Analysis of feline humeral fracture morphology and a comparison of fracture repair stabilisation methods: 101 cases (2009-2020)

OBJECTIVES

The aims of this study were to describe the type, presentation and prognostic factors of feline humeral fractures over a 10-year period and to compare three stabilisation systems for feline humeral diaphyseal fractures.

METHODS

In total, 101 cats with humeral fractures presenting to seven UK referral centres between 2009 and 2020 were reviewed. Data collected included signalment, weight at the time of surgery, fracture aetiology, preoperative presentation, fixation method, surgical details, perioperative management and follow-up examinations. Of these cases, 57 cats with humeral diaphyseal fractures stabilised using three different fixation methods were compared, with outcome parameters including the time to radiographic healing, time to function and complication rate.

RESULTS

The majority of the fractures were diaphyseal (71%), with only 10% condylar. Of the known causes of fracture, road traffic accidents (RTAs) were the most common. Neutered males were over-represented in having a fracture caused by an RTA (P = 0.001) and diaphyseal fractures were significantly more likely to result from an RTA (P = 0.01). Body weight had a positive correlation (r = 0.398) with time to radiographic healing and time to acceptable function (r = 0.315), and was significant (P = 0.014 and P = 0.037, respectively). Of the 57 humeral diaphyseal fractures; 16 (28%) were stabilised using a plate-rod construct, 31 (54%) using external skeletal fixation and 10 (18%) using bone plating and screws only. Open diaphyseal fractures were associated with more minor complications (P = 0.048). There was a significant difference between fixation groups in terms of overall complication rate between groups (P = 0.012). There was no significant difference between fixation groups in time to radiographic union (P = 0.145) or time to acceptable function (P = 0.306).

CONCLUSIONS AND RELEVANCE

All three fixation systems were successful in healing a wide variety of humeral diaphyseal fractures. There was a significantly higher overall complication rate with external skeletal fixators compared with bone plating; however, the clinical impact of these is likely low.

Results of Femoral Elongation Treatment Using Electromagnetic Intramedullary Nail. Preliminary Report

BACKGROUND

Surgical correction of lower limb discrepancy in children poses a significant clinical problem. The aim of this paper is to present our experience with the PRECICE electromagnetic intramedullary nail.

MATERIALS AND METHODS

The study group consisted of 5 patients (2 girls; 3 boys) aged 11.5 to 18 years (mean age 16.3) treated for lower limb discrepancy by femoral lengthening using the PRECICE nail intramedullary system. Average discrepancy was 63 mm (range: 45-74.5 mm).

RESULTS

Femoral lengthening was successful in all patients. The femur was lengthened by a mean of 49 mm (range: 40-58 mm). A knee flexion contracture of about 10° occurred in one patient.

CONCLUSIONS

1. Femoral lengthening in children poses a therapeutic challenge. 2. The PRECICE intrame-dullary nail system helps reduce complications and increases patient comfort.

Ex Vivo Biomechanical Comparison of Titanium Locking Plate, Stainless Steel Nonlocking Plate, and Tie-in External Fixator Applied by a Dorsal Approach on Ostectomized Humeri of Pigeons (Columba livia)

To compare the bending strength of a locking plate (LP), nonlocking plate (NLP), and an external skeletal fixator intramedullary pin (ESF-IM) tie-in fixation applied by a dorsal approach in an avian humerus fracture model, 5 left humeri obtained from pigeon (Columba livia) cadavers were randomly assigned to each repair technique (n = 15). The ESF-IM group was repaired with a 0.062-inch intramedullary pin tied-in with two 0.035-inch positive profile transfixation pins using acrylic filled plastic tubing. The LP group was repaired with a dorsally applied titanium 1.6-mm screw 7-hole locking plate (1 bicortical and 2 monocortical screws in each segment). The NLP group was repaired with a dorsally applied 6-hole stainless steel 1.5-mm dynamic compression plate (all bicortical screws). All constructs were applied before complete ostectomy to allow perfect reconstruction. Constructs were cyclically tested nondestructively for 1000 cycles in four-point bending before being tested to failure. Outcome measures included stiffness, strength, and strain energy. All specimens cycled without failure. The ESF-IM specimens were significantly stiffer and stronger than the plated repair groups. Plated constructs had significantly higher strain energies than ESF-IM. LP and NLP were of equal stiffness, strength, and strain energies. This study demonstrated that bending biomechanical properties of the ESF-IM configuration were superior to those of the dorsal plate fixation. Exact properties of fixation required to facilitate avian fracture healing are largely unknown. Further study, including assessments of optimal plate position and configuration, and torsional and in vivo studies in avian species are warranted.

Evaluation of the accuracy of a veterinary dynamometric wire tensioner

OBJECTIVES

The purpose of this study was to determine the accuracy of a commonly used veterinary wire tensioner.

METHODS

Wire tension was measured using a load cell after each of five tensioners were used to tension each of six wires to the 66, 84, and 118 mm ring settings in an adjustable custom testing fixture. Each tensioner then experienced simulated aging and testing was repeated. Percentage error was calculated for each ring size, before and after tensioner aging. Measured tension values were compared to manufacturer reported tension values for each ring size using a one-sample two-way t-test; p <0.05 was considered significant.

RESULTS

Compared to the manufacturer reported values, measured wire tension values were significantly lower for 66 mm and 84 mm rings and significantly higher for 118 mm rings, before and after simulated aging. Mean wire tension values did not significantly differ between individual wire tensioners.

CLINICAL SIGNIFICANCE

The tensioners tested achieved significantly different wire tension values than those reported by the manufacturer. This discrepancy could lead to under-tensioning and allowing excessive movement at a fracture site or over-tensioning, leading to wire breakage. We recommend tensioning wires at least to the recommended line on the device for 66 mm and 84 mm rings and at most to the recommended line for 118 mm rings. Further studies are needed to evaluate other veterinary wire tensioners and to develop a calibration method for these devices in practice.