1
|
Chung WC, Déjardin LM. Mechanical comparison of straight and pre-bent interlocking nails used for the stabilization of a tibial gap fracture model. Vet Surg 2024. [PMID: 39072761 DOI: 10.1111/vsu.14147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/22/2024] [Accepted: 07/14/2024] [Indexed: 07/30/2024]
Abstract
OBJECTIVE To compare the mechanical behavior of straight (STRT) and pre-bent (BENT) I-Loc angle-stable interlocking nails (AS-ILN) used for stabilization of canine mid-diaphyseal tibial fractures. STUDY DESIGN In vitro experimental study. SAMPLE POPULATION Tibial gap fracture models (n = 5/group). METHODS Tibial models simulating a comminuted mid-diaphyseal fracture were stabilized with either a STRT or BENT I-Loc AS-ILN. Bent nails were contoured to match the 10° tibial recurvatum of a mid-size dog. Constructs were subjected to cyclic eccentric compressive loads followed by ramp load until failure. Construct compliance, maximum compressive load and resistive torque, yield load and angular deformation at 450 N were statistically compared using t-tests (p < .05). Failure modes were described. RESULTS Compliance was 45% lower in BENT than STRT groups (p < .0001). Constructs in the BENT group sustained ~20% and 34% greater maximum and yield loads, respectively, than STRT constructs. Maximum resistive torques were similar between groups (p = .16). At 450 N, sagittal plane angular deformation increased from 0° to 4° in procurvatum (STRT group) and decreased from 10° to 8° in recurvatum (BENT group-p < .0001). Construct yield failure occurred at the nail isthmus in both groups. CONCLUSION These results demonstrated that, in a tibial gap fracture model, pre-bending I-Loc AS-ILNs provided mechanical advantages by increasing their ability to resist bending resulting from eccentric compressive loads. CLINICAL SIGNIFICANCE Pre-bending may reduce the occurrence of tibial nail yield failure. Surgeons should therefore consider pre-bending tibial I-Loc nails to match the bone anatomical recurvatum prior to implantation.
Collapse
Affiliation(s)
- William C Chung
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA
| |
Collapse
|
2
|
Sherman AH, Kraus KH, Watt D, Yuan L, Mochel JP. Linear external skeletal fixation applied in minimally invasive fashion for stabilization of nonarticular tibial fractures in dogs and cats. Vet Surg 2023; 52:249-256. [PMID: 36382668 PMCID: PMC10100410 DOI: 10.1111/vsu.13911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/12/2022] [Accepted: 10/17/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the use of linear external skeletal fixation (ESF) applied using minimally invasive techniques in dogs and cats. STUDY DESIGN Retrospective study. ANIMALS Forty-nine dogs and 6 cats. METHODS Medical records of cases with nonarticular tibial fractures, repaired using linear ESF at a single academic institution between July 2010 and 2020, were reviewed. All records of cases that had nonarticular tibial fractures repaired using linear ESF were included. Information was collected regarding signalment, surgical procedures performed, perioperative care, radiographic evaluation, and postoperative complications. RESULTS Intraoperative imaging was used in 40/55 (72%) of cases. Tibal plateau angle (TPA), tibial mechanical medial proximal and distal tibial angles (mMPTA and mMDTA, respectively) were not affected by intraoperative imaging (P = .344, P = .687, P = .418). A total of 22 (40%) complications occurred. Of these, 18 were considered minor and 4 were considered major. Open fractures had more major complications than closed fractures (P = .019). All fractures reached radiographic union of the fracture. The mean ± SD time to external fixator removal was 71 ± 48 days. CONCLUSION Linear ESF applied using minimally invasive techniques with or without intraoperative imaging was an effective treatment for nonarticular tibial fractures. CLINICAL SIGNIFICANCE Closed application of linear ESF should be considered as a minimally invasive option for stabilizing nonarticular tibial fractures.
Collapse
Affiliation(s)
- Alec H Sherman
- Department of Medicine and Surgery, College of Veterinary Medicine, Hixson-Lied Small Animal Hospital, Iowa State University, Ames, Iowa, USA
| | - Karl H Kraus
- Department of Medicine and Surgery, College of Veterinary Medicine, Hixson-Lied Small Animal Hospital, Iowa State University, Ames, Iowa, USA
| | - Danielle Watt
- Department of Medicine and Surgery, College of Veterinary Medicine, Hixson-Lied Small Animal Hospital, Iowa State University, Ames, Iowa, USA
| | - Lingnan Yuan
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| | - Jonathan P Mochel
- Department of Biomedical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa, USA
| |
Collapse
|
3
|
Saunders WB, Dejardin LM, Soltys-Niemann EV, Kaulfus CN, Eichelberger BM, Dobson LK, Weeks BR, Kerwin SC, Gregory CA. Angle-stable interlocking nailing in a canine critical-sized femoral defect model for bone regeneration studies: In pursuit of the principle of the 3R’s. Front Bioeng Biotechnol 2022; 10:921486. [PMID: 36118571 PMCID: PMC9479202 DOI: 10.3389/fbioe.2022.921486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Critical-sized long bone defects represent a major therapeutic challenge and current treatment strategies are not without complication. Tissue engineering holds much promise for these debilitating injuries; however, these strategies often fail to successfully translate from rodent studies to the clinical setting. The dog represents a strong model for translational orthopedic studies, however such studies should be optimized in pursuit of the Principle of the 3R’s of animal research (replace, reduce, refine). The objective of this study was to refine a canine critical-sized femoral defect model using an angle-stable interlocking nail (AS-ILN) and reduce total animal numbers by performing imaging, biomechanics, and histology on the same cohort of dogs. Methods: Six skeletally mature hounds underwent a 4 cm mid-diaphyseal femoral ostectomy followed by stabilization with an AS-ILN. Dogs were assigned to autograft (n = 3) or negative control (n = 3) treatment groups. At 6, 12, and 18 weeks, healing was quantified by ordinal radiographic scoring and quantified CT. After euthanasia, femurs from the autograft group were mechanically evaluated using an established torsional loading protocol. Femurs were subsequently assessed histologically. Results: Surgery was performed without complication and the AS-ILN provided appropriate fixation for the duration of the study. Dogs assigned to the autograft group achieved radiographic union by 12 weeks, whereas the negative control group experienced non-union. At 18 weeks, median bone and soft tissue callus volume were 9,001 mm3 (range: 4,939–10,061) for the autograft group and 3,469 mm3 (range: 3,085–3,854) for the negative control group. Median torsional stiffness for the operated, autograft treatment group was 0.19 Nm/° (range: 0.19–1.67) and torque at failure was 12.0 Nm (range: 1.7–14.0). Histologically, callus formation and associated endochondral ossification were identified in the autograft treatment group, whereas fibrovascular tissue occupied the critical-sized defect in negative controls. Conclusion: In a canine critical-sized defect model, the AS-ILN and described outcome measures allowed refinement and reduction consistent with the Principle of the 3R’s of ethical animal research. This model is well-suited for future canine translational bone tissue engineering studies.
Collapse
Affiliation(s)
- W. B. Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
- *Correspondence: W. B. Saunders,
| | - L. M. Dejardin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - E. V. Soltys-Niemann
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - C. N. Kaulfus
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - B. M. Eichelberger
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - L. K. Dobson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - B. R. Weeks
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - S. C. Kerwin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - C. A. Gregory
- Department of Molecular and Cellular Medicine, Institute for Regenerative Medicine, School of Medicine, Texas A & M Health Science Center, College Station, TX, United States
| |
Collapse
|
4
|
Deprey J, Blondel M, Saban C, Massenzio M, Gauthier O, Moissonnier P, Viguier E, Cachon T. Mechanical evaluation of a novel angle-stable interlocking nail in a gap fracture model. Vet Surg 2022; 51:1247-1256. [PMID: 35675144 DOI: 10.1111/vsu.13837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 03/05/2022] [Accepted: 05/14/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe the mechanical characteristics of a novel angle-stable interlocking nail (NAS-ILN) and compare them to those of a locking compression plate (LCP) by using a gap-fracture model. STUDY DESIGN Experimental study. SAMPLE POPULATION Synthetic bone models. METHODS Synthetic bone models simulating a 50 mm diaphyseal comminuted canine tibial fracture were treated with either a novel angle-stable interlocking nail (NAS-ILN) or a locking compression plate (LCP). Maximal axial deformation and load to failure in compression and 4-point bending, as well as maximal angular deformation, slack, and torque to failure in torsion, were statistically compared (P < .05). RESULTS In compression, the maximal axial deformation was lower for NAS-ILN (0.11 mm ± 0.03) than for LCP (1.10 mm ± 0.22) (P < .0001). The ultimate load to failure was higher for NAS-ILN (803.58 N ± 29.52) than for LCP (328.40 N ± 11.01) (P < .0001). In torsion, the maximal angular deformation did not differ between NAS-ILN (22.79° ± 1.48) and LCP (24.36° ± 1.45) (P = .09). The ultimate torque to failure was higher for NAS-ILN (22.45 Nm ± 0.24) than for LCP (19.10 Nm ± 1.36) (P = .001). No slack was observed with NAS-ILN. In 4-point bending, the maximal axial deformation was lower for NAS-ILN (3.19 mm ± 0.49) than for LCP (4.17 mm ± 0.34) (P = .003). The ultimate bending moment was higher for NAS-ILN (25.73 Nm, IQR [23.54-26.86] Nm) than for LCP (16.29 Nm, IQR [15.66-16.47] Nm) (P = .002). CONCLUSION The NAS-ILN showed greater stiffness in compression and 4-point bending, and a greater resistance to failure in compression, torsion, and 4-point bending, than LCP. CLINICAL IMPACT Based on these results, NAS-ILNs could be considered as alternative implants for the stabilization of comminuted fractures.
Collapse
Affiliation(s)
- Julie Deprey
- Department of Small Animal Surgery, VetAgro Sup, Campus Vétérinaire de Lyon, Marcy l'Etoile, France.,Research Unit ICE, UPSP 2016-A104, Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
| | - Margaux Blondel
- Department of Small Animal Surgery, VetAgro Sup, Campus Vétérinaire de Lyon, Marcy l'Etoile, France.,Research Unit ICE, UPSP 2016-A104, Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
| | - Charles Saban
- Department of Small Animal Surgery, VetAgro Sup, Campus Vétérinaire de Lyon, Marcy l'Etoile, France.,Research Unit ICE, UPSP 2016-A104, Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
| | - Michel Massenzio
- Univ Lyon, Université Claude Bernard Lyon 1, Univ Gustave Eiffel, IFSTTAR, Lyon, France
| | - Olivier Gauthier
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes-Atlantic College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | - Pierre Moissonnier
- Department of Small Animal Surgery, VetAgro Sup, Campus Vétérinaire de Lyon, Marcy l'Etoile, France.,Research Unit ICE, UPSP 2016-A104, Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
| | - Eric Viguier
- Department of Small Animal Surgery, VetAgro Sup, Campus Vétérinaire de Lyon, Marcy l'Etoile, France.,Research Unit ICE, UPSP 2016-A104, Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
| | - Thibaut Cachon
- Department of Small Animal Surgery, VetAgro Sup, Campus Vétérinaire de Lyon, Marcy l'Etoile, France.,Research Unit ICE, UPSP 2016-A104, Université de Lyon, VetAgro Sup, Marcy l'Etoile, France
| |
Collapse
|
5
|
Abstract
PRACTICAL RELEVANCE The femur is the most commonly fractured bone in cats. Femoral fractures usually result from high-velocity trauma such as a road traffic accident or fall from a height and, as such, are associated with a wide variety of concurrent injuries. The initial focus of treatment should always be on assessment and stabilisation of the major body systems. Once any concurrent injuries have been addressed, all femoral fractures need surgical stabilisation, with the notable exception of greenstick fractures in very young cats, which can heal with cage rest alone. A number of different surgical options are available depending on the fracture type, location, equipment, surgeon experience and owner finances. CLINICAL CHALLENGES Femoral fractures can vary hugely in complexity and the small size of feline bones can limit the choice of implants. Furthermore, cats can present unique challenges in the postoperative period due to their active nature and the limited means to control their exercise level. AUDIENCE This review is aimed at general and feline-specific practitioners who have some experience of feline orthopaedics, as well as those simply wishing to expand their knowledge. AIMS The aim of this review is to help clinicians assess, plan and manage feline femoral fractures. It provides an overview of diagnostic imaging and a discussion of a range of suitable surgical options, including the principles of different types of fixation. It also highlights cat-specific issues, approaches and implants pertinent to the management of these cases. EVIDENCE BASE A number of original articles and textbook chapters covering many aspects of femoral fractures in cats and dogs have been published. Where possible, this review draws on information from key feline research and, where necessary, extrapolates from relevant canine literature. The authors also offer practical guidance based on their own clinical experience.
Collapse
Affiliation(s)
| | - Richard L Meeson
- Department of Clinical Science and Services, Queen Mother Hospital for Animals, Royal Veterinary College, University of London, London, UK
| |
Collapse
|
6
|
Marturello DM, Perry KL, Déjardin LM. Clinical application of the small I-Loc interlocking nail in 30 feline fractures: A prospective study. Vet Surg 2021; 50:588-599. [PMID: 33625791 DOI: 10.1111/vsu.13594] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/23/2020] [Accepted: 12/25/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe medium-term functional outcome after nail osteosynthesis in feline traumatology and report clinically relevant recommendations for I-Loc angle-stable interlocking nail use in cats. STUDY DESIGN Prospective clinical study. SAMPLE POPULATION Client-owned cats (n = 29). METHODS Consecutive cases with femoral, tibial, or humeral fractures were included. Outcome measures included fracture and surgical procedure description, limb alignment, nail size vs body weight (BW), percentage of nail medullary canal (MC) fill, time to limb function at clinical union (CU), and complications. Descriptive statistics were reported and compared with historical data. RESULTS Bone distribution was 53.3% femora, 30% tibiae, and 16.7% humeri. There were six epimetaphyseal and 24 diaphyseal fractures. Overall, 67% of fractures were comminuted. Open reduction and minimally invasive techniques were used in 73% and 27% of cases, respectively. Seventeen I-Loc 3 (cat mean BW 4.4 ± 2.2 kg) and 13 I-Loc 4 (cat mean BW 5.2 ± 1.2 kg) nails were placed with mean MC fill of ≤50%. Average time to CU was 7.2 weeks. At CU, lameness had resolved or was mild in every cat, and all cats ultimately regained full limb function. No major complications were encountered. CONCLUSION Because of improved CU times, excellent functional outcomes, and low complication rate, our results provide evidence that I-Loc nails are safe and effective for feline traumatology. CLINICAL SIGNIFICANCE The I-Loc may be advantageous for fixation of epimetaphyseal fractures. Because of feline bone specific dimensional constraints, I-Loc 3 is likely appropriate for all feline humeri and most tibiae, while I-Loc 4 is well sized for feline femora.
Collapse
Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Karen L Perry
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, USA
| |
Collapse
|
7
|
Marturello DM, von Pfeil DJF, Déjardin LM. Evaluation of a Feline Bone Surrogate and In Vitro Mechanical Comparison of Small Interlocking Nail Systems in Mediolateral Bending. Vet Comp Orthop Traumatol 2020; 34:223-233. [PMID: 33368055 DOI: 10.1055/s-0040-1721708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to (1) evaluate bending structural properties of a machined short fibre epoxy (SFE) feline bone surrogate (FBS), (2) compare the bending behaviour of small angle-stable interlocking nails (I-Loc; Targon) and locking compression plates (LCP) and (3) evaluate the effect of implant removal on FBS bending strength. METHODS Part 1: Feline cadaveric femurs (n = 10) and FBS (n = 4) underwent cyclic four-point bending and load to failure. Part 2: Fracture gap FBS constructs (n = 4/group) were stabilized in a bridging fashion with either I-Loc 3 and 4, Targon 2.5 and 3.0, LCP 2.0 and 2.4, then cyclically bent. Part 3: Intact FBS with pilot holes, simulating explantation, (n = 4/group) underwent destructive bending tests. Bending compliance, angular deformation and failure moment (FM) were statistically compared (p < 0.05). RESULTS Native bone and FBS were similar for all outcome measures (p > 0.05). The smallest and largest bending compliance and angular deformation were seen in the I-Loc 4 and LCP 2.0 respectively (p < 0.05). While explanted Targon FBS had the lowest FM (p < 0.05), I-Loc and LCP constructs FM were not different (p > 0.05). CONCLUSION The similar bending properties of short fibre epoxy made FBS and native feline femurs suggest that this model could be used for mechanical testing of implants designed for feline long bone osteosynthesis. The I-Loc constructs smaller angular deformation which also suggests that these implants represent a valid alternative to size-matched Targon and LCP for feline fracture osteosynthesis. The significantly lower FM of explanted Targon may increase the risk of secondary fracture following implant removal.
Collapse
Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
| | - Dirsko J F von Pfeil
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
| |
Collapse
|
8
|
Deprey J, Blondel M, Baldinger A, Gauthier O, Hée J, Moissonnier P, Viguier E, Carozzo C, Cachon T. In vitro comparison on a gap fracture model of a novel angle-stable interlocking nail to locking plate fixation in torsion, compression and bending. Comput Methods Biomech Biomed Engin 2020. [DOI: 10.1080/10255842.2020.1812166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- J. Deprey
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
- Reseach Unit ICE, UPSP A104-2016, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
| | - M. Blondel
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
- Reseach Unit ICE, UPSP A104-2016, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
| | - A. Baldinger
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
- Reseach Unit ICE, UPSP A104-2016, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
| | - O. Gauthier
- Department of Small Animal Surgery and Anesthesia, ONIRIS Nantes-Atlantic College of Veterinary Medicine, Food Science and Engineering, Nantes, France
| | | | - P. Moissonnier
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
- Reseach Unit ICE, UPSP A104-2016, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
| | - E. Viguier
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
- Reseach Unit ICE, UPSP A104-2016, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
| | - C. Carozzo
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
- Reseach Unit ICE, UPSP A104-2016, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
| | - T. Cachon
- Surgery Unit, Lyon Veterinary Teaching Hospital, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
- Reseach Unit ICE, UPSP A104-2016, University of Lyon, Veterinary Campus of Vetagro Sup, Marcy L’Etoile, France
| |
Collapse
|
9
|
Marturello DM, von Pfeil DJF, Déjardin LM. Mechanical comparison of two small interlocking nails in torsion using a feline bone surrogate. Vet Surg 2019; 49:380-389. [PMID: 31828811 DOI: 10.1111/vsu.13364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/14/2019] [Accepted: 11/15/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the torsional behavior of two small angle-stable interlocking nails (I-Loc and Targon) with that of locking compression plates (LCP). To evaluate the effect of implant removal on the torsional strength of feline bone surrogates. STUDY DESIGN Experimental. SAMPLE POPULATION Fracture gap constructs and intact explanted bone surrogates. METHODS Fracture gap constructs were stabilized with one of six implants (I-Loc 3 and 4, Targon 2.5 and 3.0, LCP 2.0 and 2.4) and then cyclically tested in torsion (n = 4/group). To simulate implant removal, intact surrogates with implant-specific pilot holes were then twisted to failure (n = 4/group). Torsional compliance (TC; °/Nm), angular deformation (AD; °), and failure torque (FT ; Nm) were statistically compared (P < .05). RESULTS The I-Loc 4 had the smallest TC and AD of all constructs (P < .05). The largest TC (P < .05) was seen with the LCP 2.0. The Targon 2.5 had the largest AD (P < .05) secondary to locking interface slippage. Targon surrogates FT were the lowest of all groups (P < .05). Conversely, there was no difference between the FT of the I-Loc, LCP, and intact surrogates (P > .05). CONCLUSION We showed that I-Loc nails provided greater torsional stability than size-matched Targon nails and LCPs. Conversely, Targon 2.5 locking interface slippage may jeopardize that construct's stability. Furthermore, the significantly reduced bone surrogate torsional strength provided evidence that the large Targon bolt holes increased the risk of postexplantation iatrogenic fracture. CLINICAL SIGNIFICANCE Our results provide evidence to conclude that the small I-Loc nails may be valid alternatives to other osteosynthesis options for feline fracture repair.
Collapse
Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Dirsko J F von Pfeil
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| |
Collapse
|
10
|
Abstract
This article reviews the biomechanical parameters of fracture repair that influence construct stiffness and strength. The stiffness influences the relative motion between fracture fragments, known as gap strain, and, thus, callus development. Construct strength determines the magnitude and number of load events that the repair can resist before failure. Surgeons must optimize these parameters in order to achieve satisfactory outcomes for the patients.
Collapse
Affiliation(s)
- Simon Roe
- Small Animal Orthopaedics, Department of Clinical Sciences, College of Veterinary Medicine, 1052 William Moore Drive, Raleigh, NC 27607, USA.
| |
Collapse
|
11
|
Marturello DM, Gazzola KM, Déjardin LM. Tibial fracture repair with angle-stable interlocking nailing in 2 calves. Vet Surg 2019; 48:597-606. [PMID: 30682236 DOI: 10.1111/vsu.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 12/04/2018] [Accepted: 12/29/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report tibial fracture repairs with I-Loc angle-stable interlocking nails (AS-ILN) in 2 calves. STUDY DESIGN Clinical case reports. ANIMALS One 5-day-old Holstein calf and one 3-month-old beefalo calf. METHODS In a 50-kg Holstein calf, a proximal juxtametaphyseal comminuted tibial fracture with tibial tuberosity slab fracture was repaired with an 8-160-mm I-Loc nail and 2 cortical lag screws. In an 89-kg beefalo calf, a long oblique middiaphyseal tibial fracture was repaired with an 8-185-mm I-Loc nail and 5 double loop cerclage wires. In each case, an I-Loc AS-ILN was selected because unique biomechanical challenges precluded treatment with traditional osteosynthesis methods, such as external coaptation or plate fixation. RESULTS No complications were diagnosed, and clinical union was documented 4 weeks after surgery in both cases. Axial growth continued in both calves, with no evidence of angular limb deformity at 7- and 6-month follow-up. CONCLUSION This is the first report describing the use of the I-Loc nail in a bovine species. This application led to uncomplicated healing of tibial fractures and continued growth in both young calves described here. CLINICAL SIGNIFICANCE Interlocking nailing may provide an effective and safe alternative for osteosynthesis of tibial fractures in young calves. Insertion of the AS-ILN across the center of the proximal tibial physis of a rapidly growing calf does not seem to alter its growth potential.
Collapse
Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Krista M Gazzola
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| |
Collapse
|
12
|
Marturello DM, Wei F, Déjardin LM. Characterization of the torsional structural properties of feline femurs and surrogate bone models for mechanical testing of orthopedic implants. Vet Surg 2018; 48:229-236. [DOI: 10.1111/vsu.13136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 08/27/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Danielle M. Marturello
- Department of Small Animal Clinical SciencesMichigan State University East Lansing Michigan
| | - Feng Wei
- Orthopaedic Biomechanics LaboratoriesCollege of Osteopathic Medicine, Michigan State University East Lansing Michigan
| | - Loïc M. Déjardin
- Department of Small Animal Clinical SciencesMichigan State University East Lansing Michigan
| |
Collapse
|
13
|
Ex vivo torsional properties of a 2.5 mm veterinary interlocking nail system in canine femurs. Vet Comp Orthop Traumatol 2017; 30:118-124. [DOI: 10.3415/vcot-16-05-0083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 11/10/2016] [Indexed: 02/04/2023]
Abstract
SummaryObjective: To evaluate the torsional properties of the Targon® Vet Nail System (TVS) in small canine femurs and to compare these properties to those of the 2.4 mm LC-DCP® plates.Methods: Thirty-six cadaveric femurs were allocated to three groups (n = 12). In all bones, points just distal to the lesser trochanter and just proximal to the fabellae were marked and a midshaft transverse osteotomy was performed. Group 1: bones were fixed with the 2.5 mm TVS with the bolts applied at the pre-identified marks. Group 2: A TVS system with 25% shorter inter-bolt distance was used. Group 3: A 7-hole 2.4 mm LCDCP® plates were applied. All constructs were tested non-destructively for 10 cycles, followed by an acute torsion to failure.Results: Torque at yield was 0.806 ± 0.183 and 0.805 ± 0.093 Nm for groups 1 and 2 and 1.737 ± 0.461 Nm for group 3. Stiffness was 0.05 ± 0.01, 0.05 ± 0.007, and 0.14 ± 0.015 Nm/° for groups 1 to 3 respectively. Maximal angular displacement under cyclic loading was 16.6° ± 2.5°, 15.6° ± 2.1°, and 7.8° ± 1.06° respectively. There was no significant difference for any of the parameters between groups 1 and 2. Both torque at yield and stiffness were significantly greater between group 3 and groups 1 and 2.Clinical significance: The TVS had approximately half the torsional strength and approximately 1/3 of the stiffness of the 2.4 mm bone plate. Slippage of the locking mechanism was probably the cause of the early failure. The system should be considered as a low-strength and low-stiffness system when compared to bone plates.
Collapse
|
14
|
James DR, Webster N, White JD, Marchevsky AM, Cashmore RG, Havlicek M, Fearnside S, Black AP. Comparison of bone healing, as assessed by computed tomography, following tibial tuberosity advancement in dogs with and without autogenous cancellous bone grafts. N Z Vet J 2017. [DOI: 10.1080/00480169.2017.1345336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- DR James
- Surgery Department, Small Animal Specialist Hospital, Level 1/1 Richardson Place, North Ryde, NSW, Australia
| | - N Webster
- Darkroom Veterinary Imaging, St Georges Crescent, Heatherton, Vic, Australia
| | - JD White
- Internal Medicine Department, Small Animal Specialist Hospital, Level 1/1 Richardson Place, North Ryde, NSW, Australia
| | - AM Marchevsky
- Surgery Department, Small Animal Specialist Hospital, Level 1/1 Richardson Place, North Ryde, NSW, Australia
| | - RG Cashmore
- Surgery Department, Small Animal Specialist Hospital, Level 1/1 Richardson Place, North Ryde, NSW, Australia
| | - M Havlicek
- Surgery Department, Small Animal Specialist Hospital, Level 1/1 Richardson Place, North Ryde, NSW, Australia
| | - S Fearnside
- Surgery Department, Small Animal Specialist Hospital, Level 1/1 Richardson Place, North Ryde, NSW, Australia
| | - AP Black
- Surgery Department, Small Animal Specialist Hospital, Level 1/1 Richardson Place, North Ryde, NSW, Australia
| |
Collapse
|
15
|
Brückner M, Unger M, Spies M. Early Clinical Experience with a Newly Designed Interlocking Nail System-Targon®Vet. Vet Surg 2016; 45:754-63. [DOI: 10.1111/vsu.12511] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 01/28/2016] [Accepted: 04/09/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | - Martin Unger
- Small Animal Clinic of Augsburg; Augsburg Germany
| | | |
Collapse
|
16
|
Xu H, Xue Z, Ding H, Qin H, An Z. Callus Formation and Mineralization after Fracture with Different Fixation Techniques: Minimally Invasive Plate Osteosynthesis versus Open Reduction Internal Fixation. PLoS One 2015; 10:e0140037. [PMID: 26444295 PMCID: PMC4596811 DOI: 10.1371/journal.pone.0140037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 09/20/2015] [Indexed: 11/22/2022] Open
Abstract
Minimally invasive plate osteosynthesis(MIPO) has been considered as an alternative for fracture treatment. Previous study has demonstrated that MIPO technique has the advantage of less soft tissue injury compared with open reduction internal fixation (ORIF). However, the comparison of callus formation and mineralization between two plate osteosynthesis methods remains unknown. In this experiment, ulna fracture model was established in 42 beagle dogs. The fractures underwent reduction and internal fixation with MIPO or ORIF. Sequential fluorescent labeling and radiographs were applied to determine new callus formation and mineralization in two groups after operation. At 4, 8 and 12 weeks postoperatively, the animals were selected to be sacrificed and the ulna specimens were analyzed by Micro-CT. The sections were also treated with Masson staining for histological evaluation. More callus formation was observed in MIPO group in early stage of fracture healing. The fracture union rate has no significant difference between two groups. The results indicate that excessive soft tissue stripping may impact early callus formation. As MIPO technique can effectively reduce soft tissue injury with little incision, it is considered to be a promising alternative for fracture fixation.
Collapse
Affiliation(s)
- Haitao Xu
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zichao Xue
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Haoliang Ding
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Hui Qin
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhiquan An
- Department of Orthopedics, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
- * E-mail:
| |
Collapse
|