A strain-gauge study of the effect of external fixation on the canine tibia

Biomechanical comparison of mono- and bicortical screws in an experimentally induced gap fracture

Objectives: To compare the bending and torsional mechanical properties of mono- and bicortical locking screws in a canine cadaveric tibial gap ostectomy bridged by a locking compression plate (LCP).

Methods: A 10-hole 3.5 mm LCP was applied medially to the tibia with a gap ostectomy using locking screws in the two proximal and distal plate holes. One tibia of each pair was randomly assigned monocortical screws and the other bicortical screws. Constructs were tested non-destructively in mediolateral and caudocranial four-point bending and torsion, and then to failure in four-point bending. Stiffness, yield and failure variables were compared between screw lengths and load conditions using analysis of variance.

Results: Caudocranial and mediolateral fourpoint bending stiffnesses were not different between screw constructs. Torsional stiffness was greater and neutral zone smaller for bicortical constructs. Constructs were stiffer and stronger in caudocranial bending than in mediolateral bending. In caudocranial bending, bicortical constructs failed by bone fracture and monocortical constructs by screw loosening.

Conclusion: Bicortical constructs were stiffer than monocortical constructs in torsion but not bending. Bicortical screw constructs failed by bone fracture under the applied loads whereas monocortical screw constructs failed at the bone-screw interface.

Clinical relevance: Bicortical screw placement may be a safer clinical alternative than monocortical screw placement for minimally invasive percutaneous osteosynthesis LCPplated canine tibiae with comminuted diaphyseal fractures.

Effect of bending direction on the mechanical behaviour of 3.5 mm String-of-Pearls and Limited Contact Dynamic Compression Plate constructs

OBJECTIVE

To compare the bending properties of String-of-Pearls® (SOP) and Limited Contact Dynamic Compression Plate® (LC-DCP) constructs in orthogonal bending directions.

METHODS

3.5 mm SOP and LC-DCP plates were fixed to a bone model simulating a comminuted tibial fracture. Specimens were non-destructively tested in both mediolateral and craniocaudal bending for 10 cycles. Bending stiffness and total angular deformation were compared using parametric analyses (p <0.05).

RESULTS

For both constructs, stiffness was significantly less when bending moments were applied against the thickness of the plates (mediolateral bending) than against the width (craniocaudal bending). When compared to the mediolateral plane, bending constructs in the craniocaudal plane resulted in a 49% (SOP group) and 370% (LC-DCP group) increase in stiffness (p <0.001). Mediolateral bending stiffness was significantly greater in the SOP than the LC-DCP constructs. Conversely, in craniocaudal bending, SOP constructs stiffness was significantly less than that of the LC-DCP constructs. The differences between the two constructs in total angular deformation had an identical pattern of significance.

CLINICAL SIGNIFICANCE

This study found that SOP showed less variability between the orthogonal bending directions than LC-DCP in a comminuted fracture model, and also described the bi-planar bending behaviour of both constructs. Although not exhibiting identical bending properties in both planes, SOP constructs had a more homogenous bending behaviour in orthogonal loading directions. The difference between the SOP with a circular cross sectional shape compared to the rectangular shape of standard plates is probably responsible for this difference.

Structural properties of interlocking nails, canine femora, and femur-interlocking nail constructs

Using standard material testing techniques (bending stiffness, torsional stiffness, and maximum torque to failure or yield torque), the structural properties of interlocking nails (IN), canine femora, and IN/femur constructs were determined. Specimens that were tested included: 6 and 8 mm diameter IN with 5 to 10 screw holes (n = 18), and intact canine femora (n = 10), which also, with an IN inserted, formed the intact construct (IC) group, (n = 10). Specimens in the IC group were first tested with an 8 mm diameter IN with zero screws, followed by one and two screws (4.5 mm diameter) in the proximal and distal femur. A fracture model construct (FMC), (n = 14), consisting of a transverse femoral osteotomy with a 3 mm gap, was used with either 6 mm or 8 mm IN. In the 6 mm FMC, one and two 3.5 mm screws were used sequentially in the proximal and distal femoral segment. In the 8 mm FMC, one and two 3.5 mm screws and one and two 4.5 diameter screws were used similarly. When bending forces were applied parallel to IN screw holes, mean IN stiffness was 20% less than with forces perpendicular to the holes (n = 18), (P < .05). Eight-millimeter IN were 220% stiffer in torsion and 270% stiffer in bending than 6 mm IN (P < .05). Six-millimeter IN had approximately 32% of the bending stiffness and torsional stiffness of intact femurs (P < .05). Eight-millimeter IN had 93% and 79% of the bending stiffness and torsional stiffness, respectively, of intact femurs. Intact femur constructs (8 mm IN with four, 4.5 mm screws) had 147% of the bending stiffness (P < .05), and similar torsional stiffness and maximum torque, as intact femora (P > .05). The mean values of 6 mm FMC with four screws (3.5 mm) were 21% and 33% in torsional stiffness and bending stiffness, respectively, of intact femora values. When tested in torsion, 8 mm FMC failed by bone fracture; 6 mm FMC, in contrast, underwent plastic deformation. In comparing FMC stabilized with an 8 mm IN with two screws (4.5 mm diameter) in each bone segment, to intact femurs, the maximum torque was similar, FMC torsional stiffness was 40% (P < .05), and FMC bending stiffness was 65% (P < .05). These 8 mm FMC percentages are comparable to human IN fracture model construct values, indicating that the 8 mm IN/four screw construct should provide adequate stabilization for many canine diaphyseal femoral fractures.

Effects of intramedullary reaming and nailing of rat femur. A mechanical and chemical study

This study was undertaken to explore the association between mechanical and chemical effects of intramedullary reaming and nailing. The right femora of 80 rats were reamed and nailed with steel nails. Forty rats were evaluated from 3 days to 24 weeks postoperatively. The other 40 rats had the nail removed after 12 weeks, and they were then followed from 3 days to 24 weeks after nail extraction. Evaluation consisted of in vivo strain recording, geometric measurements, mechanical three-point bending test, and chemical analyses of hydroxyproline and calcium contents. Reaming and nailing caused immediate weakening of the bone as measured by in vitro mechanical tests, but within 3 weeks the mechanical properties were fully restored, whereas in vivo strain remained reduced throughout the experimental period in rats with nails. Removing the nail increased in vivo strain to a level close to that of the intact femur. Remodeling of the bone resulted in greater external anteroposterior diameter, cross-sectional area, area moment of inertia, and amount of hydroxyproline and calcium in the operated on femur as compared with the intact side. This indicates that the repair processes resulted in greater bone mass of the operated on femur than of the intact femur. Thus, there is evidence that nailing techniques effectively assist tissues by repair and remodeling.