In Vitro Biomechanical Study of Femoral Neck Fracture Fixation with Two or Three Cannulated Screws in Dogs

Abstract

Objective To evaluate the in vitro mechanical properties of basilar fractures of the femoral neck stabilized with two or three titanium-cannulated screws in dogs.

Study Design Ex vivo study.

Sample Population Cadaveric canine femur (n = 21).

Methods The bones were divided as follows: Group 1: control (no osteotomy); Group 2: osteotomy and stabilization with two cannulated screws; and Group 3: osteotomy and stabilization with three cannulated screws. All groups were tested with destructive axial compression with load applied to the femoral head. The stiffness, load, and displacement were evaluated at the failure of Group 1, and the yield load and displacement of Groups 2 and 3.

Results The placement of the three cannulated screws was more demanding than two cannulated screws because of the risk of cortical perforation, especially in the trochanteric fossa area. The smaller the width of the femoral neck, the higher the risk of cortical bone wall perforation. The intact control bones were stiffer (674 N/mm) than both the two-screw repair (90 N/mm) and three-screw repair (120 N/mm) groups (p < 0.05). The failure load was greatest for Group 1 (2692 N). The yield loads for Groups 3 and 2 were 586 and 303 N, respectively. There was no difference between groups for displacement.

Conclusion In vitro cadaveric models of femoral neck basilar fractures repaired with three cannulated screws were significantly stronger than two cannulated screws, but the clinical efficacy must be evaluated by comparing them in vitro with noncannulated stainless steel screws.

Keywords

femur - mechanical testing - fracture - cannulated screws

Authors' Contribution

F.M.C.C., S.C.R., C.R.R., and G.R.C. contributed to conception of study, study design, acquisition of data, and data analysis and interpretation. S.A.A.S and C.E.M. contributed to data analysis and interpretation. P.M. contributed to conception of study and study design. All authors drafted, revised, and approved the submitted manuscript.

Publikationsverlauf

Eingereicht: 25. Januar 2024

Angenommen: 17. Juli 2024

Artikel online veröffentlicht:
01. August 2024

• References

• 1 Daly WR. Femoral head and neck fractures in the dog and cat: a review of 115 cases. Vet Surg 1978; 7 (02) 29-38
• 2 Beale B. Orthopedic clinical techniques femur fracture repair. Clin Tech Small Anim Pract 2004; 19 (03) 134-150
• 3 Guiot LP, Déjardin LM. Fractures of the femur. In: Johnston SA, Tobias KM. eds. Veterinary Surgery. 2 ed.,. St Louis, MO: Saunders Elsevier; 2017: 2817-2924
• 4 de Moya KA, Kim SE, Guiot LP. Closed reduction and fluoroscopic-guided percutaneous pinning of femoral capital physeal or neck fractures: thirteen fractures in 11 dogs. Vet Surg 2023; 52 (06) 846-852
• 5 Matis U, Waibl H. Proximale femurfrakturen bei katze und hund. Tierarztl Prax Suppl 1985; 1: 159-178
• 6 Hayashi K, Schulz KS, Fossum TW. Management of specific fractures. In: Fossum TW. ed. Small Animal Surgery. 5 ed.,. Philadelphia, PA: Elsevier; 2019: 1036-1133
• 7 Gibson KL, vanEe RT, Pechman RD. Femoral capital physeal fractures in dogs: 34 cases (1979-1989). J Am Vet Med Assoc 1991; 198 (05) 886-890
• 8 Perez Aparicio FJ, Fjeld TO. Femoral neck fractures and capital epiphyseal separation in cats. J Small Anim Pract 1993; 34 (09) 445-449
• 9 Petazzoni M, Jaeger GH. Atlas of Clinical Goniometry and Radiographic Measurements of the Canine Pelvic Limb. Milan: Merial, 2008: 96
• 10 Gilmore DR. Internal fixation of femoral fractures. In: Bojrab MJ, Waldron DR, Toombs JP. eds. Current Techniques in Small Animal Surgery. 5 ed.,. Jackson, WY: Teton NewMedia; 2014: 1052-1061
• 11 Lambrechts NE, Verstraete FJM, Sumner-Smith G, Raath AD, Linde MJ, Groeneveld HT. Internal fixation of femoral neck fractures in the dog – an in vitro study. Vet Comp Orthop Traumatol 1993; 6 (04) 188-193
• 12 Tillson DM, Roush JK, McLaughlin RM, Gaughan EM, DeBowes RM. Biomechanical Comparison of three repair methods for proximal femoral physeal fractures in shear and tension. Vet Comp Orthop Traumatol 1994; 7 (04) 136-139
• 13 Fisher SC, McLaughlin RM, Elder SH. In vitro biomechanical comparison of three methods for internal fixation of femoral neck fractures in dogs. Vet Comp Orthop Traumatol 2012; 25 (01) 36-41
• 14 DeCamp CE, Johnston SA, Déjardin LM, Schaefer Sl. Handbook of Small Animal Orthopedics and Fracture Repair. 5 ed. St. Louis, MO: Elsevier; 2016: 868
• 15 Heo S, Lee H, Roh Y, Jeong J. Biomechanical comparison between inverted triangle and vertical configurations of three Kirschner wires for femoral neck fracture fixation in dogs: a cadaveric study. Vet Sci 2023; 10 (04) 285
• 16 Xarchas KC, Staikos CD, Pelekas S, Vogiatzaki T, Kazakos KJ, Verettas DA. Are two screws enough for fixation of femoral neck fractures? A case series and review of the literature. Open Orthop J 2007; 1: 4-8
• 17 Basile R, Pepicelli GR, Takata ET. Osteosynthesis of femoral neck fractures: two or three screws?. Rev Bras Ortop 2015; 47 (02) 165-168
• 18 Li J, Wang M, Zhou J. et al. Optimum configuration of cannulated compression screws for the fixation of unstable femoral neck fractures: finite element analysis evaluation. BioMed Res Int 2018; 2018: 1271762
• 19 Augat P, Bliven E, Hackl S. Biomechanics of femoral neck fractures and implications for fixation. J Orthop Trauma 2019; 33 (Suppl. 01) S27-S32
• 20 Tencer AF, Asnis SE, Harrington RM, Chapman JR. Biomechanics of cannulated and noncannulated screws. In: Asnis SE, Kyle RF. eds. Cannulated Screw Fixation Principles and Operative Techniques. New York, NY: Springer-Verlag; 1996: 15-40
• 21 Zhang B, Liu J, Zhang W. Ordinary cannulated compression screws or headless cannulated compression screws? A synthetic bone biomechanical research in the internal fixation of vertical femoral neck fracture. BioMed Res Int 2018; 2018: 4898301
• 22 Florschutz AV, Langford JR, Haidukewych GJ, Koval KJ. Femoral neck fractures: current management. J Orthop Trauma 2015; 29 (03) 121-129
• 23 Mazzocca AD, DeAngelis JP, Caputo AE, Browner BD, Mast JW, Mendes MW. Principles of internal fixation. In: Browner BD, Levine AM, Jupiter JB, Trafton PG, Krettek C. eds. Skeletal Trauma: Basic Science, Management, and Reconstruction. Philadelphia, PA: Elsevier Health Sciences; 2009: 83-14
• 24 Filipov O. Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck. Eur J Orthop Surg Traumatol 2011; 21 (07) 539-543
• 25 Page AE, Allan C, Jasty M, Harrigan TP, Bragdon CR, Harris WH. Determination of loading parameters in the canine hip in vivo. J Biomech 1993; 26 (4–5): 571-579
• 26 Basso T, Klaksvik J, Syversen U, Foss OA. Biomechanical femoral neck fracture experiments–a narrative review. Injury 2012; 43 (10) 1633-1639
• 27 Maurer SG, Wright KE, Kummer FJ, Zuckerman JD, Koval KJ. Two or three screws for fixation of femoral neck fractures?. Am J Orthop 2003; 32 (09) 438-442
• 28 Walker E, Mukherjee DP, Ogden AL, Sadasivan KK, Albright JA. A biomechanical study of simulated femoral neck fracture fixation by cannulated screws: effects of placement angle and number of screws. Am J Orthop 2007; 36 (12) 680-684