Download PDF
Vet Comp Orthop Traumatol 2021; 34(04): 279-286
DOI: 10.1055/s-0041-1726082
Original Research

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

Valentine D. Verpaalen 
1   Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, Georgia, United States
,
Daniel D. Lewis 
2   Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida, United States
,
Gary A. Billings
3   Georgia Department of Agriculture, Animal Industry Division, Atlanta, Georgia, United States
› Author Affiliations Funding This work was funded by a University of Florida, College of Veterinary Medicine's Resident Research Grant and the University of Florida, College of Veterinary Medicine's Mark S. Bloomberg Memorial Small Animal Surgery Resident Research Fund.
› Further Information
    Permissions and Reprints

Abstract

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.

Keywords

tibial tuberosity - fracture - external skeletal fixation - biomechanics - dog

Note

This study was presented at the Annual Conference of the Veterinary Orthopedic Society, February 2020, Sun Valley, Idaho.


Authors' Contributions

V.D.P. and G.A.B. contributed to study design, acquisition of data, and data analysis and interpretation. D.D.L. contributed to conception of study, study design and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.




Publication History

Received: 12 May 2020

Accepted: 23 January 2021

Article published online:
12 May 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Goldsmid S, Johnson KA. Complications of canine tibial tuberosity avulsion fractures. Vet Comp Orthop Traumatol 1991; 4 (02) 21-25
    Article in Thieme ConnectPubMedGoogle Scholar
  • 2 Gower JA, Bound NJ, Moores AP. Tibial tuberosity avulsion fracture in dogs: a review of 59 dogs. J Small Anim Pract 2008; 49 (07) 340-343
    CrossrefPubMedGoogle Scholar
  • 3 Skelly CM, McAllister H, Donnelly WJ. Avulsion of the tibial tuberosity in a litter of greyhound puppies. J Small Anim Pract 1997; 38 (10) 445-449
    CrossrefPubMedGoogle Scholar
  • 4 Clements DN, Gemmill T, Corr SA, Bennett D, Carmichael S. Fracture of the proximal tibial epiphysis and tuberosity in 10 dogs. J Small Anim Pract 2003; 44 (08) 355-358
    CrossrefPubMedGoogle Scholar
  • 5 Withrow S, DeAngelis M, Arnoczky S, Rosen H. Treatment of fractures of the tibial tuberosity in the dog. J Am Vet Med Assoc 1976; 168 (02) 122-124
    PubMedGoogle Scholar
  • 6 Hayashi K, Kapatkin AS. Fractures of the tibia and fibula. In: Johnston SA, Tobias KM. eds. Veterinary Surgery: Small Animal Vol 2. 2nd edition.. St. Louis, MI: Elsevier Health Sciences; 2017: 1176-1193
    Google Scholar
  • 7 Piermattei DL, Flo GL, DeCamp CE. Fractures of the tibia and fibula. In: Piermattei DL, Flo GL, DeCamp CE. eds. Handbook of Small Animal Orthopedics and Fracture Repair. 4th edition. St. Louis: Elsevier Health Sciences; 2006: 639-642
    Google Scholar
  • 8 Moyer AL, Hudson CC, Beale BS. Outcome of tibial tuberosity avulsion repaired by pin (Kirschner wire) fixation with or without a tension band. Abstracts of the 46 th annual conference of the Veterinary Orthopedic Society, Breckenridge Colorado. Published in Vet Comp Orthop Traumatol 2019; 32 (04) A13-A24
    PubMedGoogle Scholar
  • 9 Pratt JN. Avulsion of the tibial tuberosity with separation of the proximal tibial physis in seven dogs. Vet Rec 2001; 149 (12) 352-356
    CrossrefPubMedGoogle Scholar
  • 10 Parker RB. Physeal injuries. In: Bloomberg MS, Dee JF, Taylor RA. eds. Canine Sports Medicine and Surgery. Philadelphia: WB Saunders Co; 1998: 230-233
    Google Scholar
  • 11 DeCamp CE, Johnston SA, Dejardin LM, Schaefer SL. Fractures of the tibia and fibula. In: DeCamp CE, Johnston SA, Dejardin LM, Schaefer SL. eds. Handbook of Small Animal Orthopedics and Fracture Repair. 5th edition. St. Louis: Elsevier Health Sciences; 2016: 682-684
    Google Scholar
  • 12 von Pfeil DJF, Glassman M, Ropski M. Percutaneous tibial physeal fracture repair in small animals: technique and 17 cases. Vet Comp Orthop Traumatol 2017; 30 (04) 279-287
    PubMedGoogle Scholar
  • 13 Verpaalen VD, Lewis DD. Use of a hybrid external skeletal fixator construct for managing tibial tuberosity avulsion fractures in three dogs. J Am Vet Med Assoc 2021; 258 (10) 1098-1108
    CrossrefPubMedGoogle Scholar
  • 14 Johnston SA, von Pfeil DJF, Déjardin LM, Roe SC, Weh JM. Internal fracture fixation. In: Johnston SA, Tobias KM. eds. Veterinary Surgery: Small Animal. 2nd edition. St Louis: Elsevier Health Sciences; 2018: 654-690
    Google Scholar
  • 15 Kraus KH. Tension band wiring. In: Bojrab MJ, Waldron DR, Toombs JP. eds. Current Techniques in Small Animal Surgery. 5th edition. Jackson: Teton NewMedia; 2014: 780-782
    Google Scholar
  • 16 Schultz RS, Boger JW, Dunn HK. Strength of stainless steel surgical wire in various fixation modes. Clin Orthop Relat Res 1985; (198) 304-307
    PubMedGoogle Scholar
  • 17 Lewis DD, Farese JP. Circular external skeletal fixation. In: Bojrab MJ, Waldron DR, Toombs JP. eds. Current Techniques in Small Animal Surgery. 5th edition. Jackson: Teton NewMedia; 2014: 828-843
    Google Scholar
  • 18 Mirbey J, Besancenot J, Chambers RT, Durey A, Vichard P. Avulsion fractures of the tibial tuberosity in the adolescent athlete. Risk factors, mechanism of injury, and treatment. Am J Sports Med 1988; 16 (04) 336-340
    CrossrefPubMedGoogle Scholar
  • 19 Shahar R, Banks-Sills L. Biomechanical analysis of the canine hind limb: calculation of forces during three-legged stance. Vet J 2002; 163 (03) 240-250
    CrossrefPubMedGoogle Scholar
  • 20 Korvick DL, Cummings JF, Grood ES, Holden JP, Feder SM, Butler DL. The use of an implantable force transducer to measure patellar tendon forces in goats. J Biomech 1996; 29 (04) 557-561
    CrossrefPubMedGoogle Scholar
  • 21 Finni T, Komi PV, Lepola V. In vivo human triceps surae and quadriceps femoris muscle function in a squat jump and counter movement jump. Eur J Appl Physiol 2000; 83 (4-5): 416-426
    CrossrefPubMedGoogle Scholar
  • 22 Hudson CC, Kim SE, Pozzi A. Percutaneous pinning for fracture repair in dogs and cats. Vet Clin North Am Small Anim Pract 2020; 50 (01) 101-121
    CrossrefPubMedGoogle Scholar
  • 23 Boekhout-Ta CL, Kim SE, Cross AR, Evans R, Pozzi A. Closed reduction and fluoroscopic-assisted percutaneous pinning of 42 physeal fractures in 37 dogs and 4 cats. Vet Surg 2017; 46 (01) 103-110
    CrossrefPubMedGoogle Scholar
  • 24 Zide AN, Jones SC, Litsky AS, Kieves NR. A cadaveric evaluation of pin and tension band configuration strength for tibial tuberosity osteotomy fixation. Vet Comp Orthop Traumatol 2020; 33 (01) 9-14
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Birks RR, Kowaleski MP. Combined tibial plateau levelling osteotomy and tibial tuberosity transposition: an ex vivo mechanical study. Vet Comp Orthop Traumatol 2018; 31 (02) 124-130
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Newman M, Bertollo N, Walsh W, Voss K. Tibial tuberosity transposition-advancement for lateralization of the tibial tuberosity: an ex vivo canine study. Vet Comp Orthop Traumatol 2014; 27 (04) 271-276
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Neat BC, Kowaleski MP, Litsky AS, Boudrieau RJ. Mechanical evaluation of pin and tension-band wire factors in an olecranon osteotomy model. Vet Surg 2006; 35 (04) 398-405
    CrossrefPubMedGoogle Scholar
  • 28 Neat B, Kowaleski MP, Litsky AS, Boudrieau RJ. The effects of wire diameter and an additional lateral wire on pin and tension-band fixation subjected to cyclic loads. Vet Comp Orthop Traumatol 2006; 19 (04) 213-218
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Roe SC. External fixators, pins, nails, and wires. In: AO Principles of Fracture Management in the Dog and Cat. New York, New York: Germany and Thieme; 2005: 67
    Google Scholar
  • 30 Cashmore RG, Havlicek M, Perkins NR. et al. Major complications and risk factors associated with surgical correction of congenital medial patellar luxation in 124 dogs. Vet Comp Orthop Traumatol 2014; 27 (04) 263-270
    Article in Thieme ConnectPubMedGoogle Scholar
  • 31 Farese JP, Lewis DD, Cross AR, Collins KE, Anderson GM, Halling KB. Use of IMEX SK-circular external fixator hybrid constructs for fracture stabilization in dogs and cats. J Am Anim Hosp Assoc 2002; 38 (03) 279-289
    CrossrefPubMedGoogle Scholar
  • 32 Lewis RA, Lewis DD, Anderson CL. et al. Mechanics of supplemental drop wire and half-pin fixation elements in single ring circular external fixator constructs. Vet Surg 2016; 45 (04) 471-479
    CrossrefPubMedGoogle Scholar
  • 33 Lewis DD, Radasch RM, Beale BS. et al. Initial clinical experience with the IMEX™ circular external skeletal fixation system. Vet Comp Orthop Traumatol 1999; 12 (03) 108-117
    Article in Thieme ConnectPubMedGoogle Scholar
  • 34 Anderson MA, Mann FA, Kinden DA, Wagner-Mann CC. Evaluation of cortical bone damage and axial holding power of nonthreaded and enhanced threaded pins placed with and without drilling of a pilot hole in femurs from canine cadavers. J Am Vet Med Assoc 1996; 208 (06) 883-887
    PubMedGoogle Scholar
  • 35 Aron DN, Toombs JP, Hollingsworth SC. Primary treatment of severe fractures by external skeletal fixation: threaded pins compared with smooth pins. J Am Anim Hosp Assoc 1986; 22: 659-670
    PubMedGoogle Scholar
  • 36 Clary EM, Roe SC. Enhancing external skeletal fixation pin performance: consideration of the pin-bone interface. Vet Comp Orthop Traumatol 1995; 8 (01) 6-13
    Article in Thieme ConnectPubMedGoogle Scholar
  • 37 Clary EM, Roe SC. In vitro biomechanical and histological assessment of pilot hole diameter for positive-profile external skeletal fixation pins in canine tibiae. Vet Surg 1996; 25 (06) 453-462
    CrossrefPubMedGoogle Scholar
  • 38 Bennett RA, Egger EL, Histand M, Ellis AB. Comparison of the strength and holding power of 4 pin designs for use with half pin (type I) external skeletal fixation. Vet Surg 1987; 16 (03) 207-211
    CrossrefPubMedGoogle Scholar
  • 39 Egger EL, Histand MB, Blass CE, Powers BE. Effect of fixation pin insertion on the bone-pin interface. Vet Surg 1986; 15 (03) 246-252
    CrossrefPubMedGoogle Scholar
  • 40 Riemersa DJ, Schamhardt HC. The cryo-jaw, a clamp designed for in vitro rheology studies of horse digital flexor tendons. J Biomech 1982; 15 (08) 619-620
    CrossrefPubMedGoogle Scholar
  • 41 Sharkey NA, Smith TS, Lundmark DC. Freeze clamping musculo-tendinous junctions for in vitro simulation of joint mechanics. J Biomech 1995; 28 (05) 631-635
    CrossrefPubMedGoogle Scholar
  • 42 Halling KB, Lewis DD, Cross AR, Sammy RJ, Rapoff AJ. Biomechanical comparison of a circular external skeletal fixator construct to pin and tension band wire fixation for the stabilization of olecranon osteotomies in dogs: a cadaveric study. Vet Surg 2003; 32 (04) 324-335
    CrossrefPubMedGoogle Scholar