Static and Dynamic Cerclage Wire Analysis

A new type of double loop cerclage wire, conventional single wire loop cerclage, and twist-type cerclage were evaluated. The double loop cerclage was applied using the Osteo Systems double loop tightener. Two groups of single wire loop cerclage were applied using the Osteo System loop tightener and the Richards loop tightener. Two groups of twist-type cerclage were applied using the Kirschner wire twister and side-cutting pliers. The test system allowed determination of the static tension produced by each wire, as weH as its ability to resist distraction. The double loop cerclage wires were the most effective in producing static tension and in resisting distraction. While the conventional single loop cerclage wires produced more static tension than the twist cerclage wires, they were less effective in resisting distraction.     

In Vitro Cerclage Wiring Analysis

The ability of six different instruments to apply a cerclage wire under tension to a tension gage was compared. The loop knot produced greater final wire tension than the twist knot, both before and after bending. No significant difference in tension was found between the Swiss Osteo and A.S.I.F. instruments. The Rhinelander and Richards instruments gave approximately the same tension before the bend. The Rhinelander, Richards, and Vise Grip instruments showed no statistical difference in tension produced after the bend. The Bowen instrument developed the least amount of tension, both before and after bending the twist. All twist knots lost a significant amount of tension during the bending process. The twist-type knots that were twisted until breakage in the middle of the knot produced greater tension than those that were cut once they were tight. Cutting the twisted knot caused a significant decrease in wire tension. No correlation was found between operator pull and final cerclage wire tension.     

Mechanical Characteristics and Comparisons of Cerclage Wires: Introduction of the Double-Wrap and Loop/Twist Tying Methods

Objective — Evaluate the mechanical properties of twist, loop, double loop, double-wrap and loop/twist cerclage.
Methods — The initial tension generated by 18 cerclage of each type was determined using a materials testing machine after tying around a testing jig. Six wires from each type were distracted and the initial stiffness and yield load were determined. Yield behavior was further investigated in six wires of each type by determining the load required to reduce cerclage tension below 30 Newton (N) following an incremental (50 N) stepwise load and unload regimen. The amount of collapse of the simulated bone fragments that resulted in the reduction of initial tension to 30 N was measured for the final six wires of each group. Data were analyzed by analysis of variance and a multiple comparison test.
Results — Twist type cerclage generated less tension than loop-type cerclage. The yield load of these two types was similar. Double-loop and double-wrap cerclage generated superior tension and resisted a greater load before loosening. Loop/twist cerclage had an intermediate initial tension but had the greatest resistance to loading. In the collapse test, the greater the initial tension, the more collapse could occur before the wire was loose. For all types of cerclage wire fixation, a reduction of diameter of the testing jig of more than 1% caused loosening.
Clinical Relevance — Double-loop and double-wrap cerclage provide greater compression of fragments and resist loads associated with weight-bearing better than the twist and loop methods. Loop/twist cerclage may have advantages because of their superior resistance to loading. All cerclage will loosen if fracture fragments collapse.     

The Effect of Six Knotting Methods on the Biomechanical Properties of Three Large Diameter Absorbable Suture Materials

Objective— To evaluate the effect of 6 different knotting methods on the mechanical properties of 3 large absorbable suture materials used in large animal surgery. Study Design— In vitro mechanical study. Sample Population— Knotted suture loops (n=15 per group). Methods— Suture loops were created between two low‐friction pulleys with either 2 polydioxanone, 2 polyglactin 910 or 3 polyglactin 910. Strands were tied using 1 of 6 knotting technique: square knot, surgeon knot, clamped surgeon's knot, sliding half‐hitch knot (HH), Delimar knot and self‐locking knot (SLK). A single cycle to failure test was performed on each suture loop with a distraction rate of 100 mm/min. Failure modes were evaluated and breaking strength, elongation to failure and stiffness were compared. Results— All loops except two HH failed at the knot by acute breaking. The double‐stranded SLK was both stronger and stiffer than all other knots for each suture material. Clamping the first throw of the surgeon knot decreased load to failure significantly (143.11 ± 8.64 N) compared with not clamping (159.21 ± 6.14 N) for polydioxanone. Stiffness and elongation to failure were respectively lower and increased for 2 polydioxanone compared with both polyglactin 910 materials for all knotting techniques. Conclusions— Knotting techniques do influence structural properties of suture loops. The double strand loop conferred stiffer and stronger properties to the SLK Clinical Relevance— Clamping the first throw of polydioxanone should be avoided when tying a suture under tension even using large diameter suture materials. Using a SLK might be considered as a useful alternative when excessive tension is present.     

Resistance of cerclage to knot failure

The comparative ability of loop-knotted and twist-knotted cerclage to withstand tensile forces was tested. Two twist-knot devices and one loop-knot device were used to apply cerclage wires to a 5-cm diameter split circular jaw mounted on a tensile testing machine. Twist-knot devices were tested with 0.8-, 1.0-, or 1.2-mm wire, and the loop-knot device was tested with 0.8-, 1.0-, or 1.25-mm wire. For all wire sizes, the twisted knot provided greater resistance to knot failure than did the loop-knot. Of the 2 twist-knot devices, the Rhinelander wire tightener-twister produced the greatest resistance to knot failure. Knot resistance increased with increase in wire size for all devices tested.     

Knot Security of Suture Materials

The knot security of chromic gut, polyglycolic acid, polyglactin 910, polydioxanone, polypropylene, and monofilament nylon size 2-0 suture materials were tested biomechanically in vitro. Twenty reproducible knots were tied and incubated in canine serum at 37 degrees for 24 hours before testing. A "secure knot" was defined as a knot that, when tested to failure, broke rather than untied by slippage. The minimum number of throws necessary to make a secure, snug (1500 g tension) square knot was three for gut, polyglycolic acid, polyglactin 910, and polypropylene and four for polydioxanone and nylon. All throws including the first were counted. With all suture materials tested, surgeon's knots were as secure as square knots. Only gut, polyglycolic acid, and polydioxanone granny knots were as secure as square knots; no loosely tied (500 g tension) asymmetric square knots were as secure as snug square knots, and only polydioxanone and polypropylene loose square knots were as secure as snug square knots. Square knots used to start a continuous pattern required one additional throw with gut, polydioxanone, and nylon. Square knots used to end a continuous pattern required two to three additional throws with all materials tested.     

Median sternotomy closure in dogs: a mechanical comparison of technique stability

OBJECTIVE: To evaluate the mechanical properties of canine median sternotomy closure using double-loop cerclage compared with other commonly used cerclage sternotomy closure patterns. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Forty canine cadaveric sternal segments. METHODS: Median sternotomy-wire constructs were loaded to failure in a materials testing machine. Each construct was radiographed before and after testing. Specific wire configurations tested were: 2 single twist cerclage centered on the sternebrae, single twist figure of 8 pattern centered on the sternal synchondrosis, double twist figure of 8 pattern centered on the sternal synchondrosis, 2 double-loop cerclage centered on the sternebrae, and 1 double-loop cerclage centered on the sternal synchondrosis. Wire configurations were compared by craniocaudal translation of sternabrae on pre-test radiographs, and displacement during loading, and mode of failure, based on analysis of test video, and post-test radiographs. RESULTS: Double-loop cerclage did not provide superior mechanical stabilization of median sternotomy. Both figure of 8 patterns had the least displacement at higher loads. Two single twists that were centered on sternebrae were least able to prevent displacement at higher loads, caused the most craniocaudal translation before testing, and fractured more often at loads < or = 200 N compared with other configurations. CONCLUSION: Sternal wiring techniques stabilizing sternal synchondroses had the least displacement. Overall, figure of 8 cerclage appeared most suitable because they minimized displacement at high loads and facilitated accurate reduction during tensioning. CLINICAL RELEVANCE: In closing canine sternotomy, figure of 8 cerclage may be most suitable. Double-loop cerclage centered on the sternal synchondrosis should be avoided because of wire failure at high loads.     

A mechanical study of ligature security of commercially available pre-tied ligatures versus hand tied ligatures for use in equine laparoscopy

OBJECTIVE: To determine a hand-tied ligature knot configuration, suture size, and suture type that would be an acceptable substitute to commercially available ligature knots for use in equine laparoscopic surgery. STUDY DESIGN: Three-factor ANOVA with the fixed effects being suture type, suture size, and knot type. The dependent variable was ligature security (load to failure). METHODS: Commercially available Endoloop and 4 hand-tied slipknot ligatures were compared with a 4-layer square knot. The hand tied ligature knots tested were the 4S modified Roeder knot, the Brooks knot, the modified Roeder knot, and the Weston knot. Two suture sizes (0, 2) of each of 2 suture types (polydioxanone, polyglactin 910) were tested with each hand tied knot. Two types (polydioxanone, polyglactin 910) of size 0 Endoloop were tested. Twenty repetitions of each knot suture type were tested for force to yield on a materials testing machine. Statistical analysis consisted of a 3-way ANOVA with individual comparisons made using the Bonferroni method. Significance was P< or = .05. RESULTS: Only the 4S modified Roeder knot in 2 polydioxanone (103 N) was comparable with the breaking strength of the square knots (157 N). All other knot suture combinations tested were significantly weaker than the square knot (range, 2-18 N). CONCLUSION: For equine laparoscopy, a 2 polydioxanone 4S modified Roeder knot would be an acceptable alternative to the commercially available Endoloop. CLINICAL RELEVANCE: Laparoscopic slip knots are commonly used in equine laparoscopic surgery. Various knot configuration and suture size and type combinations will affect the security of the slip knot.     

In-vitro comparison of 3 knotting techniques for lateral fabellotibial suture stabilization

This study evaluated the biomechanical characteristics of a single self-locking knot (sSLK) and a double self-locking knot (dSLK) compared with the square knot (SQ) for stabilization of cranial cruciate ligament rupture. Each knot underwent monotonic tensile and cyclical loading. Starting tension, elongation, stiffness, and load to failure were all evaluated. A value of P < 0.05 was considered significant. Starting tension, overall stiffness, and load to failure were all significantly greater in both the sSLK and dSLK compared with the SQ. There was no difference in elongation among the knots. There were no significant differences in starting tension, elongation, stiffness, and load to failure between the sSLK and the dSLK. The self-locking knots were stronger and stiffer than the SQ; there is no biomechanical advantage in using the dSLK compared with the sSLK.     

In vitro Comparison of Secure Aberdeen and Square Knots with Plasma‐ and Fat‐Coated Polydioxanone

Objective: To determine (1) the minimum number of throws to form secure Aberdeen (AB) and square knots to start (SS) and end (SE) continuous patterns, in fat‐ and plasma‐coated polydioxanone; and (2) compare relative knot security (RKS) and knot volumes of these secure SS, SE, and AB knots. Study Design: In vitro experimental materials testing. Sample Population: Polydioxanone suture material (3 metric). Methods: Each knot was tested 20 times, and throws incrementally added until secure SS, SE, and AB knots were found. RKS and knot volumes were calculated for SS, SE, and AB knots. Results: Secure SE knots needed 5 throws in plasma or fat. Secure SS knots needed 4 throws in plasma, but 5 in fat. The minimum AB configuration that was secure in plasma or fat was 3+1, however, the 4+1 AB knot was also secure in fat. Mean (SD) RKS of secure knots were: SE 59.69% (5.91), SS 67.92% (12.50), AB 81.08% (8.99). AB knots had significantly higher mean RKS than any SS or SE knot in plasma or fat (P<.001). Mean knot volume of 3+1 AB knot was significantly smaller than any secure SS or SE knots by 22.6–69.4% (P<.0001). Mean knot volume of 4+1 AB knots was significantly smaller than all fat secure SS and SE knots by 19.9–57.5% (P=.0001). Conclusion: The knot security of the SS knot was decreased by fat coating polydioxanone suture, requiring an additional throw to keep it secure. Secure AB knots had a higher breaking strength and smaller knot volume than secure SS and SE knots. Clinical Relevance: The AB may be preferable to square knots in continuous closures. As many body fluids contain lipid, surgeons should tie knot configurations considered secure in fat. We advise tying a 4+1 AB and placing a minimum of 5 throws to tie SS and SE knots using 3 metric polydioxanone.     

Influence of bolt tightening torque,wire size,and component reuse on wire fixation in circular external fixation

OBJECTIVES: To evaluate the effects of bolt torque, wire size, and component reuse on the ability to maintain wire tension in 3 external skeletal fixation systems. STUDY DESIGN: Biomechanical study. METHODS: Yield strength in tension of 1.0-, 1.2-, 1.5-, and 1.6-mm-diameter wires, and yield strength in torque of Hofmann Small Bone Fixation (SBF) cannulated and slotted bolts and IMEX regular and miniature bolts were determined on a testing machine. The minimum bolt tightening torque needed to prevent wire slippage at clinically recommended wire tensions was determined. Components were tested 10 times, and loads at slippage were recorded. RESULTS: The IMEX system required a mean of 8 Nm of bolt tightening torque to maintain 900 N (1.6-mm wires). The SBF system required a mean of 3 Nm bolt torque to maintain 300 N (1.0-mm wires) and 5 Nm to maintain 600 N (1.2-mm wires). The SBF cannulated bolt required 9 Nm of torque to maintain 900 N (1.5-mm wires). The SBF slotted bolts could only maintain 800 N before yield. The IMEX miniature system required a mean bolt torque of 1.1 Nm to maintain 300 N. The cannulated and slotted bolts from both manufacturers failed to maintain 70% of initial wire tension after 7 and 4 uses, respectively. CONCLUSIONS: The IMEX systems and the SBF system using 1.0- and 1.2-mm wires could maintain clinically recommended wire tension safely. Only the IMEX system could maintain clinically recommended wire tension safely using 1.5- or 1.6-mm wires. CLINICAL RELEVANCE: The SBF system using 1.0- and 1.2-mm wires and the IMEX system using all wire sizes can maintain clinically relevant wire tension. The SBF system using 1.5-mm wires could not. Cannulated and slotted bolts should not be used more than 6 and 3 times, respectively. Nuts should not be reused.     

Biomechanical Evaluation of a Crimp Clamp System for Loop Fixation of Monofilament Nylon Leader Material Used for Stabilization of the Canine Stifle Joint

Objective —To test a crimp clamp system designed to secure monofilament nylon leader (MNL) material commonly used as lateral fabellotibial sutures (LFS) in extra-articular stabilization of the canine stifle joint.
Study Design — In vitro biomechanical tests of MNL loops secured with either the crimp clamp system or knots were performed. Suture loops (n = 94) were created from 27.3 kg tensile strength MNL and fastened with knots or crimp clamps. Tests were conducted on steam-sterilized, ethylene-oxide-sterilized, and nonsterilized MNL sutures. Loops were evaluated in single load tests and cycled tests. Values for load to failure, initial loop tension, loop elongation, mode of failure, and point of failure were determined.
Results —Crimp-clamped loops were superior to knotted loops in all parameters tested in both cycled and noncycled tests. Loop failure generally occurred by breaking within 3 mm of the fixation in both clamped and knotted tests. Loop elongation after cycling was greater in the knotted loops compared with clamped loops ( P < .001). Load to failure was greater in clamped tests than in knotted tests (P < .001), regardless of sterilization technique used. Significantly higher initial loop tension could be achieved with the clamp system compared with knot fixation ( P < .001).
Conclusions —The crimp clamp system provides superior in vitro loop fixation characteristics compared with knot fixation in 27.3 kg test MNL.
Clinical Relevance —Based on the results of biomechanical testing and the known biocompatibility of the system's implant components, clinical trials using the crimp clamp system are warranted.     

Biomechanical comparison of a circular external skeletal fixator construct to pin and tension band wire fixation for the stabilization of olecranon osteotomies in dogs: a cadaveric study

OBJECTIVE: To compare anatomic reduction and the biomechanical properties of a circular external skeletal fixator (CESF) construct to pin and tension band wire (PTBW) fixation for the stabilization of olecranon osteotomies in dogs. STUDY DESIGN: Cadaveric study. ANIMALS: Forelimbs from 12 skeletally mature mixed-breed dogs, weighing 23 to 28 kg. METHODS: An olecranon osteotomy was stabilized with either a CESF construct or PTBW fixation. A single distractive load to failure was applied to each specimen through the triceps tendon. Osteotomy reduction and biomechanical properties were compared between fixation groups. RESULTS: Reduction was not significantly different (gap: P =.171; malalignment: P =.558) between fixation groups. Osteotomies stabilized with the CESF had greater stiffness (P <.0001) and maximum load sustained (P <.0001) compared to PTBW fixation. There was no significant difference for yield load (P =.318) or for load at 1 mm of axial displacement (P =.997) between fixation groups. Failure of fixation occurred by bending of the intramedullary Steinmann pin and the fixation wires in the CESF specimens and by untwisting of the tension band wire knot with pullout and bending of the Kirschner wires in the PTBW specimens. CONCLUSIONS: Specimens stabilized with the CESF construct had similar reduction and yield load, greater stiffness and maximum load sustained, and less elastic deformation than specimens stabilized with PTBW fixation. CLINICAL RELEVANCE: The CESF construct may provide a biomechanically favorable alternative to PTBW fixation for stabilization of olecranon osteotomies in dogs, and its application warrants clinical investigation.     

Effects of ring diameter and wire tension on the axial biomechanics of four-ring circular external skeletal fixator constructs.

OBJECTIVE: To determine relative effects of ring diameter and wire tension on axial biomechanical properties of 4-ring circular external skeletal fixator constructs. SAMPLE POPULATION: 4-ring circular external skeletal fixator constructs and artificial bone models. PROCEDURE: 4-ring constructs were assembled, using 50-, 66-, 84-, or 118-mm-diameter rings. Two 1.6-mm-diameter fixation wires were attached to opposing surfaces of each ring at intersection angles of 90 degrees and placed through a gap-fracture bone model. Three examples of each construct were loaded in axial compression at 7 N/s to a maximum load of 400 N at each of 4 wire tensions (0, 30, 60, and 90 kg). Response variables were determined from resulting load-displacement curves (construct stiffness, load at 1 mm of displacement, displacement at 400 N). RESULTS: Ring diameter and wire tension had a significant effect on all response variables and had a significant interaction for construct stiffness and displacement at 400 N. Significant differences within all response variables were seen among all 4 ring diameters and all 4 wire tensions. As ring diameter increased, effect of increasing wire tension on gap stiffness and gap displacement at 400 N decreased. Ring diameter had a greater effect than wire tension on all response variables. CONCLUSIONS AND CLINICAL RELEVANCE: Although effects of wire tension decrease as ring diameter increases, placing tension on wires in larger ring constructs is important because these constructs are inherently less stiff. The differential contribution of ring diameter, wire tension, and their interactions must be considered when using circular external skeletal fixators.     

A comparison of knot security of commonly used hand-tied laparoscopic slipknots

OBJECTIVE: To compare the peak force required for failure of hand-tied laparoscopic slipknot ligatures. STUDY DESIGN: In vitro mechanical evaluation of suture material/knot combinations. Sample POPULATION: Four hand-tied laparoscopic slipknots were studied. Three suture materials and 2 suture sizes were evaluated. Twenty samples of each group were tested, for a total of 400 samples. METHODS: The 4S modified Roeder, modified Roeder, and Weston and Brooks laparoscopic slipknots using 0 polyglyconate, 0 polyglycolic acid, 1 polyglyconate, and 1 polydioxanone (PDS) were tested. A vertical distracting force (5 mm/s) was applied until failure. Mean peak force to failure was obtained for each suture material, size, and knot combination. RESULTS: Mean (+/-SEM) peak force to failure of hand-tied ligatures ranged from 156.8+/-9.1 N to 4.8+/-.4 N. The 4S-modified Roeder had the highest mean peak force to failure. Ligatures tied with polyglyconate and size 1 suture had the highest mean peak force to failure. CONCLUSIONS: The 4S-modified Roeder was significantly and consistently stronger than the other slipknots. Polyglyconate was superior to other suture materials. The 1 polyglyconate had the highest mean peak force to failure followed by 0 polyglyconate that exceeded the 1PDS. CLINICAL RELEVANCE: The 4S-modified Roeder slipknot using 1 polyglyconate has the greatest breaking strength of sutures tested and should be considered when performing laparoscopic ligatures.     

Effect of Cerclage Wires on Periosteal Bone in Growing Dogs

Three diameters of wire were placed circumferentially around the femora of six 22 week old puppies. The wires were placed over the periosteum on one limb and under the periosteum on the other limb. The effect of the wires on actively growing bone was evaluated 3 and 8 weeks after placement. Diffuse growth of periosteal new bone occurred in immature dog femora in which cerclage were placed under the periosteum. This reaction corresponded with dramatically increased medullary and periosteal microvascularity coupled with histologic active trabecular bone formation. In femora in which wires were placed over the periosteum, even though the placement of the wires should supposedly have been the most detrimental, there were active vessels within the cortex directly under all wires. In both preparations, cerclage wires were becoming encased in the growing cortical bone 8 weeks after placement. Cerclage wires did not devitalize immature bone nor did it restrict adjacent appositional bone growth.     

Multiple Intramedullary Wire Fixation of a Radial Fracture in a Dog

Multiple intramedullary wire fixation infrequently can be used as an alternative technique to plating, transfixation devices, single intramedullary pinning, or external coaptation for some radius and ulna fractures.
This report describes a comminuted fracture of the radius and ulna with fissures and comminution extending too far into the proximal radius for effective application of a bone plate or Kirschner-Ehmer apparatus. Resulting fracture instability and collapse prohibited effective use of external coaptation as a primary means of fixation. The radial fracture was repaired and stabilized with full cerclage wires and multiple intramedullary Kirschner wires. The dog was using the leg normally 12 months following surgery.     

A comparison of ultra-high-molecular weight polyethylene cable and stainless steel wire using two fixation techniques for repair of equine midbody sesamoid fractures: an in vitro biomechanical study

OBJECTIVE: To compare the monotonic tensile and fatigue strength of 16-gauge stainless steel wire (SSW) to ultra-high-molecular weight polyethylene (UHMWPE) cable using a transfixed cerclage technique in an in vitro midbody sesamoid osteotomy model. Endoscopic modifications to Martins transfixed cerclage technique were developed. A new suture technique of fixation was compared with the transfixed cerclage technique by measuring gap formation after cyclic testing. STUDY DESIGN: An in vitro biomechanical paired equine cadaver limb study. SAMPLE POPULATION: Twenty-one paired cadaveric adult equine forelimbs. METHODS: Uniaxial medial midbody sesamoid osteotomies were created in paired adult equine forelimbs. Monotonic tensile strength was measured on 10 forelimbs repaired by a transfixed cerclage technique using wire or cable. Fatigue testing to failure was performed on 4 forelimbs repaired using the transfixed cerclage technique by cycling the limbs between 500 N and 2,000 N. The limbs were initially repaired with wire, cycled until the wire broke, then repaired with cable and cycled again to failure. Fatigue testing for gap displacement was performed on 8 limbs repaired with either the transfixed cerclage technique or the suture technique. Limbs were cycled between 500 N and 2,000 N for 10,000 cycles. The limbs were repaired with wire initially, tested, and then repaired with cable and tested again. Twenty-two limbs were used for mechanical testing. The remaining limbs (20) were used to develop and practice the endoscopic transfixed cerclage (10 limbs) and suture (10 limbs) techniques. RESULTS: Ultimate tensile strength (UTS) of UHMWPE cable constructs was 34% greater than the UTS of SSW constructs. Fatigue strength was 2 to 20 times greater for UHMWPE cable constructs than SSW constructs. Separation of fragments was 153% less for limbs repaired by the suture technique compared with those repaired by the transfixed cerclage technique. CONCLUSIONS: UHMWPE cable shows promise for this clinical application because of its greater tensile and fatigue strength. The newly described suture technique significantly reduced gap formation compared with the transfixed cerclage technique. Osteotomy gap formation occurred early in cycling, suggesting that rigid support in the form of a cast may be needed during the early postoperative period for wiring techniques. CLINICAL RELEVANCE: Clinical testing of UHMWPE cable should eliminate problems of wire breakage seen with SSW. The endoscopic transfixed cerclage technique can be used by surgeons familiar with arthroscopic surgery. However, the suture technique needs to be tested in vivo to determine whether there is a clinical advantage compared with the transfixed cerclage technique.     

Repair of a proximal diaphyseal femoral fracture in a calf, using intramedullary pinning, cerclage wiring, and external fixation.

Repair of a comminuted, spiral oblique, proximal diaphyseal femoral fracture in a 7-day-old calf was achieved by use of an intramedullary pin, cerclage wires, and external fixator. Six stainless steel wires were used for full cerclage to secure a long butterfly fragment and multiple incomplete and complete nondisplaced fragments to the femur in order to create 2 principal fragments. Axial alignment and resistance to bending was provided by a round, double-pointed, end-threaded intramedullary pin (6.35 mm in diameter), which was inserted in a retrograde fashion. A type-1, double-connecting-bar external fixator, using 4 round pins (4.8 mm in diameter), was used to provide supplemental stabilization against shear and torsional forces. At 45 days after surgery, healing at the fracture site was seen on radiography of the limb, and the external fixator was removed. Eight months after surgery, the calf had a normal gait.     

Surgical repair of rib fractures in 14 neonatal foals: case selection, surgical technique and results

Reasons for performing study: Fractured ribs are encountered quite frequently in newborn Thoroughbred foals, often with fatal outcome. Surgical repair of fractures therefore requires consideration as a means of reducing mortality. Objectives: To evaluate the repair of rib fractures using internal fixation techniques in foals at 2 different equine hospitals following similar diagnostics and case selection. Methods: The records of 14 foals that underwent internal fixation of fracture ribs were reviewed. Subject details, clinical presentation, diagnosis, surgical technique, post operative care and complications were recorded. Follow-up information was obtained in 7 foals. Results: The fractured ribs were reduced and stabilised using reconstruction plate(s), self-tapping cortical screws and cerclage wire in 12 cases, Steinmann pins and cerclage wires in 1 case and both techniques in 1 case. Not every rib was reduced on each case. Surgical reduction was performed on an average of 2 ribs, range 1-3 ribs in each foal. At the time of writing, 4 foals had been sold, one age 2 years was in training and 2 others died from unrelated causes. Conclusions: Our data support the use of surgical stabilisation utilising reconstruction plates, self-tapping cortical screws and cerclage wire for selected cases of thoracic trauma in neonatal foals. The use of Steinmann pins may be suboptimal due to cyclic failure, implant migration and the potential for iatrogenic internal thoracic trauma. Potential relevance: Foals with existing extensive internal thoracic trauma resulting from rib fracture(s), or the potential for such trauma, previously considered to have a guarded to poor prognosis for survival, may be successfully managed with internal fixation of selected fracture sites.