach was used in 1 limb and a collateral ligament sparing approach used in the other limb. Constructs were tested to failure in single‐cycle 3‐point dorsopalmar/plantar or lateromedial bending. Maximum load, yield load, and composite stiffness were compared between techniques. Results: The 3.5, 4.5, and 5.5 mm drill bits removed 24±4%, 35±5%, and 45±7% of total PIPJ articular cartilage surface, respectively. Constructs with the collateral ligament sparing approach had significantly greater mean yield load (11.3±2.8 versus 7.68±1.1 kN, P=.008) and mean maximum load (13.5±3.1 versus 10.1±1.94 kN, P=.02) under lateromedial bending. Under dorsopalmar/plantar bending there was no significant difference between surgical approaches. The collateral ligament sparing arthrodesis technique had a shorter surgical time (19±3 minutes) compared with the open technique (31±3 minutes). Conclusion: A collateral ligament sparing surgical approach to the PIPJ with removal of articular cartilage by TA drilling and arthrodesis by DCP‐TA was faster and stronger in mediolateral bending than arthrodesis constructs created with an open surgical approach. Clinical Relevance: Preservation of the collateral ligaments and TA drilling for cartilage removal during PIPJ arthrodesis may be a superior approach to the conventional open approach and warrants clinical evaluation.     

Holding power of cortical screws after power tapping and hand tapping.

Paired equine third metacarpal bones were drilled and tapped for 4.5 mm and 5.5 mm cortical screws. Tapping was done by hand or with an air-driven reversible orthopedic drill. Screws were inserted and subjected to extraction forces to failure of the osseous threads or the screws. There was no difference in holding power of either screw size between hand-tapped and power-tapped holes.     

Axial compression generated by cortical and cancellous lag screws in the equine distal phalanx

Lag screw fixation using single 4.5 mm cortical bone screws is a recommended technique for repair of mid-sagittal plane fractures of the distal phalanx in adult horses. However, implant infection and technical difficulties in obtaining adequate interfragmentary compression have made this surgical procedure somewhat controversial. We hypothesized that use of larger diameter screws would result in increased axial compression and improved stability of this fracture.Paired distal phalanges from the forelimbs of 10 adult horses were collected at necropsy and divided in half in the midsagittal plane. Using a randomized block study design, four types of bone screws (4.5 mm cortical, 5.5 mm cortical, 6.5 mm cancellous pre-tapped, and 6.5 mm cancellous non-tapped) were inserted to a depth of 15 mm. During screw insertion, the axial force generated under the screw head was measured with a load washer containing a piezoelectric force transducer, while torque of insertion was recorded with a torsional testing machine. The 6.5mm screw inserted after pre-tapping generated significantly greater axial force (2781 N) than the 4.5 mm (1522 N), 5.5 mm (2073 N) or 6.5 mm non-tapped (2295 N) screws. The relationship between maximal applied torque and axial force generated was linear for each screw type. Each unit of torque applied during insertion of cortical screws resulted in a greater increase in axial compression, as compared to cancellous screws. These data suggest that use of larger diameter screws would result in improved interfragmentary compression of distal phalangeal fractures.     

In vitro evaluation of screws and suture anchors in metaphyseal bone of the canine tibia

OBJECTIVE: To compare ease of insertion, load to failure, and mode of failure of cortical and cancellous screws, BoneBiter, IMEX, and TwinFix suture anchors in canine metaphyseal tibial bone. STUDY DESIGN: Experimental biomechanical study. ANIMALS: Canine cadaveric tibias. METHODS: One investigator inserted all anchors and subjectively evaluated ease of placement. Anchor systems were loaded to failure along axis of insertion with audio-video recording to determine failure mode. RESULTS: BoneBiter was the most difficult anchor to insert successfully. Mean+/-SD loads to failure were cancellous screw (711+/-193 N), IMEX 4.7 mm 18 g wire (661+/-163 N), IMEX 4.0 mm 18 g wire (661+/-165 N), cortical screw (635+/-184 N), BoneBiter #5 Kevlar suture (393+/- 109 N), and TwinFix 5.0 mm #2 polyester (267+/-73 N). No significant differences were noted among the cortical screw, cancellous screw, IMEX 4.7 and 4.0 mm, all of which were significantly (P<.001) greater than BoneBiter and TwinFix . Failure modes were pullout of bone, suture-wire breakage, eyelet breakage, or no failure to 1000 N: screws (18,0,0,2), IMEX (18,1,1,0), BoneBiter (2,8,0,0), and TwinFix (0,10,0,0). CONCLUSIONS: Fixation devices were user friendly, with the exception of BoneBiter. Mode of failure is dependent on suture material and anchor design. Cortical and cancellous screws, and IMEX anchors with 18 g wire have significantly greater load to failure compared with BoneBiter and TwinFix suture anchors. CLINICAL RELEVANCE: Based on load to failure, ease of use, design characteristics, and cost, IMEX anchors may have advantages over other comparable soft tissue fixation devices.     

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.