The effects of wire diameter and an additional lateral wire on pin and tension-band fixation subjected to cyclic loads

Biomechanical Comparison of Three Stabilization Methods for Tibial Tuberosity Fractures in Dogs: A Cadaveric Study

OBJECTIVE

 The aim of this study was to compare the biomechanical properties of a hybrid external skeletal fixator (HESF) construct to the placement of paired interfragmentary Kirschner wires alone, and pin and tension band wire (PTBW) fixation for the stabilization of simulated tibial tuberosity fractures in dogs.

STUDY DESIGN

 Tibias were harvested from 12 skeletally mature dog cadavers weighing 20 to 30 kg. An osteotomy was made through the base of the tibial tuberosity, which was subsequently repaired with either paired Kirschner wires, PTBW fixation or a HESF. A tensile load was applied to the tibial tuberosity until failure occurred. Mode of failure was described and biomechanical parameters obtained were compared between fixation groups.

RESULTS

 The PTBW fixation and HESF construct afforded greater stiffness and load at 3 mm of axial displacement compared with fixation with Kirschner wires alone. There was no significant difference in stiffness and load at 3 mm displacement between PTBW and HESF fixation. Failure occurred by bending and pullout of the Kirschner wires for all fixation groups, preceded by untwisting of the knot in PTBW specimens.

CONCLUSION

 The HESF may provide a favourable alternative to PTBW fixation for tibial tuberosity avulsion fracture stabilization in dogs with substantial remaining growth potential.

Influence of wire configuration on resistance to fragment distraction of tension bands placed in a greater trochanteric osteotomy model

OBJECTIVE

To determine the influence of wiring configurations on initial tension and resistance to tensile loads in tension band constructs without the contributions of Kirschner-wire stabilization.

STUDY DESIGN

Experimental study.

SAMPLE POPULATION

A solid brass femur model manufactured on the basis of computed tomography of a normal right femur of a 30-kg dog modified by transection of the greater trochanter and placement of two pins that did not cross the simulated osteotomy.

METHODS

Four tension band configurations were applied to the metal trochanteric osteotomy model: figure-of-eight with one twist (OT), figure-of-eight with two twists (TT), dual interlocking single loop, and double loop (DL). Configurations were tested under both monotonic loading (n = 8 per configuration) and incremental cyclic loading (n = 8 per configuration). Initial tension after tying, residual tension remaining after each cycle, and failure load at 2 mm of displacement (considered equivalent to clinical failure) were compared between configurations.

RESULTS

The initial tension and the load to 2 mm of displacement were lower for OT wires compared with TT wires. The DL was the strongest and most stable configuration, generating 2.3 to 3.5 times greater initial tension, maintaining a greater percentage of residual tension under incremental cyclic loads, and resisting 2.0 to 2.4 times greater load before failure at 2 mm. Failure load was highly correlated with initial tension.

CONCLUSION

Wire configurations reaching greater initial tension, such as the DL, allowed constructs to resist higher tensile loads.

CLINICAL IMPACT

Wire configurations allowing higher initial tension may be warranted when tension bands are expected to sustain high tensile loads.

Biomechanical comparison of pin and nitinol bone staple fixation to pin and tension band wire fixation for the stabilization of canine olecranon osteotomies

OBJECTIVE

To compare the initial biomechanical properties of olecranon osteotomies stabilized with intramedullary pins and a Nitinol bone staple to osteotomies stabilized with pin and tension band wire fixation.

STUDY DESIGN

Ex vivo mechanical evaluation on cadaveric bones.

MATERIAL AND METHODS

Ten pairs of cadaveric forelimbs from skeletally mature Greyhounds with an olecranon osteotomy stabilized with either a pin and Nitinol bone staple or a pin and tension band wire. A single load to failure was applied to each specimen through the triceps tendon. Biomechanical properties were compared based on stiffness, yield load, and maximum load to failure and load at 2 mm of axial displacement.

RESULTS

Specimens stabilized with the bone staple were biomechanically superior in all the variables tested. There was significantly greater stiffness (118.0 ± 25.9 N/mm versus 70.1 ± 40.4 N/mm; p = 0.005), yield load (319.0 ± 99.8 N versus 238.0 ± 42.5 N; p = 0.03), maximum load sustained (385.0 ± 99.2 N versus 287.0 ± 37.4 N; p = 0.009), and load at 2 mm of axial displacement (218.0 ± 51.5 N versus 138.0 ± 48.7 N; p = 0.002) in specimens stabilized with pins and a Nitinol bone staple than specimens stabilized with pin and tension band wire fixation.

CLINICAL SIGNIFICANCE

The pin and Nitinol bone staple construct provides a biomechanically superior alternative to pin and tension band wire fixation for stabilization of olecranon osteotomies, and its use warrants further clinical investigation.

Biomechanical studies on transverse olecranon and patellar fractures: a systematic review with the development of a new scoring method

INTRODUCTION

Several methods of transverse patellar and olecranon fixation have been described. This article compares biomechanical studies of various fixation methods using a newly developed scoring method.

SOURCE OF DATA

The databases PubMed, Web of Science, Science Direct, Google Scholar and Google were searched for relevant studies.

AREAS OF AGREEMENT

Fixation hardware failure remains a problem. Various materials and fixation techniques have been tested to provide an improved fixation of transverse olecranon and patellar fractures.

AREAS OF CONTROVERSY

The difference in biomechanical testing setup between the studies makes it hard to compare different fixation techniques.

GROWING POINTS

The newly developed grading method was proved to be unbiased and reliable; however, extra specifications need to be added at some criteria when adopting the scoring method.

AREAS TIMELY FOR DEVELOPING RESEARCH

Non-metallic constructs may provide an improvement to the currently used metallic tension band wiring technique; however, clinical research is required.