Vet Comp Orthop Traumatol 2019; 32(05): 351-361
DOI: 10.1055/s-0039-1691828
Original Research
Georg Thieme Verlag KG Stuttgart · New York

Safety and Accuracy of Minimally Invasive Long Bone Fracture Repair Using a 2.5-mm Interlocking Nail: A Cadaveric Feline Study

Katrin Nabholz
1   Vetsuisse Faculty University of Zurich, Clinic for Small Animal Surgery, Zurich, Switzerland
,
Antonio Pozzi
1   Vetsuisse Faculty University of Zurich, Clinic for Small Animal Surgery, Zurich, Switzerland
,
Philipp A. Schmierer
1   Vetsuisse Faculty University of Zurich, Clinic for Small Animal Surgery, Zurich, Switzerland
,
Lucas A. Smolders
1   Vetsuisse Faculty University of Zurich, Clinic for Small Animal Surgery, Zurich, Switzerland
,
Sebastian C. Knell
1   Vetsuisse Faculty University of Zurich, Clinic for Small Animal Surgery, Zurich, Switzerland
› Author Affiliations
Funding The authors declare a financial support from B. Braun Vet Care GmbH, Tuttlingen, Germany (Implants and financial support). B. Braun Vet Care was not involved in any aspect of the study other than the financial support and the implant donation. This study has also been funded by Aesculap.
Further Information

Publication History

24 April 2018

04 April 2019

Publication Date:
06 July 2019 (online)

Abstract

Objectives The Targon Vet System (TVS) is a 2.5-mm interlocking nail that can be applied minimally invasively. The purpose of this study was to test if the TVS could be safely applied percutaneously to different feline long bones without fluoroscopic guidance.

Methods A gap fracture was created in 96 feline humeri, femora and tibiae (n = 32/group). Paired bones were randomly assigned to two treatment groups: (1) TVS inserted percutaneously with fluoroscopy and (2) TVS inserted percutaneously without fluoroscopy. Intraoperative evaluation (complications, procedure time, attempts), radiographs (pre-/postoperative alignment, length) and anatomical dissection (neurovascular injury, rotational alignment) were compared between treatment groups.

Results The use of fluoroscopy did not lead to significant differences in any of the outcome measures. Intraoperative complications predominantly occurred in the distal humerus (12/32) and the proximal femur (7/32). In total, 20/96 complications occurred with no complications for the tibia. Neurovascular structures were only damaged at the medial side of the distal humerus (10/32).

Clinical Significance We conclude that the TVS can be safely applied percutaneously to the tibia and with limitations to the femur in normal cadaveric cats without fluoroscopy. Despite the limitations of a cadaveric study, the high number of complications is leading us to consider the humerus not safe for the TVS. A learning curve has to be expected and technical recommendations should be respected to decrease complications.

Author Contribution

Katrin Nabholz contributed to conception of study, acquisition of data, and data analysis and interpretation. Antonio Pozzi contributed to conception of study and study design. Philipp A. Schmierer contributed to study design. Lucas A. Smolders contributed to data analysis and interpretation. Sebastian C. Knell contributed to conception of study, study design, and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.


Supplementary Material

 
  • References

  • 1 Reems MR, Beale BS, Hulse DA. Use of a plate-rod construct and principles of biological osteosynthesis for repair of diaphyseal fractures in dogs and cats: 47 cases (1994-2001). J Am Vet Med Assoc 2003; 223 (03) 330-335
  • 2 Bennour EM, Abushhiwa MA, Ben Ali L, Sawesi OK, Marzok MA, Abuargob OM. , et al. A retrospective study on appendicular fractures in dogs and cats in Tripoli – Libya. J Vet Adv 2014; ; 4 (03) 425-431
  • 3 Tobias KM, Johnston SA. Veterinary Surgery: Small Animal: 2-Volume Set. Elsevier Health Sciences; 2013: 576-627
  • 4 Palmer RH. Biological osteosynthesis. Vet Clin North Am Small Anim Pract 1999; 29 (05) 1171-1185 , vii
  • 5 Pozzi A, Lewis D. Surgical approaches for minimally invasive plate osteosynthesis in dogs. Vet Comp Orthop Traumatol 2009; 22 (04) 316-320
  • 6 Hudson CC, Pozzi A, Lewis DD. Minimally invasive plate osteosynthesis: applications and techniques in dogs and cats. Vet Comp Orthop Traumatol 2009; 22 (03) 175-182
  • 7 Schmierer PA, Pozzi A. Guidelines for surgical approaches for minimally invasive plate osteosynthesis in cats. Vet Comp Orthop Traumatol 2017; 30 (04) 272-278
  • 8 Nolte DM, Fusco JV, Peterson ME. Incidence of and predisposing factors for nonunion of fractures involving the appendicular skeleton in cats: 18 cases (1998-2002). J Am Vet Med Assoc 2005; 226 (01) 77-82
  • 9 McCartney WT, MacDonald BJ. Incidence of non-union in long bone fractures in 233 cats. Int J Appl Res Vet Med 2006; 4 (03) 209-212
  • 10 Horstman CL, Beale BS, Conzemius MG, Evans R R. Biological osteosynthesis versus traditional anatomic reconstruction of 20 long-bone fractures using an interlocking nail: 1994-2001. Vet Surg 2004; 33 (03) 232-237
  • 11 von Pfeil DJF, Déjardin LM, DeCamp CE. , et al. In vitro biomechanical comparison of a plate-rod combination-construct and an interlocking nail-construct for experimentally induced gap fractures in canine tibiae. Am J Vet Res 2005; 66 (09) 1536-1543
  • 12 Déjardin LM, Guiot LP, von Pfeil DJ. Interlocking nails and minimally invasive osteosynthesis. Vet Clin North Am - Small Anim Pract 2012; ; 42 (05) 935-962
  • 13 Lansdowne JL, Sinnott MT, Déjardin LM, Ting D, Haut RC. In vitro mechanical comparison of screwed, bolted, and novel interlocking nail systems to buttress plate fixation in torsion and mediolateral bending. Vet Surg 2007; 36 (04) 368-377
  • 14 Déjardin LM, Guillou RP, Ting D, Sinnott MT, Meyer E, Haut RC. Effect of bending direction on the mechanical behaviour of interlocking nail systems. Vet Comp Orthop Traumatol 1995; 8 (03) 146-152
  • 15 Muir P, Johnson KA, Markel MD. Area moment of inertia for comparison of implant cross-sectional geometry and bending stiffness. Vet Comp Orthop Traumatol 1995; ; ( (03) 24-30
  • 16 Duhautois B. Use of veterinary interlocking nails for diaphyseal fractures in dogs and cats: 121 cases. Vet Surg 2003; 32 (01) 8-20
  • 17 Dueland RT, Johnson KA, Roe SC, Engen MH, Lesser AS. Interlocking nail treatment of diaphyseal long-bone fractures in dogs. J Am Vet Med Assoc 1999; 214 (01) 59-66
  • 18 Moses PA, Lewis DD, Lanz OI, Stubbs WP, Cross AR, Smith KR. Intramedullary interlocking nail stabilisation of 21 humeral fractures in 19 dogs and one cat. Aust Vet J 2002; 80 (06) 336-343
  • 19 Díaz-Bertrana MC, Durall I, Puchol JL, Sánchez A, Franch J. Interlocking nail treatment of long-bone fractures in cats: 33 cases (1995-2004). Vet Comp Orthop Traumatol 2005; 18 (03) 119-126
  • 20 Basinger RR, Suber JT. Two techniques for supplementing interlocking nail repair of fractures of the humerus, femur, and tibia: results in 12 dogs and cats. Vet Surg 2004; 33 (06) 673-680
  • 21 Brückner M, Unger M, Spies M. In vitro biomechanical comparison of a newly designed interlocking nail system to a standard DCP. Testing of cat femora in an osteotomy gap model. Tierarztl Prax Ausg K Klientiere Heimtiere 2014; 42 (02) 79-87
  • 22 Macedo AS, Moens NMM, Runciman J, Gibson TW, Minto BW. Ex vivo torsional properties of a 2.5 mm veterinary interlocking nail system in canine femurs. Comparison with a 2.4 mm limited contact bone plate. Vet Comp Orthop Traumatol 2017; 30 (02) 118-124
  • 23 Brückner M, Unger M, Spies M. Early clinical experience with a newly designed interlocking nail system-Targon(®) Vet. Vet Surg 2016; 45 (06) 754-763
  • 24 Jaarsma RL, van Kampen A. Rotational malalignment after fractures of the femur. J Bone Joint Surg Br 2004; 86 (08) 1100-1104
  • 25 Guiot LP, Déjardin LM. Perioperative imaging in minimally invasive osteosynthesis in small animals. Vet Clin North Am - Small Anim Pract 2012; ; 42 (05) 897-911 .
  • 26 Decamp CE. Brinker, Piermattei and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. 5th ed. London: W.B. Saunders; 2015
  • 27 Giachino AA, Cheng M. Irradiation of the surgeon during pinning of femoral fractures. J Bone Joint Surg Br 1980; ; 62–B (02) 227-229
  • 28 Seals KF, Lee EW, Cagnon CH, Al-Hakim RA, Kee ST. Radiation-induced cataractogenesis: a critical literature review for the interventional radiologist. Cardiovasc Intervent Radiol 2016; 39 (02) 151-160
  • 29 Tremains MR, Georgiadis GM, Dennis MJ. Radiation exposure with use of the inverted-C-arm technique in upper-extremity surgery. J Bone Joint Surg Am 2001; ; 83–A( (05) 674-678
  • 30 Swanson EA, Tomlinson JL, Dismukes DI, Fox DB. Measurement of femoral and tibial joint reference angles and pelvic limb alignment in cats. Vet Surg 2012; 41 (06) 696-704
  • 31 Wood MC, Fox DB, Tomlinson JL. Determination of the mechanical axis and joint orientation lines in the canine humerus: a radiographic cadaveric study. Vet Surg 2014; 43 (04) 414-417
  • 32 Boero Baroncelli A, Peirone B, Winter MD, Reese DJ, Pozzi A. Retrospective comparison between minimally invasive plate osteosynthesis and open plating for tibial fractures in dogs. Vet Comp Orthop Traumatol 2012; 25 (05) 410-417
  • 33 Langley-Hobbs SJ, Straw M. The feline humerus. An anatomical study with relevance to external skeletal fixator and intramedullary pin placement. Vet Comp Orthop Traumatol 2005; 18 (01) 1-6
  • 34 Scotti S, Klein A, Pink J, Hidalgo A, Moissonnier P, Fayolle P. Retrograde placement of a novel 3.5 mm titanium interlocking nail for supracondylar and diaphyseal femoral fractures in cats. Vet Comp Orthop Traumatol 2007; 20 (03) 211-218
  • 35 Rupp RE, Chrissos MG, Ebraheim NA. The risk of neurovascular injury with distal locking screws of humeral intramedullary nails. Orthopedics 1996; 19 (07) 593-595
  • 36 Baltov A, Mihail R, Dian E. Complications after interlocking intramedullary nailing of humeral shaft fractures. Injury 2014; 45 (Suppl. 01) S9-S15
  • 37 Noger M, Berli MC, Fasel JHD, Hoffmeyer PJ. The risk of injury to neurovascular structures from distal locking screws of the Unreamed Humeral Nail (UHN): a cadaveric study. Injury 2007; 38 (08) 954-957
  • 38 Bardet JF, Hohn RB, Rudy RL, Olmstead ML. Fractures of the humerus in dogs and cats a retrospective study of 130 cases. Vet Surg 1983; 12 (02) 73-77