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.     

A biomechanical comparison of equine third metacarpal condylar bone fragment compression and screw pushout strength between headless tapered variable pitch and AO cortical bone screws

OBJECTIVES: To compare bone fragment compression and the mechanical pushout strength and stiffness of 6.5-mm Acutrak Plus (AP) and 4.5-mm AO cortical (AO) bone screws after stabilization of a simulated equine third metacarpal (MC3) bone complete lateral condylar fracture. STUDY DESIGN: In vitro biomechanical paired study of screw insertion variables, bone fragment compression, and screw pushout tests using a bone screw stabilized simulated lateral condylar fracture model. SAMPLE POPULATION: Six pairs of cadaveric equine MC3s. METHODS: Metacarpi were placed in a fixture and centered on a biaxial load cell in a materials testing system to measure torque, compressive force, and time for drilling, tapping, and screw insertion. Fragment compression was measured with a pressure-sensing device placed between the simulated fracture fragments during screw insertion for fragment stabilization. Subsequently, screws were pushed out of the stabilized bone fragments in a single cycle to failure. A paired t test was used to assess differences between site preparation, screw insertion, fragment compression, and screw pushout variables, with significance set at P <.05. RESULTS: Measured drilling variables were comparable for AO and AP specimens. However, the AP tap had significantly greater insertion torque and force. Mean maximum screw insertion torque was significantly greater for AO screws. For fragment compression, AP screws generated 65% and 44% of the compressive pressure and force, respectively, of AO screws. AP screws tended to have higher overall pushout strength. Pushout stiffness was similar between both screw types. CONCLUSION: The 6.5-mm tapered AP screw generated less interfragmentary compressive pressure and force but had similar pushout stiffness. Evaluation of failure patterns demonstrated that AP screws had greater pushout strength compared with 4.5-mm AO screws for fixation of a simulated complete lateral condylar fracture. CLINICAL RELEVANCE: The 6.5-mm tapered AP screw should provide ample holding strength but would provide less interfragmentary compression than 4.5-mm AO screws for repair of complete lateral condylar fractures in horses.     

Holding Power of Orthopedic Screws in Equine Third Metacarpal and Metatarsal Bones: Part I. Foal Bone

The holding power of orthopedic screws in the third metacarpal and metatarsal cadaver bones of foals that were aged from 1 to 14 days was tested. Comparative trials between screws inserted at the same site in contralateral bones from the same foal were performed to compare the holding power of 5.5 mm cortical and 6.5 mm cancellous screws in the metaphysis, and the holding power of 5.5 and 4.5 mm cortical screws in the diaphysis. A MTS servohydraulic tensile testing machine was used to perform screw pullouts at a displacement rate of 19 mm/sec. There was no significant difference between maximum holding power of 5.5 mm cortical screws and 6.5 mm cancellous screws in the metaphysis when expressed as kg per mm of bone width at the screw insertion site (p = 0.097) or as kg per mm of screw thread engaged in the bone (p = 0.17). There was no significant difference in holding power of 5.5 and 6.5 mm screws in the proximal versus distal metaphysis (p = 0.10). The 5.5 mm screws had significantly greater holding power than the 4.5 mm screws in the diaphysis (p = 0.0097). Fixation failure at screw pullout was always due to bone shear. In internal fixation in foal bone, the 5.5 mm screws may be a suitable alternative to 6.5 mm screws in the metaphysis. Use of 5.5 mm rather than 4.5 mm screws is recommended in the diaphysis because of greater holding power.     

Holding Power of Orthopedic Screws in Equine Third Metacarpal and Metatarsal Bones: Part II. Adult Horse Bone

Comparison was made of the holding power of 5.5 and 4.5 mm cortical orthopedic screws inserted into third metacarpal and metatarsal cadaver bones from 3- and 8-year-old horses. The tensile strength of these screws was tested mechanically. In nine comparative trials of these screws, 5.5 mm screws pulled out of bone in five trials at an average of 116.0 kg tensile force and broke in four trials at an average of 1383.2 kg. A 4.5 mm screw pulled out of bone at 834.5 kg in one trial, and screws broke at an average of 849.2 kg in eight trials. The larger 5.5 mm screw required a significantly greater (p = 0.022) pullout force than the mean force at 4.5 mm screw breakage. Fixation failure was due to screw breakage or bone shear, with 5.5 mm screws occasionally creating bone fragmentation during pullout. The average tensile breaking strengths of the 5.5 mm screws (1391.4 kg) and 4.5 mm screws (832.7 kg) determined mechanically were similar to forces at screw breakage during pullout testing in bone. Since the 5.5 mm screws have greater holding power and tensile strength than 4.5 mm screws, the use of the 5.5 mm screw in fracture repair in adult horses is recommended.     

In Vitro Pullout Strength of Screws Inserted in Adult Equine Third Metacarpal Bone After Overdrilling a 4.5-mm Threaded Insertion Hole

Objective—To determine and compare the in vitro pullout strength of 5.5-mm cortical versus 6.5-mm cancellous bone screws inserted in the diaphysis and metaphysis of adult equine third metacarpal (MCIII) bones, in threaded 4.5-mm cortical bone screw insertion holes that were then overdrilled with a 4.5-mm drill bit to provide information relevant to the selection of a replacement screw if a 4.5-mm cortical screw is stripped. Study Design—In vitro pullout tests of 5.5-mm cortical and 6.5-mm cancellous screws in equine MCIII bones. Sample Population—Two independent cadaver studies each consisting of 14 adult equine MCIII bones. Methods—Two 4.5-mm cortical screws were placed either in the middiaphysis (study 1) or distal metaphysis (study 2) of MCIII bones. The holes were then overdrilled with a 4.5-mm drill bit and had either a 5.5-mm cortical or a 6.5-mm cancellous screw inserted; screw pullout tests were performed at a rate of 0.04 mm/second until screw or bone failure occurred. Results—In diaphyseal bone, the screws failed in all tests. Tensile breaking strength for 5.5-mm cortical screws (997.5 ± 49.3 kg) and 6.5-mm cancellous screws (931.6 ± 19.5 kg) was not significantly different. In metaphyseal bone, the bone failed in all tests. The holding power for 6.5-mm cancellous screws (39.1 ± 4.9 kg/mm) was significantly greater than 5.5-mm cortical screws (23.5 ± 3.5 kg/mm) in the metaphysis. There was no difference in the tensile breaking strength of screws in the diaphysis between proximal and distal screw holes; however, the holding power was significantly greater in the distal, compared with the proximal, metaphyseal holes. Conclusions—Although tensile breaking strength was not different between 5.5-mm cortical and 6.5-mm cancellous screws in middiaphyseal cortical bone, holding power of 6.5-mm cancellous screws was greater than 5.5-mm cortical screws in metaphyseal bone of adult horses. Clinical Relevance—If a 4.5-mm cortical bone screw strips in MCIII diaphyseal bone of adult horses, either a 5.5-mm cortical or 6.5-mm cancellous screw, however, would have equivalent pullout strengths. A 6.5-mm cancellous screw, however, would provide greater holding power than a 5.5-mm cortical screw in metaphyseal bone.     

Compressive Forces Achieved in Simulated Equine Third Metacarpal Bone Lateral Condylar Fractures of Varying Fragment Thickness with Acutrak Plus Screw and 4.5 mm AO Cortical Screws

Objectives— To compare compression pressure (CP) of 6.5 mm Acutrak Plus (AP) and 4.5 mm AO cortical screws (AO) when inserted in simulated lateral condylar fractures of equine 3rd metacarpal (MC3) bones. Study Design— Paired in vitro biomechanical testing. Sample Population— Cadaveric equine MC3 bones (n=12 pair). Methods— Complete lateral condylar osteotomies were created parallel to the midsagittal ridge at 20, 12, and 8 mm axial to the epicondylar fossa on different specimens grouped accordingly. Interfragmentary compression was measured using a pressure sensor placed in the fracture plane before screw placement for fracture fixation. CP was acquired and mean values of CP for each fixation method were compared between the 6.5 mm (AP) and 4.5 mm (AO) for each group using a paired t‐test within each fracture fragment thickness group with statistical significance set at P<.05. Results— AO screw configurations generated significantly greater compressive pressure compared with AP configurations. The ratio of mean CP for AP screws to AO screws at 20, 12, and 8 mm, were 21.6%, 26.2%, and 34.2%, respectively. Conclusion— Mean CP for AP screw fixations are weaker than those for AO screw fixations, most notably with the 20 mm fragments. The 12 and 8 mm groups have comparatively better compression characteristics than the 20 mm group; however, they are still significantly weaker than AO fixations. Clinical Relevance— Given that the primary goals of surgical repair are to achieve rigid fixation, primary bone healing, and good articular alignment, based on these results, it is recommended that caution should be used when choosing the AP screw for repair of lateral condylar fractures, especially complete fractures. Because interfragmentary compression plays a factor in the overall stability of a repair, it is recommended for use only in patients with thin lateral condyle fracture fragments, as the compression tends to decrease with an increase in thickness.     

A Biomechanical Comparison of Headless Tapered Variable Pitch and AO Cortical Bone Screws for Fixation of a Simulated Lateral Condylar Fracture in Equine Third Metacarpal Bones

OBJECTIVE: To compare drilling, tapping, and screw-insertion torque, force, and time for the 4.5-mm AO and 6.5-mm Acutrak Plus (AP) bone screws, and to compare the mechanical shear strength and stiffness of a simulated complete lateral condylar fracture of the equine third metacarpal bone (MC3) stabilized with either an AO or AP screw. STUDY DESIGN: In vitro biomechanical assessment of screw-insertion variables, and shear failure tests of a bone-screw-stabilized simulated lateral condylar fracture. SAMPLE POPULATION: Eight pairs of cadaveric equine MC3s METHODS: Metacarpi were placed in a fixture and centered on a biaxial load cell in a materials-testing system to measure torque, compressive force, and time for drilling, tapping, and screw insertion. Standardized simulated lateral condylar fractures were stabilized by either an AO or AP screw and tested in shear until failure. A paired t test was used to assess differences between screws, with significance set at P < .05. RESULTS: Insertion and mechanical shear testing variables were comparable for AO and AP insertion equipment and screws. CONCLUSION: The 6.5-mm tapered AP screw can be inserted in equine third metacarpal condyles and is mechanically comparable with the 4.5-mm AO screw for fixation of a simulated lateral condylar fracture. CLINICAL RELEVANCE: Considering the comparable mechanical behavior, the potential for less-persistent soft-tissue irritation with the headless design, and the ability to achieve interfragmentary compression by inserting the screw in one hole drilled perpendicular to the fracture plane, the 6.5-mm tapered AP screw may be an attractive alternative for repair of incomplete lateral condylar fractures in horses.     

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.     

Screw fixation in lag fashion of equine cadaveric metacarpal and metatarsal condylar bone specimens: a biomechanical comparison of shaft and cortex screws

OBJECTIVE: To compare acute fixation stability and insertion effort of cortex bone screws with and without a shaft inserted in lag fashion in equine metacarpal (metatarsal, MC(T)III) bone. METHODS: Screw types with independent variables of screw diameter (4.5 or 5.5 mm) and shaft type (without shaft, with 20-mm shaft, or with 25-mm shaft) were studied. Bone specimens cut from distal equine MC(T)III condyles were used. After screw insertion in lag fashion into 2 bone blocks with an instrumented device, shear tests were conducted in a mechanical testing machine. Outcome variables of peak insertion torque, insertion energy, stiffness. yield strength, and displacement at 3 kN of load were compared. RESULTS: The effects of screw design were substantial. Screws with shaft were 30% to 40% stiffer and 60% to 70% stronger than screws without shaft. Screws with shaft could tolerate 80 to 95 kg more force than screws without shaft before yielding. At 3 kN load, the displacement with screws with shaft was 55% to 60% of that with screws without shaft. Screws with a long shaft tended to perform better than those with a short shaft. There was no difference in the shear stiffness, shear yield strength, or shear displacement between the 2 screw diameters. Although larger diameter screws required more insertion effort, and screws with a short shaft required the most insertion energy, these differences were small. CONCLUSIONS: Cortex screws with a long shaft of 4.5- or 5.5-mm diameter provide better stability in equine MC(T)III condyle bone with less insertion effort compared with those with a short shaft or no shaft. CLINICAL SIGNIFICANCE: Cortex bone screws with a shaft inserted in lag fashion should be considered for the fixation of equine MC(T)III condylar fractures.     

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.     

Stabilization of Bilateral Sacroiliac Fracture-Luxations in Small Animals with a Single Transsacral Screw

Bilateral sacroiliac fracture-luxations in four dogs and four cats weighing 3.5 kg to 30.9 kg were reduced and stabilized with a single 3.5 mm, 4.5 mm, or 6.5 mm transsacral screw. Alignment of the drill bit was visual in six cases and assisted by the use of an aiming device in two cases. Seven animals were reevaluated at months 3 to 6. No significant screw loosening or loss of reduction had occurred. Although no intraoperative complications were encountered with visual drill bit alignment, use of an aiming device for transsacral drilling is strongly recommended.     

Holding Power of Orthopedic Screws Comparison of Self-tapped and Pre-tapped Screws in Foal Bone

Comparison was made of the holding power of orthopedic screws inserted self-tapped or after pre-tapping in foal bone. Third metacarpal and metatarsal bones were used. Comparative trials were made between screws inserted at the same site in the corresponding bones from the contralateral limbs of the same foal. A MTS servohydraulic tensile testing machine was used to perform screw pullouts at a displacement rate of 19 mm/sec. The 5.5 mm cortical screws had significantly greater holding power than 6.5 mm cancellous screws when both were inserted self-tapped (p = 0.0056). Pre-tapped insertion of 5.5 mm screws produced a significantly greater holding power than self-tapped insertion of 5.5 mm screws (p = 0.018). Pre-tapped insertion of 6.5 mm screws produced a significantly greater holding power than self-tapped insertion of 6.5 mm screws (p = 0.0000). In internal fixation of fractures in foals, insertion of 5.5 mm and 6.5 mm screws pre-tapped in metaphyseal bone is recommended because it produces greater holding power than self-tapped insertion.     

A Comparison of the Synthes 4.5-mm Cannulated Screw and the Synthes 4.5-mm Standard Cortex Screw Systems in Equine Bone

Objective —To determine risk of failure of the Synthes 4.5-mm cannulated screw system instrumentation in equine bone and to compare its application with the Synthes 4.5-mm standard cortex screw system.
Study Design —The maximum insertion torque of the cannulated and standard cortex screw systems were compared with the ultimate torsional strengths of the equipment. Pullout strength and ultimate tensile load of cannulated and standard cortex screws were also determined.
Sample Population—Paired equine cadaver third metacarpal and third carpal bones.
Methods —Maximum insertion torque and ultimate torsional strengths were determined by using an axial-torsional, servohydraulic materials testing system and a hand-held torquometer. Pullout tests were performed by using a servohydraulic materials testing system.
Results —Maximum insertion torque of all cannulated instrumentation was less than ultimate torsional strength at all locations ( P < .05). Maximum insertion torques of cannulated taps and screws were greater than for standard taps and screws in the third carpal bone ( P < .002). Pullout strength of the cannulated screws was less than the standard cortex screws at all sites ( P < .001). Cannulated screws broke before bone failure in all but one bone specimen. Conclusions—The risk of cannulated instrument or screw failure during insertion into bone is theoretically low. The relatively low pullout strength of the cannulated screws implies that the interfragmentary compression achievable is likely to be less than with standard cortex screws. Clinical Relevance—The relatively low pullout strength of the cannulated screw suggests that its risk of failure during fracture repair is greater than with the standard cortex screw.     

Biomechanical comparison of orthofix pins and cortical bone screws in a canine humeral condylar fracture model

OBJECTIVE: To compare shear stability of simulated humeral lateral condylar fractures reduced with either a self-compressing pin or cortical bone screw. STUDY DESIGN: In vitro biomechanical tests. SAMPLE POPULATION: Bilateral cadaveric canine humeri (n=18) without evidence of elbow disease. METHODS: Lateral condylar fracture was simulated by standardized osteotomy. Bone fragments were stabilized with a self-compressing pin or a cortical bone screw (2.7 or 3.5 mm) inserted in lag fashion. Specimens were mounted in a materials testing system and the condylar fragment displaced in a proximal direction until failure. Mechanical testing variables derived from load-deformation curves were compared between stabilization methods using a Student's paired t-test. RESULTS: There were no statistically significant differences for mechanical testing variables between pin and screw stabilized specimens at expected walk and trot loads. Three yield points subjectively coincided with yield of the interfragmentary interface (Y1), bone at the implant interface (Y2), and implant deformation (Y3). Displacements at Y1 were 48-156% greater for pin than screw stabilized specimens. Y2 and Y3 loads were higher for screw than pin stabilized specimens, but likely supraphysiologic for dogs convalescing after surgical repair. CONCLUSIONS: A self-compressing pin or a cortical bone screw inserted in lag fashion both provided adequate strength in applied shear to sustain expected physiologic loads through the repaired canine elbow during postoperative convalescence. CLINICAL RELEVANCE: Because self-compressing pins were easy to implant and mechanical properties were not significantly different than cortical screws at expected physiologic loads, pins should be considered for the repair of traumatic humeral condylar fractures.     

Evaluation of compression generated by self compressing Orthofix bone pins and lag screws in simulated lateral humeral condylar fractures.

A simulated lateral humeral condylar fracture was created in each of the 52 humeri collected from 26 dogs. One humerus from each pair was stabilized with a 2.0 mm cortical bone screw which was inserted in lag fashion. The other humerus from each pair was stabilized with a 2.2 mm threaded diameter Orthofix pin inserted across the condyle. Prior to each repair, an antirotational K-wire was placed and then the Pressurex Sensitive film was inserted in the osteotomy site in order to determine the compressive pressure (MPa), compressive force (KN), and area of compression (cm(2)) achieved during fixation. The maximum insertional torque achieved before stripping was measured for each implant. The mean compression generated by insertion of a 2.0 mm lag screw was 20.36 +/- 1.51 MPa compared to 18.88 +/- 1.76 MPa generated by a 2.2 mm Orthofix pin (p < 0.003). The mean area of compression generated by insertion of a 2.0 mm lag screw was 2.39 +/- 1.29 cm(2), compared to 1.16 +/- 0.84 cm(2) generated by insertion of a 2.2 mm Orthofix pin (p < 0.0001). The mean compressive force (compression x area compressed) generated by insertion of a 2.0 mm lag screw was 4.96 +/- 2.90 Kn, compared to 2.20 +/- 1.65 Kn generated by insertion of a 2.2 mm Orthofix pin (p < 0.0001). The mean insertion torque to failure for the lag screws was 0.49 +/- 0.07 NM, compared to 0.91 NM +/- 0.18 NM generated by the Orthofix pins (P < 0.0001). Both repair methods are likely to be acceptable for the repair of similar fractures in small breed dogs.     

Closed Reduction and Lag Screw Fixation of Sacroiliac Luxations and Fractures

OBJECTIVE: To describe a technique for closed reduction and percutaneous insertion of a lag screw for fixation of sacroiliac fracture-luxations, and to report the success of this technique in stabilizing sacroiliac fracture-luxations. STUDY DESIGN: A retrospective clinical study. STUDY POPULATION: 13 consecutive client-owned dogs with sacroiliac fracture-luxations. METHODS: Sacroiliac fracture-luxations were stabilized by using a closed reduction and percutaneous lag screw fixation technique. Preoperative, postoperative, and last re-examination radiographs were used to assess the location and number of pelvic injuries, other orthopedic injuries, percent reduction of the sacroiliac joint, percent sacral width screw depth, position of the screw, pelvic canal diameter ratio, hemipelvic canal width ratio, and complications. Information on signalment, weight, weight-bearing status, neurologic status, and complications was obtained from the medical record. RESULTS: Mean percent reduction of the sacroiliac joint was 92.33%. All screws were placed within the sacral body with a mean screw depth/sacral width of 79.03%. No screw loosening occurred. Mean pelvic canal diameter ratios were 0.99, 1.20, and 1.14 preoperatively, immediately postoperatively, and at the last re-examination, respectively. Nine of 13 dogs were willing to walk on the ipsilateral rear leg the day after surgery. CONCLUSIONS: Closed reduction and percutaneous insertion of a lag screw for stabilization of fracture-luxation of the sacroiliac joint is an acceptable method of repair. CLINICAL RELEVANCE: Sacroiliac fracture-luxations can be successfully reduced and stabilized using a minimally invasive technique.     

Comparison of insertion time and pullout strength between self-tapping and non-self-tapping AO 4.5-mm cortical bone screws in adult equine third metacarpal bone

OBJECTIVE: To compare screw insertion characteristics and pullout mechanical properties between self-tapping (ST) and non-self-tapping (NST) AO 4.5-mm cortical bone screws in adult equine third metacarpal bone (MC3). STUDY DESIGN: In vitro biomechanical experiment. ANIMALS OR SAMPLE POPULATION: Seven pairs of adult equine MC3. METHODS: Bicortical holes were drilled transversely in proximal metaphyseal, diaphyseal, and distal metaphyseal locations of paired MC3. NST screws were inserted in pre-tapped holes in 3 sites of one bone pair, and ST screws were inserted in non-tapped holes of contralateral MC3. Tapping and screw insertion times and maximum torques were measured. Screw pullout mechanical properties were determined. RESULTS: Screw insertion time was longer for ST screws. Total time for tapping and insertion (total insertion time) was over twice as long for NST screws. Statistically significant differences were not observed between screws for any pullout mechanical property. From pullout tests, diaphyseal locations had significantly stiffer and stronger structure than metaphyseal locations. Pullout failure more commonly occurred because of screw breakage than bone failure. Bone failure and bone comminution were more commonly associated with ST screws. Bone failure sites had pullout failure loads that were 90% of screw failure sites. CONCLUSIONS: NST and ST 4.5-mm-diameter cortical bone screws have similar pullout mechanical properties from adult equine MC3. ST screws require less than half the total insertion time of NST screws. CLINICAL RELEVANCE: Use of ST 4.5-mm-diameter cortical bone screws should be considered for repair of adult equine MC3 fractures; however, bone failures at screw sites should be monitored.     

Evaluation of 2 cement techniques for augmentation of stripped 1.5 mm screw sites in the distal metaphysis of feline radii

OBJECTIVE: To evaluate the effect of 2 cement augmentation techniques on pullout strength of 1.5 mm screws placed in stripped 1.5 mm screw sites in the distal metaphysis of feline radii. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Feline radii (21 pairs). METHODS: Treatment groups (n=4) were allocated according to a Latin square design to 4 sites in each pair of radii. Positive and negative controls were a 1.5 mm screw and a screw of the same diameter in a previously stripped screw hole, respectively. Treatment groups were a 1.5 mm screw implanted in a previously stripped screw hole after injection of polymethylmethacrylate (PMMA) or a bioresorbable calcium phosphate cement (CPC, Norian skeletal repair system (SRS)). The ultimate pullout strength was compared between groups. RESULTS: The mean (+/-SEM) pullout strength of screws augmented with either bone cement was less than that of the positive control group and greater than that of the negative control. Injection of CPC or PMMA before screw implantation increased the pullout strength of the negative control by 86.8+/-22.9% and 104.1+/-32.1%, respectively. Holding power of the positive control screws differed from these 2 groups, and was 274.8+/-39.17% higher than that of the negative control. CONCLUSION: Injection of CPC or PMMA increases but does not restore the holding power of stripped 1.5 mm diameter screws. CLINICAL RELEVANCE: The use of CPC (Norian SRS) augmentation of stripped 1.5 mm diameter screws warrants clinical investigation as it combines biomechanical results similar to PMMA with osteoconduction and resorbability.     

Sacroiliac Fracture-Separation in the Dog: A Study of 92 Cases

The case records of 92 consecutive dogs that suffered sacroiliac fracture-separation were examined. Seventy-seven per cent (71 of 92) had unilateral sacroiliac injury and 23% (21 of 92) had bilateral sacroiliac injury. Of the unilateral cases, 93% (66 of 71) of the dogs had associated acetabular, ilial, femoral, or tibial fractures; coxofemoral luxations; or cruciate injuries. Eighty-five per cent (78 of 92) of the dogs had either bilateral sacroiliac injury or unilateral sacroiliac injury and other orthopedic injuries of the opposite limb, thus disabling both hind limbs.
Sixty-five per cent (60 of 92) of the dogs received lag screw fixation of the sacroiliac joint. Of 29 dogs that were re-radiographed on an average of 437 days following fixation, 38% (11 of 29) showed evidence of loosening of the lag screw fixation.a
Screws that were placed in the body of the sacrum in some dogs resulted in the fewest loosened fixations (12%, 2 of 17), compared to other locations of screw placement. The fixation had loosened in 7% (1 of 14) of dogs that had a cumulative screw depth/sacral width of 60% or more, compared with 48% of dogs (10 of 21) where cumulative screw depth was less than 60%. The number of screws per fixation and whether the separation was fully reduced or not did not affect whether the fixation loosened.     

Stabilization of Sacroiliac Luxation in 40 Cats Using Screws Inserted in Lag Fashion

Objective: To (1) identify prognostic indicators for stability after stabilization of sacroiliac luxation with screws inserted in lag fashion and (2) report dorsoventral dimensions of the sacrum in cats. Study Design: Multicenter retrospective study. Sample Population: Cats (n=40) with sacroiliac luxation. Methods: Case records and radiographs of cats presented at the Queen's Veterinary School Hospital Cambridge and the Royal Veterinary College Hatfield for screw fixation of sacroiliac luxation were reviewed. Dorsoventral dimensions of 15 feline cadaveric sacral bodies were measured to identify the appropriate implant size for use in fixation with screws inserted in lag fashion. Results: Of 40 cats, 13 had left, 14 right, and 13 bilateral sacroiliac luxations. Of 48 screws analyzed, 42 (87.5%) were placed within the sacral body or exited ventrally and 6 (12.5%) were considered malpositioned. Screw purchase within the sacrum was statistically different between unstable and stable repairs (P=.001). Using confidence intervals for screw length within the sacrum and effect on stability, the lowest screw depth that contained 95% of the screws that did not loosen was ∼60% of the sacral width. Mean dorsoventral sacral dimension at its narrowest point was 5.9±1.14 mm. There was no significant difference in the incidence of implant loosening between those luxations that were 100% reduced and those that were <100% reduced (P=.7837). Conclusions: Screw purchase within the feline sacrum of at least 60% of the sacral width significantly reduces the risk of loosening. Clinical Relevance: Screw placement to a depth of 60% of the width of the feline sacrum is recommended.