An in vitro biomechanical comparison of a limited-contact dynamic compression plate fixation with a dynamic compression plate fixation of osteotomized equine third metacarpal bones

OBJECTIVES: To compare the monotonic biomechanical properties and fatigue life of a broad, limited contact, dynamic compression plate (LC-DCP) fixation with a broad, dynamic compression plate (DCP) fixation to repair osteotomized equine 3rd metacarpal (MC3) bones. STUDY DESIGN: In vitro biomechanical testing of paired cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. ANIMAL POPULATION: Twelve pairs of adult equine cadaveric MC3 bones. METHODS: Twelve pairs of equine MC3 were divided into 3 test 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 LC-DCP (8-hole, 4.5 mm) was applied to the dorsal surface of 1 randomly selected bone from each pair. One DCP (8-hole, 4.5 mm broad) was applied dorsally to the contralateral bone from each pair. All plates and screws were applied using standard AO/ASIF techniques to MC3 bones that had mid-diaphyseal osteotomies. Mean test variable values for each method were compared using a paired t-test within each group. Significance was set at P<.05. RESULTS: The mean 4-point bending yield load, yield bending moment, composite rigidity, failure load, and failure bending moment of LC-DCP fixation were significantly greater (P<.01) than those of broad DCP fixation. Mean cycles to failure for 4-point bending was significantly (P<.001) greater for broad DCP fixation compared with broad LC-DCP fixation. Mean yield load, mean composite rigidity, and mean failure load in torsion was significantly (P<.02) greater for broad LC-DCP fixation compared with broad DCP fixation. CONCLUSION: Broad LC-DCP offers increased stability in static overload testing, however, it offers significantly less stability in cyclic fatigue testing. CLINICAL RELEVANCE: The clinical relevance of the cyclic fatigue data supports the conclusion that the broad DCP fixation is biomechanically superior to the broad LC-DCP fixation in osteotomized equine MC3 bones despite the results of the static overload testing.     

In vitro biomechanical comparison of locking compression plate fixation and limited-contact dynamic compression plate fixation of osteotomized equine third metacarpal bones

Objective— To compare monotonic biomechanical properties and fatigue life of a broad locking compression plate (LCP) fixation with a broad limited contact dynamic compression plate (LC‐DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. Study Design— In vitro biomechanical testing of paired cadaveric equine MC3 with a mid‐diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. Animal Population— Cadaveric adult equine MC3 bones (n=12 pairs). Methods— 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. The 8‐hole, 4.5 mm LCP was applied to the dorsal surface of 1 randomly selected bone from each pair. One 8‐hole, 4.5 mm LC‐DCP) was applied dorsally to the contralateral bone from each pair. All plates and screws were applied using standard ASIF techniques. All MC3 bones had mid‐diaphyseal osteotomies. 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 yield load, yield bending moment, composite rigidity, failure load and failure bending moment, under 4‐point bending, single cycle to failure, of the LCP fixation were significantly greater than those of the LC‐DCP fixation. Mean cycles to failure for 4‐point bending was significantly greater for the LCP fixation compared with LC‐DCP fixation. Mean yield load, mean composite rigidity, and mean failure load under torsional testing, single cycle to failure was significantly greater for the broad LCP fixation compared with the LC‐DCP fixation. Conclusion— The 4.5 mm LCP was superior to the 4.5 mm LC‐DCP in resisting the static overload forces (palmarodorsal 4‐point bending and torsional) and in resisting cyclic fatigue under palmarodorsal 4‐point bending. Clinical Relevance— The results of this in vitro study may provide information to aid in the selection of a biological plate for the repair of equine long bone fractures.     

An in vitro biomechanical comparison of a prototype equine metacarpal dynamic compression plate fixation with double dynamic compression plate fixation of osteotomized equine third metacarpal bones

OBJECTIVES: To compare the monotonic biomechanical properties of a prototype equine third metacarpal dynamic compression plate (EM-DCP) fixation with a double broad dynamic compression plate (DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. STUDY DESIGN: In vitro biomechanical testing of paired cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. POPULATION: Twelve pairs of adult equine cadaveric MC3 bones. METHODS: Twelve pairs of equine MC3 were divided into 3 test groups (4 pairs each) for (1) 4-point bending single cycle to failure testing, (2) 4-point bending cyclic fatigue testing, and (3) torsional testing. The EM-DCP (10-hole, 4.5 mm) was applied to the dorsal surface of one randomly selected bone from each pair. Two DCPs, 1 dorsally (10-hole, 4.5 mm broad) and 1 laterally (9-hole, 4.5 mm broad) were applied to the contralateral bone from each pair. All plates and screws were applied using standard AO/ASIF techniques to MC3 bones that had mid-diaphyseal osteotomies. 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 EM-DCP fixation were significantly greater (P<.0001) than those of the double broad DCP fixation. Mean cycles to failure in 4-point bending of the EM-DCP fixation was significantly greater (P<.0008) than that of the double broad DCP fixation. Mean yield load, composite rigidity, and failure load in torsion of the EM-DCP fixation were significantly greater (P<.0035) than that of the double broad DCP fixation. CONCLUSION: The EM-DCP provides increased stability in both static overload testing and cyclic fatigue testing. CLINICAL RELEVANCE: Results of this in vitro study support the conclusion that the prototype EM-DCP fixation is biomechanically superior to the double broad DCP fixation for the stabilization of osteotomized equine MC3.     

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 evaluation of plate luting using osteotomized equine third metacarpal bones with a limited contact-dynamic compression plate

OBJECTIVES: To evaluate the effects of plate luting on the biomechanical properties of a broad limited contact-dynamic compression plate (LC-DCP) fixation to repair osteotomized equine 3rd metacarpal (MC3) bones. STUDY DESIGN: In vitro biomechanical testing of paired cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by LC-DCP fixation, with 1 of the pair luted with polymethylmethacrylate (PMMA). ANIMAL POPULATION: Ten pairs of adult equine cadaveric MC3 bones. METHODS: Ten pairs of equine MC3 were divided into 2 test groups (5 pairs each) for (1) palmarodorsal 4-point bending single cycle to failure testing and (2) palmarodorsal 4-point bending cyclic fatigue testing. The LC-DCP (8 hole, 4.5 mm) was applied to the dorsal surface of each pair of MC3 bones. All plates and screws were applied using standard AO/ASIF techniques. All MC3 bones had mid-diaphyseal osteotomies. One of the matched pairs of LC-DCP-MC3 constructs were randomly chosen to be luted with PMMA. 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 palmarodorsal 4-point bending yield bending moment, failure bending moment of the LC-DCP fixation with luting was not significantly different (P>.05) than those of the LC-DCP fixation without luting. Mean cycles to failure for palmarodorsal 4-point bending was significantly (P<.0003) greater, with a 7.2-fold increase, for the LC-DCP fixation with luting compared with the LC-DCP fixation without luting. CONCLUSION: Luting the broad LC-DCP with PMMA in the fixation osteotomized equine MC3 bones increases the fatigue life of cyclic loading for palmarodorsal 4-point bending under the in vitro conditions studied. CLINICAL RELEVANCE: The cyclic fatigue data supports the conclusion that luted broad LC-DCP fixation is biomechanically superior to the non-luted broad LC-DCP fixation in osteotomized equine MC3 bones.     

In vitro biomechanical comparison of dynamic compression plates with a rough contact surface and a polished contact surface for fixation of osteotomized equine third metacarpal bones

Objectives: To compare the number of cycles to failure of 4.5 mm broad dynamic compression plates (DCP), 4.5 mm broad limited‐contact dynamic compression plates (4.5‐LC‐DCP), and 5.5 mm broad limited‐contact dynamic compression plates (5.5‐LC‐DCP) having a rough (denoted by a prefix R‐) versus a standard smooth contact surface for the fixation of osteotomized equine 3rd metacarpal (MC3) bones. Study Design: Experimental. Animal Population: Fifteen pairs of adult equine cadaveric MC3 bones. Methods: Fifteen pairs of equine MC3 were divided into 3 test groups (5 pairs each) for comparison of (1) R‐DCP fixation with DCP fixation, (2) R‐4.5‐LC‐DCP fixation with 4.5‐LC‐DCP fixation, and (3) R‐5.5‐LC‐DCP fixation with 5.5‐LC‐DCP fixation to repair osteotomized equine MC3 bones under palmarodorsal 4‐point bending cyclic fatigue testing. For each group an 8‐hole plate with rough contact surface was applied to the dorsal surface of one randomly selected bone from each pair and a corresponding 8‐hole plate with smooth contact surface was applied dorsally to the contralateral bone from each pair. All plates and screws were applied using standard ASIF techniques. All MC3 bones had mid‐diaphyseal osteotomies. Mean number of cycles to failure for each method were compared using a paired t‐test within each group. Significance was set at P<.05. Results: Mean cycles to failure ± standard deviation was significantly greater for the R‐DCP fixation (230,025 ± 23,129) compared with the DCP fixation (103,451 ± 14,556), for the R‐4.5‐LC‐DCP fixation (99,237 ± 14,390) compared with the 4.5‐LC‐DCP fixation (46,464 ± 6325) and for the R‐5.5‐LC‐DCP fixation (65,113 ± 7796) compared with the 5.5‐LC‐DCP fixation (34,224 ± 3835). Conclusion: For the fixation of osteotomized MC3 bones, the constructs with plates having rough contact surface were superior to the corresponding constructs with plates having standard smooth contact surfaces in resisting cyclic fatigue under palmarodorsal 4‐point bending.     

An in vitro biomechanical comparison of two interlocking-nail systems for fixation of ostectomized equine third metacarpal bones

OBJECTIVE--To compare the mechanical properties of 2 interlocking-nail systems for fixation of ostectomized equine third metacarpi (MC3): (1) a standard interlocking nail with 2 parallel screws proximal and distal to a 1-cm ostectomy; and (2) a modified interlocking nail with 2 screws proximal and distal to a 1-cm ostectomy with the screws offset by 30 degrees. ANIMAL OR SAMPLE POPULATION--Twelve pairs of adult equine forelimbs intact from the midradius distally. METHODS--Twelve pairs of equine MC3 were divided into 2 test groups (6 pairs each): torsion and caudocranial 4-point bending. Standard interlocking nails (6-hole, 13-mm diameter, 230-mm length) were placed in 1 randomly selected bone from each pair. Modified interlocking nails (6-hole, 13-mm, 230-mm length, screw holes offset by 30 degrees) were placed in the contralateral bone from each pair. All bones had 1-cm mid-diaphyseal ostectomies. Six construct pairs were tested in caudocranial 4-point bending to determine stiffness and failure properties. The remaining 6 construct pairs were tested in torsion to determine torsional stiffness and yield load. Mean values for each fixation method were compared using a paired t test within each group. Significance was set at P <.05. RESULTS--Mean (+/-SEM) values for the MC3-standard interlocking-nail composite and the MC3-modified interlocking-nail composite, respectively, in 4-point bending were: composite rigidity, 3,119 +/- 334.5 Nm/rad (newton. meter/radian) and 3,185 +/- 401.2 Nm/rad; yield bending moment, 205.0 +/- 18.46 Nm and 186.7 +/- 6.17 Nm; and failure bending moment, 366.4 +/- 21.82 Nm and 378.1 +/- 20.41 Nm. There were no significant differences in the biomechanical values for bending between the 2 fixation methods. In torsion, mean (+/-SEM) values for the MC3-standard interlocking-nail composite and the MC3-modified interlocking-nail composite were: composite rigidity, 135.5 +/- 7.128 Nm/rad and 112.5 +/- 7.432 Nm/rad; gap stiffness, 207.6 +/- 10.57 Nm/rad and 181.7 +/- 12.89 Nm/rad; and yield load, 123.3 +/- 2.563 Nm and 107.5 +/- 8.353 Nm, respectively. Composite rigidity and gap stiffness for standard interlocking-nail fixations were significantly higher than the modified interlocking-nail fixation technique in torsion. Yield load had a tendency to be higher for the standard interlocking-nail fixation (P =.15). CONCLUSIONS--No significant differences in biomechanical properties were identified between a standard interlocking nail and one with the screw holes offset by 30 degrees in caudocranial 4-point bending. The standard interlocking nail was superior to the modified interlocking nail in torsional gap stiffness and composite rigidity. The torsional yield load also tended to be higher for the standard interlocking nail. CLINICAL RELEVANCE--The standard interlocking nail with parallel screw holes is superior to a modified interlocking nail with the screw holes offset by 30 degrees in ostectomized equine MC3 bones in vitro when tested in torsion.     

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.     

An in vitro biomechanical comparison of a prototype intramedullary pin-plate with a dynamic compression plate for equine metacarpophalangeal arthrodesis

OBJECTIVES : To compare the biomechanical properties of a prototype intramedullary pin-plate (IMPP) implant specifically designed for equine metacarpophalangeal (MCP) arthrodesis with a dynamic compression plate (DCP) system. STUDY DESIGN : In vitro biomechanical testing of paired cadaveric equine forelimbs with a simulated traumatic disruption of the suspensory apparatus, stabilized by one of two methods for MCP arthrodesis. ANIMAL POPULATION : Twenty-one pairs of adult equine cadaveric forelimbs. METHODS : Each forelimb had the distal sesamoidean ligaments severed to create a disrupted suspensory apparatus. For each forelimb pair, the MCP joint was stabilized with the IMPP in one limb, and a DCP in the other limb. Seven matching limb pairs were tested in axial compression in a single cycle to failure, 7 matching limb pairs were tested in torsion in a single cycle to failure, and 7 matching limb pairs were fatigued tested in axial compression. Mean test variable values for each method were compared using a paired t-test within each group. Significance was set at P<.05. RESULTS : The mean yield load, yield stiffness, and failure load (axial compression, torsional loading) was significantly greater for the IMPP compared with the DCP system. Mean cycles to failure for axial compression was significantly greater for the IMPP compared with the DCP system. Significance in all tests was P<.0001. CONCLUSION : The IMPP was superior to the DCP system in resisting the biomechanical forces most likely to cause failure of MCP joint arthrodesis. CLINICAL RELEVANCE : The IMPP implant should be considered for MCP arthrodesis in horses with traumatic disruption of the suspensory apparatus. The specific design of the IMPP implant may facilitate equine MCP arthrodesis and avoid convalescent complications related to cyclic fatigue.     

An in vitro biomechanical comparison of a locking compression plate fixation and kerf cut cylinder fixation for ventral arthrodesis of the fourth and the fifth equine cervical vertebrae

Objectives: To (1) define mechanical properties in flexion, extension, and left lateral bending of cadaveric equine 4th and 5th cervical (C4–C5) articulations, (2) compare biomechanical properties of C4–C5 when stabilized with a kerf cut cylinder (KCC) compared with a ventrally placed 4.5 mm locking compression plate (LCP). Study Design: In vitro biomechanical investigation. Sample Population: Cadaveric adult equine cervical vertebral columns (n=54). Methods: Cervical vertebrae aged by horse dentition and size measured from radiographs were divided into 3 age groups then randomly allocated to 3 groups. The C4–C5 articulation was treated differently in each of the groups: KCC group; KCC‐implanted LCP group; 8‐hole 4.5 mm LCP implanted and intact group; no implant. Specimens were randomly subdivided into 1 of 3 loading conditions, before testing to failure under 4‐point bending. Stiffness, yield bending moment, failure bending moment, and failure mode were recorded. General linear models were performed to analyze associations between biomechanical properties and test variables. Results: All specimens failed at the C4–C5 intervertebral articulation. The cervical vertebrae with the LCP construct had significantly higher stiffness, yield bending moment, and failure bending moment than the KCC‐implanted cervical vertebrae. Failure modes differed between groups and varied with loading direction: KCC group, fractures of C5 associated with the KCC were common; LCP group, screw pull out or fractures (of C4 and C5 bodies, during extension and the caudal aspect of C4 during left lateral bending) were common; and intact group, subluxations were most common. Conclusions: In this model, LCP constructs had superior biomechanical properties compared with KCC constructs. Further research investigating the effect of repetitive loading is indicated.     

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.     

A biomechanical comparison of headless tapered variable pitch and AO cortical bone screws for fixation of a simulated slab fracture in equine third carpal bones

OBJECTIVE: To compare the mechanical shear strengths and stiffnesses obtained from in vitro testing of a simulated complete third carpal bone (C3) frontal plane radial facet slab fracture (osteotomy) stabilized with either a 4/5 Acutrak (AT) compression screw or a 4.5-mm AO cortical bone (AO) screw inserted in lag fashion. Drilling, tapping, and screw insertion torques, forces, and times also were compared between AT and AO implants. STUDY DESIGN: In vitro biomechanical assessment of site preparation, screw insertion, and shear failure test variables of bone screw stabilized simulated C3 slab fracture in paired cadaveric equine carpi. SAMPLE POPULATION: Eight pairs of cadaveric equine C3 without orthopedic abnormalities. METHODS: Standardized simulated C3 slab fractures were repaired with either AO or AT screws (AO/C3 and AT/C3 groups, respectively). Drilling, tapping, and screw insertion torques, forces, and times were measured with a materials testing machine for each screw type. Repaired specimens were tested in axially oriented shear until failure. Paired Students t-tests were used to assess differences between site preparation, screw insertion, and shear testing variables. Significance was set at P <.05. RESULTS: There were no significant differences in bone fragment measurements of the standardized simulated C3 slab fractures created for AO or AT screws. There were no significant differences for mean and maximum drilling torques; however, the tapered AT drill had greater maximum drilling force compared with the 3.2-mm and 4.5-mm AO drill bits. Mean insertion torque and force measured from the self-tapping AT screw were not significantly different compared with the 4.5-mm AO tap. There were no significant differences in maximum screw torque among constructs. Total procedure time was significantly longer for the AT group (5.8 +/- 1.6 minutes) compared with the AO group (2.9 +/- 1.1 minutes; P =.001). AT stabilized specimens had significantly greater mean +/- SD initial shear stiffness (3.64 +/- 1.08 kN/mm) than AO specimens (1.64 +/- 0.73 kN/mm; P =.005). All other shear mechanical testing variables were not statistically different among screw types. CONCLUSION: The 4/5 Acutrak insertion technique was accurate and safe, and the AT screw effectively stabilized simulated equine C3 frontal plane slab fractures. When tested in shear, this screw type was mechanically comparable to the 4.5-mm AO screw; however, AT constructs had greater initial shear stiffness. Initial shear stiffness was likely an indirect measure of interfragmentary compression, and thus may indicate that the AT screw provides a more rigid fixation for frontal plane C3 slab fractures in horses. CLINICAL RELEVANCE: Considering the comparable mechanical behavior, greater initial shear stiffness for AT screw stabilized C3 slab fracture fragments, the ability to accurately insert the screw with the aid of a guide pin, and the potential for less persistent soft tissue irritation with the headless screw design, the 4/5 tapered AT screw is an attractive alternative for repair of C3 slab fractures in horses.     

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.     

Comparison of limited-contact dynamic compression plate and locking compression plate constructs for proximal interphalangeal joint arthrodesis in the horse

This study compared in vitro monotonic and cyclic mechanical properties of equine proximal interphalangeal joint arthrodeses stabilized using an open or closed technique combined with axial 4.5 mm narrow limited-contact dynamic compression plate (LC-DCP) or 4.5 mm narrow locking compression plate (LCP). Ten forelimb pairs were randomly assigned to LCP or LC-DCP groups. One limb in each pair was assigned to either open or closed technique. Limbs were tested for cyclic fatigue at 20 000 cycles and then single-cycle to failure under 3-point dorsopalmar bending. There was no significant difference in stiffness of constructs during cyclic fatigue testing or on force or stiffness at failure in single cycle to failure testing between open and closed techniques or between plate types. Both implants, surgical technique, or combinations thereof are suitable for clinical use. More work is necessary to define the interaction between implant type and surgical technique.     

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.     

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.     

Arthrodesis of the equine proximal interphalangeal joint: a mechanical comparison of 2 parallel 5.5 mm cortical screws and 3 parallel 5.5 mm cortical screws

OBJECTIVE: To compare the biomechanical characteristics and mode of failure of 2 techniques using parallel 5.5 mm screws for pastern joint arthrodesis in horses. STUDY DESIGN: Randomized block design, for horse (1-5), method of fixation (two 5.5 mm screws versus three 5.5 mm screws), side (right, left), and end (front, hind). Constructs were tested to failure in 3-point bending. SAMPLE POPULATION: Twenty limbs (5 cadavers). METHODS: A combined aiming device was used to facilitate screw placement. Two parallel 5.5 mm screws were inserted in lag fashion in 1 limb of a pair, and three 5.5 mm screws were inserted in the contralateral limb. Constructs were then tested in 3-point bending in a dorsal-to-palmar (plantar) direction using a materials testing machine at a loading rate of 19 mm/s. Maximal bending moment at failure and stiffness were obtained from bending moment-angular deformation curves. RESULTS: There was no significant difference between two and three 5.5 mm screw constructs for bending moment and stiffness (P<.05). All constructs ultimately failed by bone fracture or screw bending. For proximal interphalangeal (PIP) joint arthrodesis constructs loaded in 3-point bending, no significant effect of treatment, side, or end on maximal bending moment or stiffness was detected. CONCLUSIONS: Two 5.5 mm cortical screws inserted in parallel should provide a surgically simpler and equally strong PIP joint arthrodesis compared with three 5.5 mm cortical screws. CLINICAL RELEVANCE: Two 5.5 mm cortical screws inserted in parallel for PIP joint arthrodesis should perform similarly under conditions used in this study, as three 5.5 mm screws inserted in a similar manner, when loaded under bending.