In vitro biomechanical properties of linear, circular, and hybrid external skeletal fixation devices for use in large ruminants

OBJECTIVE: To report the biomechanical properties of 3 external skeletal fixation (ESF) devices for use in large ruminants. STUDY DESIGN: In vitro biomechanical testing of ESF constructs. SAMPLE POPULATION: Adult buffalo (weighing, 250-350 kg) tibiae (n=27). METHODS: ESF constructs (bilateral linear fixator [BLF], 4-ring circular external fixator [CEF], and hybrid fixator [HF]) were made using mild (low carbon) steel implants plated with nickel and cadaveric buffalo tibiae. After ESF application, a 1 cm mid-diaphyseal gap was created. Constructs were loaded to failure, on a materials testing machine, in axial compression (n=5/ESF type) and craniocaudal bending (n=3/ESF type). In addition, 3 CEF constructs were tested in intact tibiae under craniocaudal bending. RESULT: In compression, HF was the strongest and most rigid construct; yield load was significantly higher for HF than for BLF or CEF. Under bending, both CEF and HF had similar strength and modulus of elasticity. Strength for BLF was higher than CEF and HF, whereas the reverse was true for modulus of elasticity. CONCLUSIONS: ESF made from mild steel for use in large ruminants could withstand相似文献   

An In Vitro Comparison of Hollow Ground and Trocar Points on Threaded Positive-Profile External Skeletal Fixation Pins in Canine Cadaveric Bone

OBJECTIVE: To compare the microstructural damage created in bone by pins with lathe-cut and rolled-on threads, and to determine the peak tip temperature and damage created by positive-profile external fixator pins with either hollow ground (HG) or trocar (T) tips during insertion. STUDY DESIGN: An acute, in vitro biomechanical evaluation. SAMPLE POPULATION: Twenty-seven canine tibiae. METHODS: Lathe-cut thread design with T point (LT-T), rolled-on thread design with T point (RT-T), and rolled-on thread design with HG point (RT-HG) pins were evaluated. Twenty pins of each type were inserted under constant drilling pressure into 12 canine tibiae (12 diaphyseal and 8 metaphyseal sites per pin type). Peak pin tip temperature, drilling energy, end-insertional pin torque, and pullout force were measured for each pin. For the histologic study, five pins of each type were inserted into cortical and cancellous sites in 15 additional tibiae. Entry and exit damage, and thread quality were assessed from 100 micron histologic sections by using computer-interfaced videomicroscopy. RESULTS: T-tipped pins reached higher tip temperature in both diaphyseal and metaphyseal bone compared with HG-tipped pins. RT-T pins had higher pullout strength (diaphyseal) and end-insertional torque compared with other combinations. No differences in drilling energy or insertional bone damage was found between the three pin types (P < .05). CONCLUSIONS: T-tipped pins mechanically outperformed HG-tipped pins. Pin tip and thread design did not significantly influence the degree of insertional bone damage. CLINICAL RELEVANCE: T-tipped pins may provide the best compromise between thermal damage and interface friction for maximizing performance of threaded external fixator pins.     

Evaluation of strength at the acrylic-pin interface for variably treated external skeletal fixator pins

Objective: To report pullout force to failure at the acrylic–pin interface for variably treated 3.2 mm external skeletal fixator pins. Study Design: In vitro biomechanical evaluation. Sample Population: 3.2 mm external skeletal fixator pins in polymethylmethacrylate bars. Methods: 3.2 mm external skeletal fixator pins were used for each of 5 treatment groups: polished, unpolished, 3 notched, 5 notched, and machine knurled. Each pin was seated into a 2‐cm‐diameter acrylic connecting bar and tested in pullout force to failure. Each group consisted of 6 pins. The force required to remove the pins from the acrylic bar was measured and compared between groups. Results: Significant differences between treatment groups were determined (P<.05). Within a construct group failure mode was consistent. Fracture of the acrylic bar was only seen with knurled pin ends. Conclusions: When using 2 cm acrylic bars in external skeletal fixation (ESF), a knurled pin shaft or a pin surface with 5 notches should be considered to improve the overall stability of the ESF construct.     

Two techniques for supplementing interlocking nail repair of fractures of the humerus, femur, and tibia: results in 12 dogs and cats

OBJECTIVE: To describe 2 devices for improving stabilization of inadequately stabilized interlocking nail (ILN) repairs of the humerus, tibia, and femur in dogs and cats. STUDY DESIGN: Prospective study. ANIMALS: Twelve client-owned dogs and cats. METHODS: Two devices to further stabilize ILN repair of inadequately stabilized diaphyseal fractures were developed. Device 1 was an axial extension for the ILN that was connected to a conventional type I external skeletal fixator (ESF) with a short connecting bar. Device 2 had hybrid ILN bolt/ESF pins that were used to lock the ILN and serve as the pins for a type I ESF. Devices were used at the initial surgery when the stability of ILN repair was considered inadequate based on palpable fracture segment movement, insufficient medullary canal filling of the ILN at the fracture site, or when the ILN was used in a buttress mode. Outcome was obtained by recheck examinations, radiography, and telephone interview. RESULTS: Device 1 was applicable to fractures of the humerus and femur, but was not used for fractures of the tibia because the ILN extension would have interfered with the stifle. No gross loosening of the ILN/ESF extension connection to the ILN occurred. Device 2 was easily placed and used in the humerus, femur, and tibia. Device 2 allowed removal of the ILN interlock to one or both main fracture segments non-invasively. Clinically, both devices added stability compared with ILN repair alone. Both devices facilitated controlled destabilization of the fracture repair as healing progressed. Complications of pin tract infection, and premature hybrid bolt/ESF pin loosening resulting in premature ESF removal each occurred in 1 patient. Four of 28 hybrid ILN/ESF pins were grossly loose at 4- or 6-week postoperative recheck examinations. Outcomes were excellent (9), good (1), fair (1), and poor (1). CONCLUSIONS: Inadequately stabilized ILN repair of fractures can be stabilized by use of either device, both of which also permit controlled destabilization of the repair during healing. Device 2 can be used when non-invasive removal of the ILN interlock is desired during healing. CLINICAL RELEVANCE: These 2 devices should be considered as alternative methods for stabilization of inadequately stabilized ILN repairs in dogs and cats, or when controlled destabilization of an ILN fracture repair is desired.     

Use of a new investigational interlocking nail supplement in the repair of comminuted diaphyseal tibia fractures in two dogs

Two dogs were diagnosed with highly comminuted diaphyseal tibial fractures following traumatic incidents. Investigational hybrid interlocking nail (ILN) bolt/external skeletal fixator (ESF) pins were used to repair both fractures. The surgery was successful, and fractures healed without complications by 6 weeks (case no. 1) and 17 weeks (case no. 2) after surgery. This article describes the application and the advantages of a new, investigational ILN supplement that was specifically designed to accomplish initial rigid stability and allow progressive destabilization to the fracture repair. The authors are continuing to study the biomechanical properties of this procedure in order to accurately establish clear recommendations for its use in certain fracture situations.     

A Comparison of Acute Pull-Out Strength Between Two-Way and One-Way Transfixation Pin Insertion for External Skeletal Fixation in Canine Bone

This study tested the hypothesis that two-way insertion of an external skeletal fixator trans-fixation pin would weaken the pin-bone interface. Smooth and partially threaded (end) trans-fixation pins were placed in tibiae of 32 cadavers by slow speed drilling or hand placement through a predrilled pilot hole. In one bone of each tibial pair, pins were inserted 2 cm beyond the distal cortex and retracted to a predetermined position (two-way). In the contralateral limb, the pins were inserted in one forward motion to the predetermined position (one-way). The peak force (Newtons) required to extract the pins (pull-out strength) axially at a rate of 1 mm/sec was determined by using a universal testing machine. A significant (p < .05) decrease in pull-out strength was found in pins placed by two-way insertion (674 +/- 410) as opposed to one-way insertion (766 +/- 432). The results of this in vitro study suggest that one-way insertion should be used clinically to decrease weakening of the pin-bone interface and prevent possible failure of external fixators. A significantly greater pull-out strength was found for threaded pins placed in the proximal diaphysis (1459 +/- 330 Newtons) compared to the distal metaphysis (873 +/- 297 Newtons).     

Management of femoral fractures in dogs with unilateral semicircular external skeletal fixators

Objective: To report use of semicircular external skeletal fixators (ESF) for management of femoral fractures in dogs. Study Design: Prospective clinical study. Animals: Dogs (n=16) with femoral fractures (n=18). Methods: A semicircular ESF system composed of 6‐hole 45° or 5‐hole 40° carbon‐fiber arches, 6 mm threaded rods, half pin fixation bolts, 6 mm nuts, and negative profile end‐threaded half pins were used for open repair of femoral fractures. ESF configuration, complications, limb use, fixator removal time, and functional outcomes were evaluated. Outcome was graded as excellent, good, fair, or poor. Results: Seventeen fractures with sufficient follow‐up healed. Eight dogs started using the limb immediately after waking up from anesthesia whereas initial limb use was 1–4 days after repair in the other dogs. Time to fixator removal ranged from 28 to 63 days (mean, 38 days). Functional outcome was excellent in 13 cases, good in 4, and poor in 1 nonunion. Conclusion: Semicircular ESF combined with open surgical reduction can be used to successfully repair metaphyseal and diaphyseal femoral fractures in young growing dogs.     

In Vitro Biomechanical and Histological Assessment of Pilot Hole Diameter for Positive-Profile External Skeletal Fixation Pins in Canine Tibiae

This study was conducted to evaluate the effect of pilot hole (PH) diameter (0, 1.5, 2.0, 2.7, 3.1, 3.3, 3.5, and 3.7 mm) on the biomechanical and microstructural performance of positive-profile threaded external skeletal fixation pins (3.18 mm inner diameter, 3.97 mm outer diameter) using cadaveric canine tibiae. Eight pins per pilot hole diameter (four pins per bone) were used to assess differences in end-insertional torque and pin pull-out strength. Histological evaluation of eight bicortical pin tracts per pilot hole diameter was accomplished using computer-interfaced videomicroscopy on specimens processed using a bulk-staining technique. Compared with no predrill, use of 2.7 mm PH increased end-insertional torque and pull-out strength by 25% and 13.5%, respectively. No significant differences were observed in biomechanical variables for the PH diameter range of 2.0 to 3.1 mm. Compared with no predrill, use of a 3.1 mm PH increased thread area by 18%. Microfracturing around the threads decreased as PH diameter increased. Damage to the interface at the entry and exit sites of both near and far cortices also decreased as PH diameter increased. It was concluded that predrilling a PH whose diameter approximates, but does not exceed the inner diameter of the positive profile pin will not only improve initial pin stability compared with no predrilling, but it will also reduce microstructural damage that may lead to excessive bone resorption and premature pin loosening.     

External fixation of the lumbar spine in a canine model

OBJECTIVE: To compare the mechanical properties of two types of external skeletal fixation of the lumbar spine with polymethylmethacrylate (PMMA)/Steinmann pin fixation in a canine unstable spine model. STUDY DESIGN: Cadaver study. SAMPLE POPULATION: Lumbar spines of 17 mature large-breed dogs. METHODS: Spine stiffness (N-m/deg) in flexion, extension, and rotation under physiological loading conditions and spine strength (N-m) in flexion were determined. Spines were destabilized at L3-L4, instrumented and retested. Fixation techniques included four-pin PMMA (PMMA4), eight-pin PMMA (PMMA8), eight-pin biplanar type I external skeletal fixator (ESF) (SK), and eight-pin spinal arch ESF (ARCHES). RESULTS: All fixation groups were as stiff as intact spines in extension and rotation and were significantly stiffer in flexion. In flexion, both PMMA8 and ARCHES were significantly stiffer than SK, and PMMA8 was significantly stiffer than PMMA4. In rotation, PMMA8 and ARCHES were significantly stiffer than SK, and in flexion to failure, PMMA8 and ARCHES were significantly stiffer than PMMA4. CONCLUSIONS: External skeletal spinal fixation (ESSF) has mechanical properties comparable to more commonly used PMMA/pin internal fixation techniques. CLINICAL RELEVANCE: External fixation of the canine spine has several potential advantages over internal fixation including minimal dissection for pin placement, the ability to span affected vertebrae with placement of implants distant from the site of injury, postoperative adjustability, and complete removal of implants after healing. This study supports the biomechanical stability ESSF of the canine lumbar spine. Further studies are indicated to evaluate zones of consistently safe and secure placement of pins and clinical efficacy.     

Effects of static fixation and dynamization after interlocking femoral nailing locked with an external fixator: an experimental study in dogs

OBJECTIVE: To determine bone healing at 20 weeks, after either static fixation (SG) or after dynamization (DG) at 4 weeks in osteotomized canine femurs repaired with an interlocking nail (ILN) secured with a type I external skeletal fixator (ESF). STUDY DESIGN: Experimental study. ANIMALS: Ten adult beagle dogs. METHODS: After mid-diaphyseal femoral osteotomy, femurs in 10 dogs were repaired with an ILN secured with 4 (2 proximal, 2 distal) threaded custom pins (TP; 2.7-mm-diameter cortical screw with a 2-mm shaft attached to the screw head) to which 2 parallel connecting bars were attached in a type I ESF configuration. In 5 dogs, dynamization was performed at 4 weeks by removing the connecting bars and 2 distal screws. Limb function, range of motion of the stifle joint (ROMSJ), radiographic evidence of bone healing, and complications were studied for 20 weeks. RESULTS: Full limb function was achieved between 8 and 10 weeks in SG dogs, but a decreased ROMSJ was observed from 5 to 8 weeks. In DG dogs, full limb function occurred between 5 and 6 weeks except in 1 dog, and ROMSJ was considered normal in all dogs. Bone healing was not affected by dynamization. Average healing time for SG was 12.8 weeks, and for DG it was 13.6 weeks. Periosteal reaction at TP insertion points, osteolysis around the thread and head of TPs were observed in both groups. A windshield-wiper effect was observed at the tip of 1 ILN. CONCLUSION: ILN locked with a type I ESF can be used for fixation of mid-shaft femoral fractures. Dynamization at 4 weeks did not affect bone healing but did prevent stifle ankylosis and promoted earlier limb function. CLINICAL RELEVANCE: ILN locked with a type I ESF is seemingly a feasible method for repair of mid-shaft femoral fractures and may decrease risk of nail failure.     

External skeletal fixation in the management of equine mandibular fractures: 16 cases (1988-1998)

Fifty-three cases of equine mandibular fractures were managed surgically from 1988-1998, of which 16 (30%) were repaired by external skeletal fixation (ESF). Three surgical methods were utilised: transmandibular 4.76 or 6.35 mm Steinmann pins incorporated into fibreglass casting material or nonsterile dental acrylic (methyl methacrylate - MMA) bars reinforced with steel; transmandibular 9.6 mm self-tapping threaded pins +/- 4.76 or 6.35 mm Steinmann pins incorporated into MMA bars reinforced with steel; and 4.5 mm or 5.5 mm ASIF cortical bone screws incorporated into MMA bars reinforced with steel or a ventral MMA splint. Fourteen horses were presented to the hospital for fixator removal at an average of 56.2 days. At removal, fractures were stable and occlusion of incisor and cheek teeth was considered adequate. Complications of the procedure occurred in 3 horses. Two horses with persistent drainage and ring sequestra from pin tracts required curettage 4 or 5 months after ESF removal. A third horse required replacement of the original fibreglass ESF with MMA bars to regain access to open, infected wounds. Another horse required removal of the second premolar at the time of fixator removal because the tooth root had been damaged in the original injury. ESF for the surgical management of mandibular fractures in horses has produced good results, with incisive and cheek tooth alignment reestablished in all horses. Horses that were managed via ESF had a rapid return to full feed and did not require any supplementation via nasogastric tube or oesophagostomy to maintain bodyweight or hydration status.     

Comparison of bone healing,as assessed by computed tomography,following tibial tuberosity advancement in dogs with and without autogenous cancellous bone grafts

Abstract

AIMS: To objectively compare measures of bone healing, using computed tomography (CT) in dogs following bilateral tibial tuberosity advancement (TTA), between tibiae treated with and without autogenous cancellous bone grafts.

METHODS: Ten dogs with bilateral cranial cruciate ligament disease requiring surgical stabilisation were prospectively recruited to undergo single-session bilateral TTA, with only one, randomly assigned, tibia receiving bone graft in the osteotomy deficit. Bone healing at the osteotomy site was assessed using CT performed 38–70 days post-operatively. CT images were evaluated using both objective measurements of osseous bridging and subjective evaluation by six radiologists. Repeated measures ANOVA was used to compare the objective outcomes between the grafted and non-grafted tibiae.

RESULTS: The mean percentage of the osteotomy deficit bridged at the lateral cortex was greater in grafted (77.6, SD 35.2%) compared to non-grafted (63.0, SD 36.5%) tibiae (p=0.001), but did not differ at the medial cortex (p=0.1). The mean minimum callus width was greater in grafted (7.2, SD 3.3 mm) compared to non-grafted (3.6, SD 2.9 mm) tibiae (p<0.001). There was no difference in mean attenuation (measured in Hounsfield units) of the callus between grafted and non-grafted tibiae (p=0.5). The grafted tibia was deemed to have superior bone healing in 50/60 subjective assessments made by radiologists.

CONCLUSIONS: Superior osseous bridging was detected by CT analysis following TTA using autogenous cancellous bone grafts compared with no graft. This was shown by greater bridging percentage at the lateral cortex and formation of a broader callus. Qualitative assessments made by six radiologists also supported the conclusion that bone healing was improved by use of autogenous cancellous bone graft. CT was a useful method for assessing evidence of bone healing following TTA.

CLINICAL RELEVANCE: These findings justify the application of autogenous cancellous bone graft to augment healing following TTA in dogs.     

Axial pull-out strength of 3.5 cortical and 4.0 cancellous bone screws placed in canine proximal tibias using manual and power tapping

An in vitro experimental cadaveric mechanical testing study was performed using 20 radiographically mature dogs, weighing between 18-33 kg. The aim of the study was to compare the axial pull-out strength of 3.5 mm cortical and 4.0 mm cancellous bone screws inserted in the canine proximal tibia using manual and power tapping techniques. 3.5 cortical and 4.0 cancellous bone screws were inserted in canine cadaver proximal tibiae using a manual or power tapping technique. The screws were extracted using a servohydraulic materials testing machine in order to measure axial pull-out strength. Axial pull-out strength was recorded relative to the total bone width and total cortical width of each tibia. The mean axial pull-out strength for all constructs was 717.8+/-56.5 N without any statistically significant difference among groups (p=0.4183). The groups were equal in animal body weight, cortical width and total bone width (p=0.2808). The axial pull-out strength in proportion to cortical and total bone width was not significantly different among groups (p=0.5318). Axial pull-out strengths of 3.5 mm cortical and 4.0 mm cancellous bone screws inserted in the proximal tibial metaphysis were not significantly different. Axial pull-out strength was not affected by the use of power tapping in either screw type.     

Fractures of the femur.

The most common indications for the use of ESF in femoral fractures are closed transverse, short oblique, and minimally comminuted fractures in the central one third of the bone. External skeletal fixation is usually used in combination with IM pins and wiring techniques. During the process of open reduction and internal fixation, the surgeon should strive for accurate anatomic alignment and stability at the fracture site. The fixator is applied after the internal fixation is in place and the surgical wound is closed. The number of fixation pins placed in each fracture fragment depends on the type of fracture and the stability gained by internal fixation. Partially threaded fixation pins are recommended. They are inserted through skin stab incisions with low-speed power equipment. Recent modifications of the Type Ia fixator may increase fixator rigidity. Important postoperative concerns include exercise restriction, pin tract care, and protection of the fixator from the environment. Complications associated with ESF can be minimized by realizing its indications and limitations.     

An In Vitro Biomechanical Study of a Multiplanar Circular External Fixator Applied to Equine Third Metacarpal Bones

The biomechanical characteristics of a 4-ring circular multiplanar fixator applied to equine third metacarpal bones with a 5 mm mid-diaphyseal osteotomy gap were studied. Smooth Steinmann pins, either 1/8 inch, 3/16 inch, or 1/4 inch, were driven through pilot holes in the bone in a crossed configuration and full pin fashion and fastened to the fixator rings using cannulated fixation bolts. The third metacarpal bone fixator constructs were tested in three different modes (cranial-caudal four-point bending, axial compression, and torsion). Loads of 2,000 N were applied in bending and axial compression tests and a load of 50 N ± m was applied during testing in torsion. Fixator stiffness was determined by the slope of the load displacement curves. Three constructs for each pin size were tested in each mode. Comparisons between axial stiffness, bending stiffness, and torsional stiffness for each of the three different pin sizes were made using one-way analysis of variance. There was no visually apparent deformation or permanent damage to the fixator frame, and no third metacarpal bone failure in any of the tests. Plastic deformation occurred in the 1/8 inch pins during bending, compression, and torsion testing. The 3/16 inch and 1/4 inch pins elastically deformed in all testing modes. Mean (±SE) axial compressive stiffness for the 1/8 inch, 3/16 inch, and 1/4 inch pin fixator constructs was: 182 ± 16 N/mm, 397 ± 21 N/mm, and 566 ± 8.7 N/mm; bending stiffness was 106 ± 3.3 N/mm, 410 ± 21 N/mm, and 548 ± 12 N/mm; and torsional stiffness was 6.15 ± 0.82 N.m/degree, 7.14 ± 0.0 N±m/degree, and 11.9 ± 1.0 N.m/degree respectively. For statically applied loads our results would indicate that a 4-ring fixator using two 1/4 inch pins per ring may not be stiff enough for repair of an unstable third metacarpal bone fracture in a 450 kg horse.     

Treatment of growth deformities with external skeletal fixation.

Growth deformities of the long bones are usually caused by premature closure of the physis. The most commonly affected bones are the radius, ulna, and tibia. Premature closure of the physis can result in shortened, angular, and rotational bone deformities, especially when one bone of a paired bone system like the radius and ulna is affected. Adjacent joints may develop osteoarthritis. Corrective osteotomy to realign in joint surfaces is indicated in mature animals. Bilateral or type II external fixation frames are used to stabilize the osteotomies. The advantages of ESF are: (1) The transfixation pins can be used as guide pins to realign joints. (2) The fixation allows rigid stabilization of the osteotomy site. (3) Postoperative correction of alignment can be achieved. (4) Implant removal after bone union is simple.     

Dissipation of Heat During Polymerization of Acrylics Used for External Skeletal Fixator Connecting Bars

Objective — To determine the amount of heat conducted by transfixation intramedullary pins (IP) and Kirschner wires (KW) during polymerization of acrylics used for external skeletal fixator (ESF) connecting bars.
Study Design — Thermal conduction was measured using thermistors applied to IP and KW surfaces during the polymerization phase of acrylics.
Methods — Type II ESF were created from IP or KW placed into wooden dowels and plastic tubing used to create connecting bars filled with one of two types of acrylic (Acrylic Pin External Fixation System or Technovit, Jorgensen Laboratories, Loveland, CO). Thermistors were positioned on the acrylic column surface and on IP or KW surfaces 5 or 10 mm from the acrylic column. Five ESF test groups were created. The maximum temperature (Tmax) of the acrylic column (Tmax-A), IP (Tmax-IP), KW (Tmax-KW), and duration that Tmax-IP or Tmax-KW remained greater than or equal to 55°C were calculated.
Results — All IP and KW thermistors placed 5 mm from acrylic columns reached mean temperatures greater than 50°C and had peak temperature ranges greater than 55°C compared with all IP and KW thermistors placed 10 mm from the acrylic columns in all groups. Thermistors placed 5 mm from the acrylic column in two groups maintained temperatures greater than 55°C for greater than or equal to 0.5 minutes.
Conclusions — Acrylic columns positioned 5 mm from a thermistor on a IP or KW had the potential to reach or exceed temperatures that have been reported to cause thermal necrosis of tissues.
Clinical Relevance — Acrylic Pin External Fixation System or Technovit acrylic connecting bars used in ESF designs have the potential to cause thermal injury to soft and bony tissue by thermal conduction along transfixation pins or wires.     

Flexible External Fixation for Craniodorsal Coxofemoral Luxations in Dogs

An external fixator consisting of two Ellis pins connected by a flexible band was developed and evaluated as a treatment for craniodorsal coxofemoral luxations in dogs. The technique for closed application of the fixator without injury to the coxofemoral joint or sciatic nerve was developed in six dog cadavers. The coxofemoral joints were then surgically destabilized and the limbs were manipulated through a full range of motion to assess the efficacy of the fixator in maintaining joint reduction. The fixator maintained joint reduction and stability after a surgically created craniodorsal luxation except when the femur was externally rotated 90d?. A flexible external fixator was then applied unilaterally in four healthy dogs. The dogs tolerated the fixator well and were bearing weight on the limb within 2 days after surgery; the range of motion was not limited by the fixator. The efficacy of a flexible external fixator in maintaining joint reduction after craniodorsal coxofemoral luxation was then evaluated in eight large dogs. The right coxofemoral joint in each dog was luxated surgically by removal of the dorsal joint capsule and transection of the ligament of the head of the femur and deep gluteal muscle. The joint was reduced and the fixator pins were applied in a closed fashion. In four dogs, a flexible external band was applied to the pins. Luxation did not reccur in these four dogs. The bands were not applied initially in four control dogs. Luxation occurred in three of the four control dogs within 24 hours of surgery. The joints that luxated were reduced and the flexible bands applied. Luxation did not recur after the bands were in place. The dogs tolerated the external fixators well, were bearing weight within 2 days of surgery, and walking with only minimal lameness 5 days after surgery. Luxation of the coxofemoral joints did not occur during the 2-week period in which the fixators were in place. The joints remained stable 1 week after removal of the fixators, at which time the dogs were euthanatized. Necropsy evaluation identified inflammation surrounding the pins and fibrous thickening of the dorsal joint capsule. The flexible external fixators were applied closed, maintained reduction of the coxofemoral joint after replacement of a craniodorsal luxation, and allowed weight bearing and limb usage soon after surgery. The flexible external fixator has several advantages over other methods of treating craniodorsal coxofemoral luxations. Complications noted in this study included pin tract drainage, pin loosening, and disruption of the flexible bands.     

Realignment of the radius in canine antebrachial growth deformities treated with corrective osteotomy and bilateral (type II) external fixation

OBJECTIVE: To identify factors affecting radial alignment after oblique corrective osteotomy stabilized with a type II external fixator and to evaluate the results of this treatment for antebrachial growth deformities. STUDY DESIGN: Retrospective study SAMPLE POPULATION: Twenty-eight dogs with unilateral antebrachial growth deformities treated with acute corrective osteotomy stabilized with a type II external fixator. METHODS: Medical records and preoperative and postoperative radiographs of the affected and contralateral limb were reviewed. Cause of deformity, age, weight, and gender were recorded. Radial length, varus/valgus angulation, and cranial/caudal angulation were measured from radiographs of the treated and contralateral limbs. Preoperative and postoperative angulation and length discrepancy were compared between affected and contralateral limbs. RESULTS: Correction of varus/valgus angle discrepancy was achieved by using acute corrective osteotomy stabilized with type II external skeletal fixation. No significant change was noted for correction of cranial/caudal angle discrepancy or length discrepancy between the affected and control limb. CLINICAL RELEVANCE: Varus/valgus angle deformities can be treated successfully with type III external fixation after oblique corrective osteotomy. Patients with significant length or cranial/caudal angle discrepancies or both that negatively impact function may require the use of hinged circular fixators or other dynamic techniques to achieve adequate correction.     

Biomechanical characteristics of allogeneic cortical bone pins designed for fracture fixation.

The biomechanical characteristics of 1.2 mm diameter allogeneic cortical bone pins harvested from the canine tibia were evaluated and compared to 1.1 mm diameter stainless steel pins and 1.3 mm diameter polydioxanone (PDS) pins using impact testing and four-point bending. The biomechanical performance of allogeneic cortical bone pins using impact testing was uniform with no significant differences between sites, side, and gender. In four-point bending, cortical bone pins harvested from the left tibia (204.8 +/- 77.4 N/mm) were significantly stiffer than the right tibia (123.7 +/- 54.4 N/mm, P = 0.0001). The site of bone pin harvest also had a significant effect on stiffness, but this was dependent on interactions with gender and side. Site C in male dogs had the highest mean stiffness in the left tibia (224.4 +/- 40.4 N/mm), but lowest stiffness in the right tibia (84.9 +/- 24.2 N/mm). Site A in female dogs had the highest mean stiffness in the left tibia (344.9 +/- 117.4 N/mm), but lowest stiffness in the right tibia (60.8 +/- 3.7 N/mm). The raw and adjusted bending properties of 1.2 mm cortical bone pins were significantly better than 1.3 mm PDS pins, but significantly worse than 1.1 mm stainless steel pins (P < 0.0001). In conclusion, cortical bone pins may be suitable as an implant for fracture fixation based on initial biomechanical comparison to stainless steel and PDS pins used in clinical practice.