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Kadic LIM, Rademacher N, Liu CC, Leise BS, McCauley CT, Riggs LM. The influence of a tension band fixation as an adjunct for arthrodesis of the metacarpophalangeal joint in the horse. Vet Surg 2024; 53:194-203. [PMID: 37752808 DOI: 10.1111/vsu.14036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 08/02/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
OBJECTIVES To determine the influence of a stainless-steel cable (SSC) tension band fixation as an adjunct to a locking compression plate (LCP) for arthrodesis of the equine metacarpophalangeal (MCP) joint. STUDY DESIGN Experimental. An ex vivo biomechanical paired equine cadaver limb study. SAMPLE POPULATION Five MCP joint pairs were collected from adult Thoroughbred horses, euthanized for reasons unrelated to orthopedic disease. METHODS Each pair of MCP joints were randomly implanted with either a dorsally placed 5.5 mm LCP and a palmarly placed 2.0 mm SSC or a dorsally placed 5.5 mm LCP alone. Each construct was tested in cyclic loading followed by single cycle to failure in axial compression. Displacement at a target load of 1 kN over 3600 cycles at 1 Hz was recorded prior to single cycle to failure testing. RESULTS In cyclic testing, displacement was not significantly different between the first and last 5% of testing cycles regardless of construct. Maximum displacement of each construct during cyclic testing was <1.1 mm. In single cycle testing, the observed yield point did not reveal any difference between LCP and LCP-SSC (p = .440). The maximum load at failure was significantly higher in LCP-SSC compared to constructs with the LCP alone (p = .046). CONCLUSION The addition of the SSC to the LCP did not statistically affect construct displacement during cyclic loading or construct yield load during subsequent single cycle to failure. CLINICAL SIGNIFICANCE This study provided much needed information regarding the necessity of a tension band SSC application in the arthrodesis of the MCP/MTP joint in horses.
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Affiliation(s)
- Lawrence I M Kadic
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Nathalie Rademacher
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Chin-Chi Liu
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Britta S Leise
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Charles T McCauley
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Laura M Riggs
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, Louisiana, USA
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Hoogervorst LA, Oudelaar BW, Broekhuis D. An open comminuted tibia fracture including a 5 cm tibial bone defect in a child: Successful management using a locking compression plate. Trauma Case Rep 2023; 48:100944. [PMID: 37781164 PMCID: PMC10539656 DOI: 10.1016/j.tcr.2023.100944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/03/2023] Open
Abstract
Traumatic bone defects (TBDs), although rare in children, are severe injuries that often represents a challenge for both orthopaedic and trauma surgeons. We present a case of a 6-year-old girl who sustained an open (Gustilo-Anderson type II) comminuted tibia fracture including a ± 5.0 cm distal tibial TBD following a road traffic accident. Open reduction and internal fixation with a 3.5 Locking Compression Plate (LCP) without additional bone grafting was performed, followed by cast immobilization for four months. One and a half years after reconstruction, the patient regained pain-free activity including full-range of motion of her leg and radiographs showed good tibial and fibular alignment, the presence of fracture consolidation and sufficient filling of the TBD. This case report aims to show first evidence of the safety and efficacy of single LCP plating followed by cast immobilization applied in a paediatric patient with a large tibial TBD.
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Affiliation(s)
- Lotje A. Hoogervorst
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Biomedical Data Science and Medical Decision Making, Leiden University Medical Center, Leiden, the Netherlands
| | - Bart W. Oudelaar
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
| | - Demien Broekhuis
- Department of Orthopaedics, Leiden University Medical Center, Leiden, the Netherlands
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Breen LJ, Coleridge MOD, O'Brien T. The Surgical Repair of a Salter-Harris Type-2 Physeal Fracture of the Proximal Phalanx in a Foal. J Equine Vet Sci 2023; 126:104500. [PMID: 37105415 DOI: 10.1016/j.jevs.2023.104500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 04/29/2023]
Abstract
A 6-month-old thoroughbred colt foal was referred to a private equine referral hospital for evaluation of an acute onset, left hind limb lameness. On arrival the foal was 4/5 lame on the left hind at walk and there was diffuse swelling of the left hind pastern and fetlock region. The physical exam was otherwise unremarkable. Digital radiographs of the left hind pastern identified a Salter-Harris type-2 physeal fracture of the proximal phalanx. The fracture was initially treated conservatively using a cast, but the immobilization was not sufficient at achieving adequate reduction. As a result, the fracture was stabilized surgically using a construct consisting of a cortical lag screw, four locking head screws and a locking T-plate. The foal recovered uneventfully and was sound and in race training at a 2 year follow up. This case report highlights that surgical repair via internal fixation is preferable to conservative management of proximal physeal fractures of the first phalanx.
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Affiliation(s)
- Louise J Breen
- Fethard Equine Hospital, O'Bryne & Halley, Fethard, Co. Tipperary, Ireland.
| | | | - Tom O'Brien
- Fethard Equine Hospital, O'Bryne & Halley, Fethard, Co. Tipperary, Ireland
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de Souza AF, Paretsis NF, De Zoppa ALDV. Proximal Interphalangeal Arthrodesis in Horses: A Meta-Analysis of Retrospective Studies. J Equine Vet Sci 2023; 122:104226. [PMID: 36649830 DOI: 10.1016/j.jevs.2023.104226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 12/07/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
The aim of this study was to determine the clinical outcomes reported in retrospective studies of proximal interphalangeal arthrodesis (PIA) in horses through a meta-analysis of retrospective studies. CAB Abstracts, PubMed, ScienceDirect, Web of Science, and Scopus were searched. The primary outcomes included survival and surgical site infection (SSI) rates, return to activities, and time of hospital stay and casting. Subgroups were formed for fractures and other conditions. Meta-analyses were performed with fixed and random effects models to estimate proportions, mean values, and effect size by odds ratio (OR) with 95% confidence intervals (CI). Twenty-one full articles were included, totaling 458 horses. The survival rate was 90% (95% CI [86%-93%]), return to activities was 65% (95% CI [61%-70%]), and SSI was 12% (95% CI [8%-16%]). The mean hospitalization was 25 days (95% CI [18-35 days]) and time of casting was 29 days (95% CI [21-42 days]). The OR of survival (P = .769), return to activities (P = .576), and SSI (P = .467) were similar between cases of fractures and other conditions. PIA is an efficient and safe method to treat injuries in the pastern region, with a high survival rate and low SSI. However, the rate of return to soundness for intended use was modest, being potentially lower for fracture cases. Thus, investigations of more efficient interventions are needed to improve this outcome.
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Affiliation(s)
- Anderson Fernando de Souza
- Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil.
| | - Nicole Fidalgo Paretsis
- Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
| | - André Luis do Valle De Zoppa
- Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, SP, Brazil
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Auer JA, Fürst AE, Bettschart‐Wolfensberger R, Haab M. Management of ulna fractures in adult horses. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | - Anton E. Fürst
- Vetsuisse Faculty University of Zurich – Equine Hospital Zurich Lenzburg Switzerland
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Quantitative Assessment of the Restoration of Original Anatomy after 3D Virtual Reduction of Long Bone Fractures. Diagnostics (Basel) 2022; 12:diagnostics12061372. [PMID: 35741182 PMCID: PMC9222009 DOI: 10.3390/diagnostics12061372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/27/2022] [Accepted: 05/30/2022] [Indexed: 02/04/2023] Open
Abstract
Background: The purpose of this study was to demonstrate the usefulness of 3D image-based virtual reduction by validating the evaluation criteria according to guidelines suggested by the AO Surgery Reference. Methods: For this experiment, 19 intact radial ORTHObones (ORTHObones radius, 3B Scientific, Germany, Hamburg) without any fractures were prepared. All ORTHObones with six cortical marking holes (three points on the distal part and three points on the proximal part) were scanned using a CT scanner twice (before/after intentional fracture of the ORTHObone). After the virtual reduction of all 19 ORTHObones, accuracy evaluations using the four criteria (length variation, apposition variation, alignment variation, Rotation Variation) suggested in the AO Surgery Reference were performed. Results: The mean (M) length variation was 0.42 mm, with 0.01 mm standard deviation (SD). The M apposition variation was 0.48 mm, with 0.40 mm SD. The M AP angulation variation (for alignment variation) was 3.24°, with 2.95° SD. The M lateral angulation variation (for alignment variation) was 0.09°, with 0.13° SD. The M angle of axial rotation was 1.27° with SD: 1.19°. Conclusions: The method of accuracy evaluation used in this study can be helpful in establishing a reliable plan.
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Marcondes GDM, Paretsis NF, Souza AFD, Ruivo MRBA, Rego MAF, Nóbrega FS, Cortopassi SRG, De Zoppa ALDV. Locking compression plate fixation of critical-sized bone defects in sheep. Development of a model for veterinary bone tissue engineering. Acta Cir Bras 2021; 36:e360601. [PMID: 34190837 PMCID: PMC8232063 DOI: 10.1590/acb360601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/03/2021] [Indexed: 11/22/2022] Open
Abstract
PURPOSE To develop a segmental tibial bone defect model for tissue engineering studies in veterinary orthopedics using single locking compression plate (LCP) fixation and cast immobilization. METHODS A 3-cm bone defect was created in the right tibia of 18 adult Suffolk sheep. A 10-hole, 4.5-mm LCP was applied to the dorsomedial aspect of the bone. Four locking screws were inserted into the proximal and three into the distal bone fragment. Operated limbs were immobilized with casts. Animals were submitted to stall rest, but were allowed to bear weight on the operated limb. During the recovery period, animals were checked daily for physiological parameters, behavior and lameness. Follow-up radiographs were taken monthly. RESULTS Surgical procedures and postoperative recovery were uneventful. Animals adapted quickly to casts and were able to bear weight on the operated limb with no signs of discomfort or distress. No clinical or radiographic complications were detected over a 90-day follow-up period. CONCLUSIONS Surgical creation of tibial segmental bone defects followed by fixation with single LCP and cast immobilization was deemed a feasible and appropriate model for veterinary orthopedic research in tissue engineering.
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Auer JA, Lischer C, Haab M. Displacement osteotomies/ostectomies in the horse. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- J. A. Auer
- Department of the University Zürich Veterinary Medicine College Lenzburg Switzerland
| | - C. Lischer
- Clinic for Horses, General Surgery and Radiology Free University of Berlin Berlin Germany
| | - M. Haab
- Department of the University Zürich Veterinary Medicine College Felbach Switzerland
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Somm F, Suárez Sánchez-Andrade J, Martens A, Zedler ST, Klopfenstein MD, Boswell JC, Bladon BM, Lischer CJ, Richardson DW, Auer JA, Fürst AE, Kümmerle JM. A retrospective multicenter study on the use of locking compression plates for scapulohumeral arthrodesis in small equids. Vet Surg 2021; 50:954-965. [PMID: 33682947 DOI: 10.1111/vsu.13618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 02/04/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To report on technical aspects and outcomes after scapulohumeral arthrodesis (SHA) with a locking compression plate (LCP) in small equids. STUDY DESIGN Retrospective multicenter case series. ANIMALS Client-owned Shetland Ponies, Miniature Shetlands, and American Miniature Horses (n = 15). METHODS Inclusion criteria were completed SHA with an LCP to treat scapulohumeral osteoarthritis/subluxation and availability of postoperative radiographs. Contributing surgeons completed a questionnaire to collect data. All radiographs were reviewed for this study. Follow-up information was obtained via re-admission to the hospital or telephone interview of the referring veterinarian or owner. Outcome was subjectively scored as excellent, good, moderate, or poor based on lameness and function. RESULTS Sixteen SHAs were performed in 15 equids (body weight 65-145 kg) by nine different surgeons. A narrow 4.5/5.0 mm LCP (7-16 holes) was used in 14 of the 16 SHAs. Follow-up was collected 2.5 years after surgery (median; range: 9 weeks to 10 years). Major complications related to the SHAs were noted in 4 of the 13 horses alive long term, consisting of implant failure (n = 1), surgical site infection (n = 2), and scapular fracture (n = 1). The outcome was graded as excellent in 4, good in 5, and moderate in 4 horses. Two ponies were euthanized because scapulohumeral osteoarthritis and subluxation developed in the contralateral limb. CONCLUSION Although major complications occurred in about one-third of ponies, SHA with LCP led to long-term survival with good function in most ponies. CLINICAL SIGNIFICANCE SHA with an LCP offers a high chance for good long-term outcome in small equids although contralateral disease may affect outcome.
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Affiliation(s)
- Fabienne Somm
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | | | - Ann Martens
- Department of Surgery and Anaesthesiology of Domestic Animals, Faculty of Veterinary Medicine, Ghent University, Merelbeke, Belgium
| | - Steven T Zedler
- University of Queensland, Equine Specialist Hospital, Queensland, Australia
| | - Micael D Klopfenstein
- Department of Equine Surgery, Swiss Institute for Equine Medicine, University of Bern, Bern, Switzerland
| | | | | | - Christoph J Lischer
- Equine Clinic, Faculty of Veterinary Medicine, Free University of Berlin, Berlin, Germany
| | - Dean W Richardson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania, USA
| | - Jörg A Auer
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Anton E Fürst
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Jan M Kümmerle
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Kang JW, Cha SM, Kim SG, Choi IC, Suh DH, Park JW. Tips and tricks to achieve osteotomy healing and prevent refracture after ulnar shortening osteotomy. J Orthop Surg Res 2021; 16:110. [PMID: 33541409 PMCID: PMC7863478 DOI: 10.1186/s13018-021-02266-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Parallel osteotomy is essential for favorable osteotomy reduction and healing and technically challenging during diaphyseal ulnar shortening osteotomy (USO). This study aimed to evaluate the advantages of guided osteotomy for parallel osteotomy and reduction osteotomies, healing over freehand osteotomy. It also aimed to identify surgical factors affecting healing after diaphyseal USO. METHODS Between June 2005 and March 2016, 136 wrists that had undergone diaphyseal USO for ulnar impaction syndrome (UIS) were evaluated. The wrists were divided into two groups according to the osteotomy technique (group 1: freehand osteotomy, 74 wrists; group 2: guided osteotomy, 62 wrists). The osteotomy reduction gap and time to osteotomy healing (union and consolidation) were compared between the groups. A multiple regression test was performed to identify the surgical factors affecting healing. The cut-off length of the reduction gap to achieve osteotomy union on time and the cut-off period to decide the failure of complete consolidation were statistically calculated. RESULTS The baseline characteristics did not differ between the two groups. The osteotomy reduction gap and time to osteotomy union, and complete consolidation were shorter in group 2 than in group 1 (p = 0.002, < 0.001, 0.002). The osteotomy reduction gap was a critical surgical factor affecting both time to osteotomy union and complete consolidation (p < 0.001, < 0.001). The use of a dynamic compression plate affected only the time to complete consolidation (p < 0.001). The cut-off length of the osteotomy reduction gap to achieve osteotomy union on time was 0.85 mm. The cut-off period to decide the failure of complete consolidation was 23.5 months after osteotomy. CONCLUSIONS The minimal osteotomy reduction gap was the most important for timely osteotomy healing in the healthy ulna, and guided osteotomy was beneficial for reducing the osteotomy reduction gap.
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Affiliation(s)
- Jong Woo Kang
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Soo Min Cha
- Department of Orthopedic Surgery, Regional Rheumatoid and Degenerative Arthritis Center, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang-gyun Kim
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - In Cheul Choi
- Department of Orthopedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - Dong Hun Suh
- Department of Orthopedic Surgery, Korea University Anam Hospital, Korea University College of Medicine, 73, Goryeodae-ro, Seongbuk-gu, Seoul, 02841 South Korea
| | - Jong Woong Park
- Department of Orthopedic Surgery, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
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Regenerative Medicine for Equine Musculoskeletal Diseases. Animals (Basel) 2021; 11:ani11010234. [PMID: 33477808 PMCID: PMC7832834 DOI: 10.3390/ani11010234] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 01/08/2021] [Accepted: 01/15/2021] [Indexed: 01/15/2023] Open
Abstract
Simple Summary Lameness due to musculoskeletal disease is the most common diagnosis in equine veterinary practice. Many of these orthopaedic disorders are chronic problems, for which no clinically satisfactory treatment exists. Thus, high hopes are pinned on regenerative medicine, which aims to replace or regenerate cells, tissues, or organs to restore or establish normal function. Some regenerative medicine therapies have already made their way into equine clinical practice mainly to treat tendon injures, tendinopathies, cartilage injuries and degenerative joint disorders with promising but diverse results. This review summarises the current knowledge of commonly used regenerative medicine treatments and critically discusses their use. Abstract Musculoskeletal injuries and chronic degenerative diseases commonly affect both athletic and sedentary horses and can entail the end of their athletic careers. The ensuing repair processes frequently do not yield fully functional regeneration of the injured tissues but biomechanically inferior scar or replacement tissue, causing high reinjury rates, degenerative disease progression and chronic morbidity. Regenerative medicine is an emerging, rapidly evolving branch of translational medicine that aims to replace or regenerate cells, tissues, or organs to restore or establish normal function. It includes tissue engineering but also cell-based and cell-free stimulation of endogenous self-repair mechanisms. Some regenerative medicine therapies have made their way into equine clinical practice mainly to treat tendon injures, tendinopathies, cartilage injuries and degenerative joint disorders with promising results. However, the qualitative and quantitative spatiotemporal requirements for specific bioactive factors to trigger tissue regeneration in the injury response are still unknown, and consequently, therapeutic approaches and treatment results are diverse. To exploit the full potential of this burgeoning field of medicine, further research will be required and is ongoing. This review summarises the current knowledge of commonly used regenerative medicine treatments in equine patients and critically discusses their use.
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Zhou X, Li J, Yang H, Li D, Zhang J, Zhang Y, Huang Y, Xu N. Comparison of 2 Different Fixation Implants for Operative Treatment of Mid-Shaft Clavicle Fractures: A Retrospective Study. Med Sci Monit 2019; 25:9728-9736. [PMID: 31854381 PMCID: PMC6931238 DOI: 10.12659/msm.918773] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background This retrospective analysis was designed to compare the outcomes of mid-shaft clavicle fracture operative treatment using bridge combined fixation system (BCFS) versus clavicular locking plate (CLP). Material/Methods Operative surgeries performed between January 2016 and July 2018 were included in the analysis. The surgical internal fixation implants were chosen according to surgeon preference and the choice of patients between the BCFS and CLP. Functional outcomes, fracture union, complications, pain, and patient satisfaction post-operation were assessed at a follow-up of 12 to 24 months. Results Two hundred and seventeen (217) patients, aged 21–79 years, were operated, 87 using BCFS and 130 using CLP. The operation time of the BCFS group was significantly less than the CLP group (P<0.01). We also found that BCFS group had higher degree of satisfaction (100% vs. 97%, P<0.03) and less VAS scale (0.25±0.18 vs. 0.35±0.21, P<0.001) compared with the CLP group, but the significance could only be obtained during the follow-up at 3 months after surgery. No significant differences were observed between the 2 groups when compared for fracture unions, functional scores, or complications. Conclusions BCFS significantly reduced the operation time when compared with CLP. No significant differences were observed for functional outcomes, including fracture union and complications, and there was less pain and higher patient satisfaction. Both methods appeared to be safe in terms of complications. However, the effectiveness and safety of BCFS in treating comminuted multi-fragmentary mid-shaft clavicle fractures (AO/OTA 15-2C classification) need further confirmation.
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Affiliation(s)
- Xindie Zhou
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Jin Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China (mainland)
| | - Haoyu Yang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland).,Department of Orthopedics, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, Jiangsu, China (mainland)
| | - Dong Li
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Junjie Zhang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Yi Zhang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Yong Huang
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
| | - Nanwei Xu
- Department of Orthopedics, The Affiliated Changzhou No. 2 People's Hospital of Nanjing Medical University, Changzhou, Jiangsu, China (mainland)
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Paes F, Ferrigno C, Marinho P, Pereira C, Bregadioli T, Dal-bó IS, Ferraro M. Comparação biomecânica de CRIF e placa de reconstrução na estabilização de fraturas distais de fêmur em cães. ARQ BRAS MED VET ZOO 2019. [DOI: 10.1590/1678-4162-9485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O presente estudo objetivou comparar, biomecanicamente, por meio do ensaio de compressão excêntrica, a resistência dos implantes Clamp and Rod Internal Fixation (CRIF) 5,0mm e placa de reconstrução 3,5mm na fixação de fraturas distais de fêmur de cão. Foram utilizados 22 fêmures de 11 cadáveres de cão entre 2 e 7 anos de idade e peso corporal entre 20 e 40kg e subdivididos em dois grupos, denominados grupo CRIF (GC - 11 fêmures) e grupo placa (GP - 11 fêmures).Para realização dos testes, foi simulada falha que mimetizasse uma fratura distal nos corpos de prova, por meio de uma osteotomia de até 0,5cm, realizada com auxílio de serra oscilatória, imediatamente proximal ao início da tróclea. Os implantes foram fixados segundo os padrões AOSIF, lateralmente ao fêmur, sendo utilizados três parafusos distais e cinco proximais ao foco de fratura. Foi empregado o programa de computador PMI para calcular o ponto máximo de resistência antes da falha e avaliaram-se as variáveis força máxima, deformação máxima real, rigidez, força intermediária e deformação intermediária real. Não foram encontradas diferenças estatisticamente significativas entre os GC e GP quanto às variáveis avaliadas, sugerindo que ambos os implantes são boas opções de fixações para tais fraturas.
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Affiliation(s)
- F. Paes
- Universidade de São Paulo, Brazil
| | | | - P.V.T. Marinho
- Instituto Federal de Educação, Ciência e Tecnologia do Sul de Minas Gerais, Brazil
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Kadic L, Brunsting J, Vanderperren K, Martens A. Scapulohumeral arthrodesis in four Shetland ponies. EQUINE VET EDUC 2019. [DOI: 10.1111/eve.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- L. Kadic
- Hagyard Equine Medical Institute Lexington Kentucky USA
| | | | - K. Vanderperren
- Department of Veterinary Medical Imaging and Small Animal Orthopaedics Faculty of Veterinary Medicine Ghent University MerelbekeBelgium
| | - A. Martens
- Department of Surgery and Anaesthesiology of Domestic Animals Faculty of Veterinary Medicine Ghent University Merelbeke Belgium
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Chapman HS, Richardson DW, Ortved KF. Arthrodesis of the metacarpophalangeal and metatarsophalangeal joints to treat osteoarthritis in 17 horses. Vet Surg 2019; 48:850-857. [PMID: 31120590 DOI: 10.1111/vsu.13236] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 06/22/2018] [Accepted: 06/27/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To describe arthrodesis of the metacarpophalangeal (MCP) or metatarsophalangeal (MTP) joint with a locking compression plate (LCP) and a metallic tension band and report the outcome of horses treated for osteoarthritis (OA) with this technique. STUDY DESIGN Retrospective case series. ANIMALS Seventeen horses with OA of the MCP or MTP joint treated with arthrodesis. METHODS Medical records (2004-2017) of horses treated for OA with arthrodesis of the MCP or MTP joint with an LCP and metallic tension band were reviewed. Preoperative variables included age, sex, breed, affected limb, and lameness grade. Surgical variables included implants used, surgery time, postoperative angle of joint, intraoperative complications, and anesthetic recovery method. Outcome was obtained from medical records and phone interviews. RESULTS Lameness was scored as 4 out of 5 (range, 2-4) in 13 of 17 horses. All horses survived to discharge and were alive >6 months postoperatively, without any report of long-term complications. All horses were allowed unrestricted turnout, and 1 horse was lightly ridden. No postoperative infections or implant failures were reported. The only complications consisted of cast sores (n = 4). CONCLUSION Arthrodesis of the MCP/MTP joint was associated with acceptable morbidity and good long-term outcomes in these 17 horses with OA refractory to medical management. CLINICAL SIGNIFICANCE The morbidity and prognosis after fetlock arthrodesis for OA seem more favorable than reported in horses treated with traumatic disruption of the suspensory apparatus.
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Affiliation(s)
- Hannah-Sophie Chapman
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Dean W Richardson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Kyla F Ortved
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
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Durket E, Kersh K, Dembek K, Riedesel E, Silverstone A, Kraus KH. Influence of plate type and placement on the immobilization of bilateral equine mandibular osteotomies: Ex vivo study. Vet Surg 2019; 48:1450-1455. [PMID: 30951203 DOI: 10.1111/vsu.13198] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 02/06/2019] [Accepted: 03/09/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the influence of plate fixation (locking or dynamic compression) and the site of application (ventral [V] or ventrolateral [VL]) on the resistance to bending of transverse mandibular fractures. STUDY DESIGN Ex vivo, simple randomized study. SAMPLE POPULATION Mandibles harvested from adult equine cadavers (n = 18). METHODS Bilateral osteotomies were created 1 cm caudal to the mental foramen and perpendicular to the long axis of each mandible. Mandibles were fixed with 1 of 3 methods: (1) VL dynamic compression plate (DCP), (2) V-DCP, or (3) VL locking compression plating (LCP). Constructs were mounted on a custom testing jig and tested for resistance in bending by applying force to the rostral aspect of the mandible. Stiffness and change of distance of the dorsal osteotomy at 200 N were compared among constructs. RESULTS VL-LCP constructs were 5.25 and 2.42 times stiffer than V and VL constructs, respectively (P<.001). Change in the width of the osteotomy gap at 200 N of load was reduced 6.04 times when osteotomies were stabilized with VL compared to V (P<.001); no difference was detected between the VL and VL-LCP constructs (P=.836). CONCLUSION Ventrolateral LCP fixation of equine transverse mandibular osteotomies provided greater resistance to bending compared with V and VL constructs. CLINICAL SIGNIFICANCE These results provide evidence to recommend fixation of transverse interdental mandibular fractures with VL-LCP rather than with DCP in horses.
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Affiliation(s)
- Elyse Durket
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
| | - Kevin Kersh
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
| | - Katarzyna Dembek
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
| | - Elizabeth Riedesel
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
| | - Auri Silverstone
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
| | - Karl H Kraus
- Department of Veterinary Clinical Sciences, Iowa State University, Ames, Iowa
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SURGICAL MANAGEMENT OF APPENDICULAR LONG-BONE FRACTURES IN FREE-RANGING FLORIDA PANTHERS ( PUMA CONCOLOR CORYI): SIX CASES (2000-2014). J Zoo Wildl Med 2018. [PMID: 29517460 DOI: 10.1638/2017-0058r1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The clinical outcomes of six free-ranging Florida panthers ( Puma concolor coryi) that underwent surgical stabilization of appendicular long-bone fractures (three femoral fractures, one tibial and one tibial and fibular fracture and two radial and ulnar fractures) were evaluated. These panthers presented to the University of Florida from 2000-2014. Estimated age of the panthers ranged from 0.5 to 4.5 yr, and weights ranged from 22 to 65 kg. Causes of injuries were vehicular collision ( n = 4) and capture related ( n = 2). All panthers underwent open reduction and fracture stabilization. Fixation failure necessitated three subsequent surgeries in one panther. Five panthers survived the immediate postoperative period, and all of these panthers' fractures obtained radiographic union (range, 8-36 [mean, 22] wk). The five surviving panthers underwent convalescence for 7-14 mo at White Oak Conservation Center before being released back into the wild; however, one panther was killed when hit by a car 3 days after release. The remaining four panthers were tracked for up to 106 mo in the wild and successfully integrated back into the native population. Surgical stabilization of appendicular long-bone fractures in free-ranging Florida panthers can be successful, but must take into account the stress that a large, undomesticated felid will place on the stabilized limb during convalescence as well as the difficulties involved in rehabilitating a wild panther in captivity.
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Ex vivo cyclic mechanical behaviour of 2.4 mm locking plates compared with 2.4 mm limited contact plates in a cadaveric diaphyseal gap model. Vet Comp Orthop Traumatol 2018; 26:479-88. [DOI: 10.3415/vcot-13-07-0089] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 07/31/2013] [Indexed: 11/17/2022]
Abstract
SummaryObjectives: To compare the mechanical properties of locking compression plate (LCP) and limited contact dynamic compression plate (LC-DCP) constructs in an experimental model of comminuted fracture of the canine femur during eccentric cyclic loading.Methods: A 20 mm mid-diaphyseal gap was created in eighteen canine femora. A 10-hole, 2.4 mm stainless steel plate (LCP or LC-DCP) was applied with three bicortical screws in each bone fragment. Eccentric cyclic loadings were applied at 10 Hertz for 610,000 cycles. Quasistatic loading / unloading cycles were applied at 0 and 10,000 cycles, and then every 50,000 cycles. Structural stiffness was calculated as the slope of the linear portion of the load-displacement curves during quasistatic loading / unloading cycles.Results: No bone failure or screw loosening occurred. Two of the nine LCP constructs failed by plate breakage during fatigue testing, whereas no gross failure occurred with the LC-DCP constructs. The mean first stiffness of the LCP constructs over the course of testing was 24.0% lower than that of constructs stabilized by LC-DCP. Construct stiffness increased in some specimens during testing, presumably due to changes in boneplate contact. The first stiffness of LC-DCP constructs decreased by 19.4% and that of locked constructs by 34.3% during the cycling period. A biphasic stiffness profile was observed: the second stiffness was significantly greater than the first stiffness in both groups, which allowed progressive stabilization at elevated load levels.Clinical significance: Because LCP are not compressed to the bone, they may have a longer working length across a fracture, and thus be less stiff. However, this may cause them to be more susceptible to fatigue failure if healing is delayed.
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Biomechanical Property of a Newly Designed Assembly Locking Compression Plate: Three-Dimensional Finite Element Analysis. JOURNAL OF HEALTHCARE ENGINEERING 2017; 2017:8590251. [PMID: 29065654 PMCID: PMC5494084 DOI: 10.1155/2017/8590251] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 05/03/2017] [Indexed: 11/17/2022]
Abstract
In this study, we developed and validated a refined three-dimensional finite element model of middle femoral comminuted fracture to compare the biomechanical stability after two kinds of plate fixation: a newly designed assembly locking compression plate (NALCP) and a locking compression plate (LCP). CT data of a male volunteer was converted to middle femoral comminuted fracture finite element analysis model. The fracture was fixated by NALCP and LCP. Stress distributions were observed. Under slow walking load and torsion load, the stress distribution tendency of the two plates was roughly uniform. The anterolateral femur was the tension stress area, and the bone block shifted toward the anterolateral femur. Maximum stress was found on the lateral border of the number 5 countersink of the plate. Under a slow walking load, the NALCP maximum stress was 2.160e+03 MPa and the LCP was 8.561e+02 MPa. Under torsion load, the NALCP maximum stress was 2.260e+03 MPa and the LCP was 6.813e+02 MPa. Based on those results of finite element analysis, the NALCP can provide adequate mechanical stability for comminuted fractures, which would help fixate the bone block and promote bone healing.
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Jacobs CC, Levine DG, Richardson DW. Use of locking compression plates in ulnar fractures of 18 horses. Vet Surg 2017; 46:242-248. [PMID: 28146292 DOI: 10.1111/vsu.12607] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/20/2016] [Accepted: 07/13/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To describe the outcome, clinical findings, and complications associated with the use of the locking compression plate (LCP) for various types of ulnar fractures in horses. STUDY DESIGN Retrospective case series. SAMPLE POPULATION Client owned horses (n = 18). METHODS Medical records, radiographs, and follow-up for horses having an ulnar fracture repaired using at least 1 LCP were reviewed. Fifteen of 18 horses had fractures of the ulna only, and 3 horses had fractures of the ulna and proximal radius. RESULTS All 18 horses were discharged from the hospital. Complications occurred in 5 horses; incisional infection (n = 4, 22%), implant-associated infection (n = 2, 11%), and colic (n = 1, 6%). Follow-up was available for all horses at a range of 13-120 months and 15 horses (83%) were sound for their intended purpose and 3 horses (17%) were euthanatized. One horse was euthanatized for complications associated with original injury and surgery. CONCLUSIONS The LCP is a viable method of internal fixation for various types of ulnar fractures, with most horses in this series returning to soundness.
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Affiliation(s)
- Carrie C Jacobs
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - David G Levine
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Dean W Richardson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
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Matres-Lorenzo L, Diop A, Maurel N, Boucton MC, Bernard F, Bernardé A. Biomechanical Comparison of Locking Compression Plate and Limited Contact Dynamic Compression Plate Combined with an Intramedullary Rod in a Canine Femoral Fracture-Gap Model. Vet Surg 2016; 45:319-26. [PMID: 26909507 DOI: 10.1111/vsu.12451] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the biomechanical properties of locking compression plate (LCP) and a limited contact dynamic compression plate combined with an intramedullary rod (LC-DCP-R) in a cadaveric, canine, femoral fracture-gap model. STUDY DESIGN In vitro biomechanical study; nonrandomized, complete block (dog). SAMPLE POPULATION Paired cadaveric canine femora (n = 10 dogs). METHODS Paired femurs with a mid-diaphyseal 20 mm gap were stabilized with either LCP or LC-DCP-R. Nondestructive testing up to 60% of body weight (BW) was followed by a continuous destructive test. Comparative structural properties, 3-dimensional (3D) interfragmentary motion, and plate linear strain were evaluated. Paired comparisons were made between LCP and LC-DCP-R. RESULTS Stiffness after nondestructive testing was significantly lower for LCP with a mean (95% confidence interval [CI]) of 61 N/mm (46-76) versus 89 N/mm (67-110) for LC-DCP-R (P = .0072). Ultimate load to failure was significantly lower for LCP with a median (interquartile range [IQR]) of 270 N (247-286) versus 371.5 (353-385) for LC-DCP-R (P = .002). Axial motion at 60% BW was significantly higher for LCP with a median (IQR) of 1.01 mm (0.71-1.26) versus 0.36 mm (0.20-0.49) for LC-DCP-R (P = .002). Shear motion was significantly higher for LCP with a median (IQR) of 1.18 (0.78-1.58) versus 0.72 mm (0.45-1.00) for LC-DCP-R (P = .018). Strain was significantly higher for mid-LCP surface with a mean (95%CI) at 60% BW of 979 μdef (579-1378) versus 583 μdef (365-801) at mid-LC-DCP-R surface (P = .0153). The elastic limit strain of the plates was not different and was reached at a mean (95%CI) load of 241 N (190-292) for LCP versus 290 N (245-336) for LC-DCP-R (P = .12). CONCLUSION The LC-DCP-R showed higher stiffness and resistance to failure, lower interfragmentary motion, and lower plate strain and stress compared to LCP.
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Affiliation(s)
| | - Amadou Diop
- Equipe Biomécanique et Remodelage Osseux (EPBRO), École Nationale Supérieure d'Arts et Métiers, Paris, France
| | - Nathalie Maurel
- Equipe Biomécanique et Remodelage Osseux (EPBRO), École Nationale Supérieure d'Arts et Métiers, Paris, France
| | - Marie-Charlotte Boucton
- Equipe Biomécanique et Remodelage Osseux (EPBRO), École Nationale Supérieure d'Arts et Métiers, Paris, France
| | - Fabrice Bernard
- Centre Hospitalier Vétérinaire Saint-Martin, Saint Martin Bellevue, France
| | - Antoine Bernardé
- Centre Hospitalier Vétérinaire Saint-Martin, Saint Martin Bellevue, France
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Affiliation(s)
- J. A. Auer
- Emeritus Professor Equine Department Vetsuisse Faculty; Equine Department; University of Zürich; Switzerland
| | - A. E. Fürst
- Clinic for Equine Surgery; Equine Department; University of Zürich; Switzerland
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Qiu WJ, Li YF, Ji YH, Xu W, Zhu XD, Tang XZ, Zhao HL, Wang GB, Jia YQ, Zhu SC, Zhang FF, Liu HM. The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities. Sci Rep 2015; 5:15318. [PMID: 26549312 PMCID: PMC4637827 DOI: 10.1038/srep15318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/21/2015] [Indexed: 11/25/2022] Open
Abstract
In this study, we performed a network meta-analysis to compare the outcomes of seven most common surgical procedures to fix DRF, including bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. Published studies were retrieved through PubMed, Embase and Cochrane Library databases. The database search terms used were the following keywords and MeSH terms: DRF, bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. The network meta-analysis was performed to rank the probabilities of postoperative complication risks for the seven surgical modalities in DRF patients. This network meta-analysis included data obtained from a total of 19 RCTs. Our results revealed that compared to DRF patients treated with bridging external fixation, marked differences in pin-track infection (PTI) rate were found in patients treated with plaster fixation, volar plating, and dorsal and volar plating. Cluster analysis showed that plaster fixation is associated with the lowest probability of postoperative complication in DRF patients. Plaster fixation is associated with the lowest risk for postoperative complications in DRF patients, when compared to six other common DRF surgical methods examined.
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Affiliation(s)
- Wen-Jun Qiu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Yi-Fan Li
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Yun-Han Ji
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Wei Xu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Xiao-Dong Zhu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Xian-Zhong Tang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Huan-Li Zhao
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Gui-Bin Wang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Yue-Qing Jia
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Shi-Cai Zhu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Feng-Fang Zhang
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
| | - Hong-Mei Liu
- Department of Orthopedic Surgery, Tongren Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200336, P.R. China
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Stewart S, Richardson D, Boston R, Schaer TP. Risk Factors Associated With Survival to Hospital Discharge of 54 Horses With Fractures of the Radius. Vet Surg 2015; 44:1036-41. [PMID: 26455917 DOI: 10.1111/vsu.12412] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine (1) survival to discharge of horses with radial fractures (excluding osteochondral fragmentation of the distal aspect of the radius and stress fractures); and (2) risk factors affecting survival to hospital discharge in conservative and surgically managed fractures. STUDY DESIGN Case series. ANIMALS Horses (n = 54). METHODS Medical records (1990-June 2012) and radiographs of horses admitted with radial fracture were reviewed. Horses with osteochondral fragmentation of the distal aspect of the radius or stress fractures were excluded. Evaluated risk factors were age, fracture configuration, surgical repair method, surgical duration, hospitalization time, implant failure rate, and surgical site infection (SSI) rate. RESULTS Of 54 horses, overall survival to discharge was 50%. Thirteen (24%) were euthanatized on admission because of (1) fracture severity; (2) presence of an open fracture; or (3) financial constraints. Fourteen (26%) horses with minimally displaced incomplete fractures were conservatively managed and 12 (86%) survived to discharge. Twenty-seven (50%) horses had surgical treatment by open reduction and internal fixation (ORIF) and 15 (56%) survived to hospital discharge. Open fractures were significantly more likely to develop SSI (P = .008), which also resulted in a 17-fold increase in implant failure (P < .005). Six of 8 surgically managed horses with an open fracture did not survive to discharge. Outcome was also adversely affected by age (P < .005) and surgical duration > 168 minutes (P < .027). Presence of SSI trended toward a decreased survival rate (P = .09). CONCLUSION Prognosis for survival to discharge with minimally displaced incomplete fractures is good. Young horses have a good prognosis survival to discharge for ORIF, whereas ORIF in adult horses has a poor prognosis and SSI strongly correlates with catastrophic implant failure.
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Affiliation(s)
- Suzanne Stewart
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Dean Richardson
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Ray Boston
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, Kennett Square, Pennsylvania
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Auer JA, Grainger DW. Fracture management in horses: Where have we been and where are we going? Vet J 2015; 206:5-14. [DOI: 10.1016/j.tvjl.2015.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 05/30/2015] [Accepted: 06/01/2015] [Indexed: 12/31/2022]
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Zhao HL, Wang GB, Jia YQ, Zhu SC, Zhang FF, Liu HM. Comparison of Risk of Carpal Tunnel Syndrome in Patients with Distal Radius Fractures After 7 Treatments. Med Sci Monit 2015; 21:2837-44. [PMID: 26391617 PMCID: PMC4588632 DOI: 10.12659/msm.894075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background To compare risk of carpal tunnel syndrome (CTS) in distal radius fracture (DRF) patients after 7 treatments using bridging external fixation (BrEF), non-bridging external fixation (non-BrEF), plaster fixation, K-wire fixation, dorsal plating fixation, volar plating fixation, and dorsal and volar plating by performing a network meta-analysis. Material/Methods An exhaustive search of electronic databases identified randomized controlled trails (RCTs) closely related to our study topic. The published articles were screened, based on predefined inclusion and exclusion criteria, to select high-quality studies for the present network meta-analysis. Data extracted from the selected studies were analyzed using STATA version 12.0 software. Results The literature search and selection process identified 12 eligible RCTs that contained a total of 1370 DRF patients (394 patients with BrEF, 377 patients with non-BrEF, 89 patients with K-wire fixation, 192 patients with plaster fixation, 42 patients with dorsal plating fixation, 152 patients with volar plating fixation, and 124 patients with dorsal and volar plating fixation). Our network meta-analysis results demonstrated no significant differences in CTS risk among the 7 treatments (P>0.05). The value of surface under the cumulative ranking curve (SUCRA), however, suggested that dorsal plating fixation is the optimal treatment, with the lowest risk of CTS in DRF patients (dorsal plating fixation: 89.2%; dorsal and volar plating: 57.8%; plaster fixation: 50.9%; non-BrEF: 50.6%; volar plating fixation: 39.6%; BrEF: 38.4%; K-wire fixation: 23.6%). Conclusions Our network meta-analysis provides evidence that dorsal plating fixation significantly decreases the risk of CTS and could be the method of choice in DRF patients.
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Affiliation(s)
- Huan-Li Zhao
- Department of Orthopedics, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Gui-Bin Wang
- Department of Radiology, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Yue-Qing Jia
- Department of Traumatic Orthopedics, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Shi-Cai Zhu
- Department of Radiology, Linyi People's Hospital, Linyi, Shandong, China (mainland)
| | - Feng-Fang Zhang
- Department of Radiology, Linyi Hospital of Traditional Chinese Medicine, Linyi, Shandong, China (mainland)
| | - Hong-Mei Liu
- Department of Surgery, Linyi People's Hospital, Linyi, Shandong, China (mainland)
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Keller SA, Fürst AE, Kircher P, Ringer S, Kuemmerle JM. Locking Compression Plate Fixation of Equine Tarsal Subluxations. Vet Surg 2015; 44:949-56. [DOI: 10.1111/vsu.12400] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Sara A. Keller
- Equine Department; Vetsuisse Faculty; University of Zurich; Switzerland
| | - Anton E. Fürst
- Equine Department; Vetsuisse Faculty; University of Zurich; Switzerland
| | - Patrick Kircher
- Section of Diagnostic Imaging; Vetsuisse Faculty; University of Zurich; Switzerland
| | - Simone Ringer
- Section of Anesthesiology; Vetsuisse Faculty; University of Zurich; Switzerland
| | - Jan M. Kuemmerle
- Equine Department; Vetsuisse Faculty; University of Zurich; Switzerland
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Petersen W, Wall A, Paulin T, Park HU, Heymann L. Stability of two angular stable locking plates for open wedge high tibial osteotomy (HTO): TomoFix™ versus LOQTEQ® HTO plate. Arch Orthop Trauma Surg 2014; 134:1437-42. [PMID: 25015791 DOI: 10.1007/s00402-014-2042-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2014] [Indexed: 11/24/2022]
Abstract
INTRODUCTION The aim of this study was to test the mechanical stability of LOQTEQ® HTO plate in comparison to the TomoFix™ internal plate fixator. MATERIALS AND METHODS An unstable fracture gap model with two standardized polyoxymethylene (POM) cylinders was used for this study. With this model 5 LOQTEQ® HTO plates and 5 TomoFix™ were cyclically loaded. The start load was 100 N and increased by 50 N after each successful completed cycle. Each load step included 250,000 cycles. All tests were performed in accordance with the American Society for Testing and Materials (ASTM) Standard Specification and Test Method for Metallic Bone Plates F382-99(2003)e1. RESULTS The mean fatigue strength of the LOQTEQ® HTO Plate was 155 % of the value gained by the TomoFix™ implant. This difference was statistically significant (t test <0.001). There was also a significant difference in the cycles but both implants survived. The LOQTEQ® HTO Plate system survived 1,520,336.8 (±121,687.7) cycles, whereas the TomoFix™ group passed on average 847,802,600 (±134,660.7) cycles. In both groups, the only failure mode was plate breakage in a shaft hole. CONCLUSIONS The results of the present study showed that fatigue strength of the LOQTEQ® HTO plate was significantly higher in comparison to TomoFix™. These results justify the clinical use of the LOQTEQ® HTO plate.
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Affiliation(s)
- Wolf Petersen
- Department of Trauma and Orthopaedic Surgery, Martin Luther Hospital, Caspar Theyss Straße 27-31, Grunewald, 14193, Berlin, Germany,
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Wang DX, Xiong Y, Deng H, Jia F, Gu S, Liu BL, Li QH, Pu Q, Zhang ZZ. Biomechanical analysis and clinical effects of bridge combined fixation system for femoral fractures. Proc Inst Mech Eng H 2014; 228:899-907. [PMID: 25201264 DOI: 10.1177/0954411914548866] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This work aimed to compare the stress distribution and mechanical properties of our bridge combined fixation system and commonly used metal locking plate screw system by finite element analysis and by using the Zwick/Z100 testing machine. In addition, we also investigated the clinical outcome of our bridge combined fixation system for femoral fractures in 59 patients from June 2005 to January 2013. As a result, the stress distribution in the bone plate and screws of metal locking plate screw system during walking and climbing stairs was significantly lower than that of metal locking plate screw system. No significant difference in the displacement was observed between two systems. The equivalent bending stiffness of bridge combined fixation system was significantly lower than that of metal locking plate screw system. There were no significant differences in the bending strength, yield load, and maximum force between two systems. All the cases were followed up for 12-24 months (average 18 months). The X-ray showed bone callus was formed in most patients after 3 months, and the fracture line was faint and disappeared at 6-9 months postoperatively. No serious complications, such as implant breakage and wound infection, occurred postoperatively. According to self-developed standard for bone healing, clinical outcomes were rated as excellent or good in 55 out of 59 patients (success rate: 93.2%). Therefore, our findings suggest that our bridge combined fixation system may be a promising approach for treatment of long-bone fractures.
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Affiliation(s)
- Da-xing Wang
- Department of Orthopedics, Yan'an Hospital, Kunming, China
| | - Ying Xiong
- Department of Orthopedics, Yan'an Hospital, Kunming, China
| | - Hong Deng
- Department of Orthopedics, Yan'an Hospital, Kunming, China
| | - Fu Jia
- Department of Orthopedics, Yan'an Hospital, Kunming, China
| | - Shao Gu
- Department of Orthopedics, Yan'an Hospital, Kunming, China
| | - Bai-lian Liu
- Department of Orthopedics, Yan'an Hospital, Kunming, China
| | - Qun-hui Li
- Department of Orthopedics, Yan'an Hospital, Kunming, China
| | - Qi Pu
- Department of Orthopedics, Yan'an Hospital, Kunming, China
| | - Zhong-Zi Zhang
- Department of Orthopedics, Yan'an Hospital, Kunming, China
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Schleining JA, Bergh MS. Surgical correction of angular and torsional metatarsal deformity with cylindrical osteotomy and locking compression plates in a calf. Vet Surg 2014; 43:563-8. [PMID: 24720385 DOI: 10.1111/j.1532-950x.2014.12186.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 07/01/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To report successful surgical correction of concurrent angular and torsional metatarsal deformities in a calf using a cylindrical osteotomy and locking compression plate (LCP) technology. STUDY DESIGN Case report. ANIMALS A 10-week-old composite bull calf. METHODS Using Paley's principles of angular limb deformity correction, a cylindrical osteotomy was performed to concurrently correct varus deformity and external torsion of the metatarsus. The limb was aligned and stabilized using two 3.5 mm broad LCP with locking head screws. RESULTS The calf was immediately weight bearing after surgery and did not experience any postoperative complications. Follow-up radiographs 5 months postoperatively revealed complete osteotomy healing and remodeling. The limb was in good alignment, the calf was fully weight bearing, and client satisfaction was very high. Telephone follow-up with the owner 16 months after surgery revealed continued full use of the operated limb and the bull was being used in a pasture breeding program. CONCLUSIONS Cylindrical osteotomy with LCP stabilization can provide a favorable outcome in angular and torsional metatarsal deformity correction in cattle.
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Affiliation(s)
- Jennifer A Schleining
- Department of Veterinary Diagnostic and Production Animal Medicine, College of Veterinary Medicine, Iowa State University, Ames, Iowa
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Seo JP, Yamaga T, Tsuzuki N, Yamada K, Haneda S, Furuoka H, Sasaki N. In vitro biomechanical comparison of a 5-hole 4.5 mm locking compression plate and 5-hole 4.5 mm dynamic compression plate for equine proximal interphalangeal joint arthrodesis. Vet Surg 2014; 43:606-11. [PMID: 24512440 DOI: 10.1111/j.1532-950x.2014.12164.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Accepted: 06/01/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the biomechanical properties of a 5-hole 4.5 mm narrow locking compression plate (LCP) and 5-hole 4.5 mm narrow dynamic compression plate (DCP) for equine proximal interphalangeal (PIP) joint arthrodesis. STUDY DESIGN Experimental mechanical study. ANIMALS Cadaveric adult equine forelimbs (n = 6 pair). METHODS For each forelimb pair, 1 PIP joint was stabilized with LCP and the contralateral PIP joint with DCP. The 6 construct pairs were tested using a single-cycle, 3-point dorsopalmar bending system. PIP joints were evaluated with pre- and post-test radiography. RESULTS The LCP technique had significantly greater yield load, failure load, and stiffness under single-cycle, 3-point dorsopalmar bending to failure than the DCP technique. There was no significant difference between the 2 constructs for displacement at yield and failure point. CONCLUSIONS Biomechanically, the LCP technique provided significantly greater stability than the DCP technique under the test condition.
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Affiliation(s)
- Jong-Pil Seo
- Departments of Clinical Veterinary Science, Obihiro University of Agriculture and Veterinary Medicine, Hokkaido, Japan
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Nóbrega F, Ferreira M, Alievi M, Beck C, Gonzalez P, Dal-Bó I, Stédile R. Osteossíntese de mandíbula e maxila em equinos adultos: relato de quatro casos. ARQ BRAS MED VET ZOO 2013. [DOI: 10.1590/s0102-09352013000600018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Fraturas da mandíbula secundárias a trauma externo não são raras em equinos, sendo este o osso mais comumente fraturado quando o trauma é na região da cabeça. Na maioria dos casos, são abertas e com dano aos tecidos moles adjacentes. Como os ossos da cabeça não são submetidos às forças de carga do apoio, a exigência para fixação da fratura é menos desafiadora. O presente trabalho descreve o tratamento cirúrgico de quatro fraturas de mandíbula em equinos, sendo que, em um caso, havia também fratura de maxila. Quatro cavalos adultos com histórico de traumatismo na região da cabeça foram atendidos, avaliados clinicamente, radiografados e, após diagnóstico, submetidos a tratamento cirúrgico. No primeiro caso, o equino apresentava fratura rostral da mandíbula, sendo esta tratada com cerclagens. Além disso, o animal apresentava fratura múltipla de maxila, que foi corrigida com uma cerclagem próxima aos dentes incisivos, uma placa com parafusos e duas hemicerclagens na região entre os dentes incisivos e pré-molares. O segundo animal apresentava fratura múltipla dos ramos horizontal e vertical direito da mandíbula e foi tratado com uso de cinco placas de reconstrução e parafusos. No terceiro paciente foi diagnosticada fratura simples no ramo horizontal da mandíbula esquerda, que foi estabilizada com uma placa e parafusos. O quarto paciente apresentava fratura rostral de mandíbula, com avulsão de quatro dentes incisivos, sendo realizada a extração dos dentes incisivos e sutura da mucosa labial. Todos os animais obtiveram consolidação das fraturas em diferentes períodos de pós-operatório, o que permitiu melhora na qualidade de vida.
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Kuemmerle JM, Kühn K, Bryner M, Fürst AE. Equine ulnar fracture repair with locking compression plates can be associated with inadvertent penetration of the lateral cortex of the radius. Vet Surg 2013; 42:790-4. [PMID: 24015890 DOI: 10.1111/j.1532-950x.2013.12059.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 07/02/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate if the use of locking head screws (LHS) in the distal holes of a locking compression plate (LCP) applied to the caudal aspect of the ulna to treat equine ulnar fractures is associated with a risk of injury to the lateral cortex of the radius. STUDY DESIGN Controlled laboratory study. SAMPLE POPULATION Cadaveric equine forelimbs (n = 8 pair). METHODS After transverse ulnar osteotomy, osteosynthesis was performed with a narrow 10-13 hole 4.5/5.0 LCP applied to the caudal aspect of each ulna. The distal 3 holes were filled with 4.5 mm cortex screws (CS) in 1 limb (group 1) and with 5.0 mm LHS contralaterally (group 2). CS were inserted in an angle deemed appropriate by the surgeon and LHS were inserted perpendicular to the plate. Implant position and injury to the lateral cortex of the radius were assessed by radiography, CT, and limb dissection. RESULTS In group 1, injury of the lateral radius cortex did not occur. In group 2, 4 limbs and 6/24 LHS were associated with injury of the lateral radius cortex by penetration of a LHS. This difference was statistically significant. CS were inserted with a mean angle of 17.6° from the sagittal plane in a caudolateral-craniomedial direction. CONCLUSIONS Use of LHS in the distal part of a LCP applied to the caudal aspect of the ulna is associated with a risk of inadvertent injury to the lateral cortex of the radius.
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Affiliation(s)
- Jan M Kuemmerle
- Equine Hospital, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Xu GH, Liu B, Zhang Q, Wang J, Chen W, Liu YJ, Peng AQ, Zhang YZ. Biomechanical comparison of gourd-shaped LCP versus LCP for fixation of comminuted tibial shaft fracture. JOURNAL OF HUAZHONG UNIVERSITY OF SCIENCE AND TECHNOLOGY. MEDICAL SCIENCES = HUA ZHONG KE JI DA XUE XUE BAO. YI XUE YING DE WEN BAN = HUAZHONG KEJI DAXUE XUEBAO. YIXUE YINGDEWEN BAN 2013; 33:250-257. [PMID: 23592139 DOI: 10.1007/s11596-013-1106-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2012] [Indexed: 11/29/2022]
Abstract
The purpose of this study was to compare monotonic biomechanical properties of gourd-shaped LCP fixation with LCP fixation of human tibial shaft in gap fracture mode. Twenty paired fresh cadaveric human tibias were randomly divided into 4 groups (5 pairs each): (1) axial loading single cycle to failure testing, (2) torsion single cycle to failure testing, (3) 4-point bending single cycle to failure testing, and (4) dynamic 4-point bending testing. A 7-hole 4.5 mm gourd-shaped LCP was secured on the anteromedial surface of 1 randomly selected bone from each pair, respectively, using 6 locking screws in the 1st, 2nd, 3rd, 5th, 6th and 7th hole with the middle hole unfilled and just located at the mid-diaphysis of the tibia. A 7-hole 4.5 mm LCP was secured on the other bone with the same method. Standard AO/ASIF techniques were used. After fixation finished, a 10 mm gap in the mid-diaphysis of tibia was created, centrally located at the unfilled hole. The axial, torsional, and bending stiffness and failure strengths were calculated from the collected data in static testings and statistically compared using paired Student's t-test. The 4-point bending fatigue lives of the two constructs were calculated from the dynamic testing data and also statistically compared using paired Student's t-test. Failure modes were recorded and visually analyzed. P<0.05 was considered significant. Results showed that the axial, torsional and bending stiffness of gourd-shaped LCP construct was greater (4%, 19%, 12%, respectively, P<0.05) than that of the LCP construct, and the axial, torsional and bending failure strengths of gourd-shaped LCP construct were stronger (10%, 46%, 29%, respectively, P<0.05) than those of the LCP construct. Both constructs failed as a result of plate plastic torsional deformation. After axial loading and 4-point bending testings, LCP failed in term of an obvious deformation of bent apex just at the unfilled plate hole, while the gourd-shaped LCP failed in term of a deformation of bent arc between the 3rd and 5th holes, which indicated a more consistent stress distribution on gourd-shaped LCP. Fatigue life of gourd-shaped LCP construct was significantly greater than LCP construct (153 836±2 228 vs. 132 471±6 460 cycles, P<0.01). All constructs failed as a result of fracture of the plate through the compression hole of the unfilled combination screw hole. The biomechanical testing showed that gourd-shaped LCP can provide greater stiffness and strength, and longer fatigue life than LCP. The gourd-shaped LCP may be more advantageous mechanically and may reduce the plate breakage rate clinically.
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Affiliation(s)
- Guo-Hui Xu
- Department of Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Bo Liu
- Department of Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Qi Zhang
- Department of Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Juan Wang
- Department of Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Wei Chen
- Department of Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Yue-Ju Liu
- Department of Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - A-Qin Peng
- Department of Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Ying-Ze Zhang
- Department of Trauma Emergency Center, the Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
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Chen ACY, Lin YH, Kuo HN, Yu TC, Sun MT, Lin CL. Design optimisation and experimental evaluation of dorsal double plating fixation for distal radius fracture. Injury 2013; 44:527-34. [PMID: 23099020 DOI: 10.1016/j.injury.2012.09.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 09/24/2012] [Indexed: 02/02/2023]
Abstract
This study determines the relative effects of changes in osteoporosis condition, plate/screw design factors (plate angle/length/width/thickness and screw diameter) and fixation methods (screw number and screw length) on the biomechanical response of dorsal double plating (DDP) fixation at a distal radius fracture to determine the optimal design and evaluate its biomechanical strength using the dynamic fatigue test. Eighteen CAD and finite element (FE) models corresponding to a Taguchi L18 array were constructed to perform numerical simulations to simulate the mechanical responses of a DDP fixed in a simply distal radius fracture bone. The Taguchi method was employed to determine the significance of each design factor in controlling bone/plate/screw stress and distal fragment displacement under axial (100 N), bending (1 N m) and torsion (1 N m) loads. Simulation results indicated that the order rank to determine the mechanical response was the plate thickness, plate width, screw diameter, and number of screws. Dorsal intermediate (L) plate with 60 mm length, 1.8 mm thickness, 6.0 mm width and 2.8 mm diameter, 20 mm length dual-thread locking screw can be found for optimisation. The DDP, including an L plate with 0°, 30° and 60° angles and a straight I plate, were made with Ti6Al4V to fix onto the sawbones with three corresponding radius fractures to perform the dynamic testing. The specimens were oscillated with loads between 10 N and 150 N at 5 Hz for 20,000 cycles. The average stiffness in 20,000 test cycles was 425.7 N/mm, 461.1 N/mm and 532.1N/mm for the 0°, 30° and 60° constructs, respectively. No difference in stiffness was found in the same angled constructs throughout the 20,000 cycles of testing (p > 0.05). Lack of gross construct failures during cyclic testing and reasonable stiffness corroborated that our new constructs tested to date seem stable enough to support restricted post-operative loads.
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Affiliation(s)
- Alvin Chao-Yu Chen
- Department of Orthopaedic Surgery, Chang Gung Memorial Hospital & University College of Medicine, 5th, Fu-Hsing St., Kuei-Shan, Tao-Yuan 333, Taiwan.
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Chao P, Lewis DD, Kowaleski MP, Pozzi A. Biomechanical Concepts Applicable to Minimally Invasive Fracture Repair in Small Animals. Vet Clin North Am Small Anim Pract 2012; 42:853-72, v. [DOI: 10.1016/j.cvsm.2012.07.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hoerdemann M, Gédet P, Ferguson SJ, Sauter-Louis C, Nuss K. In-vitro comparison of LC-DCP- and LCP-constructs in the femur of newborn calves - a pilot study. BMC Vet Res 2012; 8:139. [PMID: 22909337 PMCID: PMC3514370 DOI: 10.1186/1746-6148-8-139] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 08/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background To compare the biomechanical in-vitro characteristics of limited-contact dynamic compression plate (LC-DCP) and locking compression plate (LCP) constructs in an osteotomy gap model of femoral fracture in neonatal calves. Pairs of intact femurs from 10 calves that had died for reasons unrelated to the study were tested. A 7-hole LC-DCP with six 4.5 mm cortical screws was used in one femur and a 7-hole LCP with four 5.0 mm locking and two 4.5 mm cortical screws was used in the corresponding femur. The constructs were tested to failure by cyclic compression at a speed of 2 mm/s within six increasing force levels. Results The bone-thread interface was stripped in 21 of 80 cortical screws (26.3%) before a pre-set insertion torque of 3 Nm was achieved. Only 3 corresponding intact pairs of constructs could be statistically compared for relative structural stiffness, actuator excursion and width of the osteotomy gap. Relative structural stiffness was significantly greater, actuator excursion and width of the osteotomy gap were significantly smaller in the LCP constructs. While failure occurred by loosening of the screws in the LC-DCP constructs, locking constructs failed by cutting large holes in the soft distal metaphyseal bone. Conclusions An insertion torque sufficient to provide adequate stability in femurs of newborn calves could not be achieved reliably with 4.5 mm cortical screws. Another limiting factor for both constructs was the weak cancellous bone of the distal fracture fragment. LCP constructs were significantly more resistant to compression than LC-DCP constructs.
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McDuffee LA, Pack L, Lores M, Wright GM, Esparza-Gonzalez B, Masaoud E. Osteoprogenitor Cell Therapy in an Equine Fracture Model. Vet Surg 2012; 41:773-83. [DOI: 10.1111/j.1532-950x.2012.01024.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Laurie A. McDuffee
- Departments of Health Management; University of Prince Edward Island; Charlottetown; PEI; Canada
| | - LeeAnn Pack
- Companion Animals; University of Prince Edward Island; Charlottetown; PEI; Canada
| | - Marcos Lores
- Departments of Health Management; University of Prince Edward Island; Charlottetown; PEI; Canada
| | - Glenda M. Wright
- Biomedical Sciences; University of Prince Edward Island; Charlottetown; PEI; Canada
| | - Blanca Esparza-Gonzalez
- Departments of Health Management; University of Prince Edward Island; Charlottetown; PEI; Canada
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In vitro biomechanical evaluation and comparison of a new prototype locking plate and a limited-contact self compression plate for equine fracture repair. Vet Comp Orthop Traumatol 2012; 25:273-80. [PMID: 22695636 DOI: 10.3415/vcot-11-01-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 02/24/2012] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine if the mechanical properties (strength and stiffness) of a new prototype 4.5 mm broad locking plate (NP-LP) are comparable with those of a traditional 4.5 mm broad limited-contact self compression plate (LC-SCP), and to compare the bending and torsional properties of the NP-LP and LC-SCP when used in osteotomized equine third metacarpal bones (MC3). METHODS The plates alone were tested in four-point bending single cycle to failure. The MC3-plate constructs were created with mid-diaphyseal osteotomies with a 1 cm gap. Constructs were tested in four-point bending single cycle to failure, four-point bending cyclic fatigue, and torsion single cycle to failure. RESULTS There were not any significant differences in bending strength and stiffness found between the two implants. The MC3-NP-LP construct was significantly stiffer than the MC3-LC-SCP in bending. No other biomechanical differences were found in bending, yield load in torsion, or mean composite rigidity. Mean cycles to failure for bending fatigue testing were similar for both constructs. CLINICAL SIGNIFICANCE The NP-LP was comparable to the LC-SCP in intrinsic, as well as structural properties. The NP-LP construct was more rigid than the LC-SCP construct under four-point bending, and both constructs behaved similarly under four-point bending cyclic fatigue testing and torsion single cycle to failure. The new NP-LP implant fixation is biomechanically comparable to the LC-SCP in a simulated MC3 fracture.
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Nobari S, Katoozian H, Zomorodimoghadam S. Three-dimensional design optimisation of patient-specific femoral plates as a means of bone remodelling reduction. Comput Methods Biomech Biomed Engin 2010; 13:819-27. [DOI: 10.1080/10255841003630645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Klopfenstein Bregger MD, Jackson MA, Kummer M, Kircher PR, Auer JA, Fürst AE. Ulnar osteotomy for treatment of cubital subluxation, following locking compression plate osteosynthesis of a radius fracture in a foal. EQUINE VET EDUC 2010. [DOI: 10.1111/j.2042-3292.2010.00142.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Levine DG, Richardson DW. Clinical use of the locking compression plate (LCP) in horses: a retrospective study of 31 cases (2004-2006). Equine Vet J 2010; 39:401-6. [PMID: 17910263 DOI: 10.2746/042516407x196555] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Fracture repair and arthrodesis in horses require rigid fixation in order to achieve early post operative comfort. The locking compression plate (LCP) was designed to allow greater stability and less periosteal disruption than conventional plates. OBJECTIVE To describe a series of clinical cases in which the LCP was used for fracture stabilisation or arthrodesis. METHODS Medical records, radiographs and follow-up for 31 horses having fracture stabilisation or arthrodesis with the LCP were reviewed. Reasons for treatment included fracture of the olecranon (n = 2), metatarsal III (n = 2), ilial shaft (n = 1), femur (n = 2), radius (n = 2), medial condylar (n = 5) and complex lateral condylar (n = 1); or arthrodesis of the metacarpophalangeal joint (n = 8), proximal interphalangeal joint (n = 8) and carpus (n = 2). RESULTS Of the 31 horses, 27 were discharged from the hospital. Complications included incisional infection (32%), implant infection (19%), implant loosening/ breakage (22%), contralateral limb laminitis (16%), colic (3%) and diarrhoea (3%). Follow-up was available on all horses with at least 6 weeks of follow-up ranging up to 25 months. Of the 31 horses, 25 are sound for intended purpose, one is lame and 5 were subjected to euthanasia for complications associated with the original injury. CONCLUSIONS The LCP is an acceptable means of fracture stabilisation and arthrodesis in the horse. POTENTIAL RELEVANCE The LCP should be considered for difficult fracture configurations and arthrodeses, especially when increased stability of the fixation is needed.
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Affiliation(s)
- D G Levine
- Department of Clinical Studies, New Bolton Center, University of Pennsylvania, 382 West Street Road, Kennett Square, Pennsylvania 19348-1692, USA
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Bischofberger AS, Fürst A, Auer J, Lischer C. Surgical management of complete diaphyseal third metacarpal and metatarsal bone fractures: clinical outcome in 10 mature horses and 11 foals. Equine Vet J 2009; 41:465-73. [PMID: 19642407 DOI: 10.2746/042516409x389388] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Osteosynthesis of third metacarpal (McIII) and third metatarsal (MtIII) bone fractures in horses is a surgical challenge and complications surrounding the repair are common. Retrospective studies evaluating surgical repair, complications and outcome are necessary to increase knowledge and improve success of long bone fracture repair in the horse. OBJECTIVES To evaluate clinical findings, surgical repair, post operative complications and outcome of 10 mature horses and 11 foals with McIII or MtIII fractures that were treated with open reduction and internal fixation (ORIF). METHODS Medical records were reviewed and follow-up information obtained by means of radiographs and/or telephone questionnaire. RESULTS Survival was achieved in 62% of the horses (3 mature/10 foals). On long-term evaluation (> 6 months) 11 horses (2 mature/9 foals) were fit for their intended activity, one mature horse had a chronic low grade lameness, and one foal was lost to follow-up because it was sold. The main fracture types were simple transverse (333%) or simple oblique (28.6%) and 71.4% of the fractures were open, 3 Type I (one mature/2 foals) and 12 type II (7 mature/5 foals). The preoperative assessment revealed inadequate emergency treatment in 10 horses (5 mature/5 foals; 47.6%). Survival rate of horses with open fractures was 12.5% (1/8) in mature and 85.7% (6/7) in foals. Post operative incisional infection (4 mature, 3 foals) was only managed successfully in 2 foals. Fracture instability related to inadequate fracture fixation technique occurred in 4 horses (all mature) and was always associated with unsuccessful outcome. CONCLUSIONS Age, bodyweight and infection are strongly associated with outcome in treatment of complete McIII/MtIII fractures. CLINICAL RELEVANCE Rigid fixation using plates and screws can be successful in treatment of closed or open, complete diaphyseal McIII/MtIII fractures in mature horses and foals. Instable fixation, infection and a bodyweight > 320 kg are major risk factors for unsuccessful outcome.
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Affiliation(s)
- A S Bischofberger
- University Veterinary Teaching Hospital of Camden, Faculty of Veterinary Science, University of Sydney, Camden, New South Wales, Australia
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JANICEK JOHNC, WILSON DAVIDA, CARSON WILLIAML, KRAMER JOANNE. An In Vitro Biomechanical Comparison of Dynamic Condylar Screw Plate Combined with a Dorsal Plate and Double Plate Fixation of Distal Diaphyseal Radial Osteotomies in Adult Horses. Vet Surg 2009; 38:719-31. [DOI: 10.1111/j.1532-950x.2009.00522.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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O'Toole RV, Andersen RC, Vesnovsky O, Alexander M, Topoleski LDT, Nascone JW, Sciadini MF, Turen C, Eglseder WA. Are locking screws advantageous with plate fixation of humeral shaft fractures? A biomechanical analysis of synthetic and cadaveric bone. J Orthop Trauma 2008; 22:709-15. [PMID: 18978547 DOI: 10.1097/bot.0b013e31818df8cb] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate whether locking screws offer any advantage over nonlocking screws for plate fixation of humeral shaft fractures for weight-bearing applications. DESIGN : Mechanical evaluation of stiffness in torsion, bending, and axial loading and failure in axial loading in synthetic and cadaveric bone. SETTING Biomechanical laboratory in an academic medical center. METHODS : We modeled a comminuted midshaft humeral fracture in both synthetic and cadaveric bone. Humeri were plated posteriorly. Two study groups each used identical 10-hole, 3.5-mm locking compression plates that can accept either locking or nonlocking screws. The first group used only nonlocking screws and the second only locking screws. Stiffness testing and failure testing were performed for both the synthetic bones (n = 6) and the cadaveric matched pairs (n = 12). Fatigue testing was set at 90,000 cycles of 440 N of axial loading. MAIN OUTCOME MEASURES Torsion, bending, and axial stiffness and axial failure force after cyclic loading. RESULTS With synthetic bones, no significant difference was observed in any of the 4 tested stiffness modes between the plates with locking screws and those with nonlocking screws (anteroposterior, P = 0.51; mediolateral, P = 0.50; axial, P = 0.15; torsional, P = 0.08). With initial failure testing of the constructs in axial loading, both plates failed above anticipated physiologic loads of 440 N (mean failure load for both constructs >4200 N), but no advantage to locking screws was shown. The cadaveric portion of the study also showed no biomechanical advantage of locking screws over nonlocking screws for stiffness of the construct in the 4 tested modes (P > 0.40). Fatigue and failure testing showed that both constructs were able to withstand strenuous fatigue and to fail above anticipated loads (mean failure >3400 N). No difference in failure force was shown between the 2 groups (P = 0.67). CONCLUSIONS Synthetic and cadaveric bone testing showed that locking screws offer no obvious biomechanical benefit in this application.
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Affiliation(s)
- Robert V O'Toole
- Department of Orthopaedics, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD 21201, USA.
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CARPENTER RYANS, GALUPPO LARRYD, SIMPSON EDWINL, DOWD JOSEPHP. Clinical Evaluation of the Locking Compression Plate for Fetlock Arthrodesis in Six Thoroughbred Racehorses. Vet Surg 2008; 37:263-8. [DOI: 10.1111/j.1532-950x.2008.00375.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Janicek JC, Carson WL, Wilson DA. Development of an in vitro three dimensional loading-measurement system for long bone fixation under multiple loading conditions: a technical description. J Orthop Surg Res 2007; 2:21. [PMID: 18036239 PMCID: PMC2213636 DOI: 10.1186/1749-799x-2-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2007] [Accepted: 11/24/2007] [Indexed: 11/10/2022] Open
Abstract
The purpose of this investigation was to design and verify the capabilities of an in vitro loading-measurement system that mimics in vivo unconstrained three dimensional (3D) relative motion between long bone ends, applies uniform load components over the entire length of a test specimen, and measures 3D relative motion between test segment ends to directly determine test segment construct stiffness free of errors due to potting-fixture-test machine finite stiffness.Intact equine cadaveric radius bones, which were subsequently osteotomized/ostectomized and instrumented with bone plates were subjected to non-destructive axial, torsion, and 4-point bending loads through fixtures designed to allow unconstrained components of non-load associated 3D relative motion between radius ends. 3D relative motion between ends of a 50 mm long test segment was measured by an infrared optical tracking system to directly determine its stiffness. Each specimen was then loaded to ultimate failure in either torsion or bending. Cortical bone cross-section diameters and published bone biomechanical properties were substituted into classical mechanics equations to predict the intact test segment theoretical stiffness for comparison and thus loading-measurement system verification.Intact measured stiffness values were the same order of magnitude as theoretically predicted. The primary component of relative motion between ends of the test segment corresponded to that of the applied load with the other 3D components being evident and consistent in relative magnitude and direction for unconstrained loading of an unsymmetrical double plate oblique fracture configuration. Bone failure configurations were reproducible and consistent with theoretically predicted.The 3D loading-measurement system designed: a) mimics unconstrained relative 3D motion between radius ends that occurs in clinical situations, b) applies uniform compression, torsion, and 4-point bending loads over the entire length of the test specimen, c) measures interfragmentary 3D relative motion between test segment ends to directly determine stiffness thus being void of potting-fixture-test machine stiffness error, and d) has the resolution to detect differences in the 3D motion and stiffness of intact as well osteotomized-instrumented and ostectomized-instrumented equine radii.
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Affiliation(s)
- John C Janicek
- From the University of Missouri Comparative Orthopaedic Laboratory, Columbia, MO, USA.
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Roch SP, Gemmill TJ. Treatment of medial patellar luxation by femoral closing wedge ostectomy using a distal femoral plate in four dogs. J Small Anim Pract 2007; 49:152-8. [PMID: 18005108 DOI: 10.1111/j.1748-5827.2007.00420.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This case report describes the treatment of recurrent medial patellar luxation associated with varus deformity of the distal femur by distal femoral ostectomy stabilised using a distal femoral plate. Four dogs (five affected limbs) were included in the study. All cases had received previous surgery for medial patellar luxation but remained significantly lame. All were treated by femoral ostectomy to correct distal femoral varus deformity with application of a distal femoral bone plate. All cases improved following surgery. An excellent outcome was recorded in four of five cases. Lameness persisted in one case despite satisfactory patellar stability as a result of concurrent cranial cruciate ligament deficiency. One case suffered implant failure. Femoral ostectomy is an effective treatment for medial patellar luxation associated with femoral varus deformity. The distal femoral plate provides a convenient method by which to stabilise the ostectomy. Care should be exercised when the 2 mm distal femoral plate is applied.
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Affiliation(s)
- S P Roch
- Willows Referral Service, 78 Tanworth Lane, Shirley, Solihull B90 4DF, UK
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