Colin F. Mitchell

In vitro biomechanical comparison of locking compression plate fixation and limited-contact dynamic compression plate fixation of osteotomized equine third metacarpal bones.

OBJECTIVE To compare monotonic biomechanical properties and fatigue life of a broad locking compression plate (LCP) fixation with a broad limited contact dynamic compression plate (LC-DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. STUDY DESIGN In vitro biomechanical testing of paired cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. ANIMAL POPULATION Cadaveric adult equine MC3 bones (n=12 pairs). METHODS MC3 were divided into 3 groups (4 pairs each) for: (1) 4-point bending single cycle to failure testing; (2) 4-point bending cyclic fatigue testing; and (3) torsional single cycle to failure testing. The 8-hole, 4.5 mm LCP was applied to the dorsal surface of 1 randomly selected bone from each pair. One 8-hole, 4.5 mm LC-DCP) was applied dorsally to the contralateral bone from each pair. All plates and screws were applied using standard ASIF techniques. All MC3 bones had mid-diaphyseal osteotomies. Mean test variable values for each method were compared using a paired t-test within each group. Significance was set at P<.05. RESULTS Mean yield load, yield bending moment, composite rigidity, failure load and failure bending moment, under 4-point bending, single cycle to failure, of the LCP fixation were significantly greater than those of the LC-DCP fixation. Mean cycles to failure for 4-point bending was significantly greater for the LCP fixation compared with LC-DCP fixation. Mean yield load, mean composite rigidity, and mean failure load under torsional testing, single cycle to failure was significantly greater for the broad LCP fixation compared with the LC-DCP fixation. CONCLUSION The 4.5 mm LCP was superior to the 4.5 mm LC-DCP in resisting the static overload forces (palmarodorsal 4-point bending and torsional) and in resisting cyclic fatigue under palmarodorsal 4-point bending. CLINICAL RELEVANCE The results of this in vitro study may provide information to aid in the selection of a biological plate for the repair of equine long bone fractures.

An in vitro biomechanical comparison of a 5.5 mm limited-contact dynamic compression plate fixation with a 4.5 mm limited-contact dynamic compression plate fixation of osteotomized equine third metacarpal bones.

OBJECTIVES To compare monotonic biomechanical properties and fatigue life of a 5.5 mm broad limited-contact dynamic compression plate (5.5-LC-DCP) fixation with a 4.5 mm broad LC-DCP (4.5-LC-DCP) fixation to repair osteotomized equine third metacarpal (MC3) bones. STUDY DESIGN In vitro biomechanical testing of paired cadaveric equine MC3 with a mid-diaphyseal osteotomy, stabilized by 1 of 2 methods for fracture fixation. SAMPLE POPULATION Adult equine cadaveric MC3 bones (n=18 pair). METHODS MC3 were divided into 3 test groups (6 pairs each) for: (1) 4-point bending single cycle to failure testing; (2) 4-point bending cyclic fatigue testing; and (3) torsional single cycle to failure testing. The 8-hole, 5.5 mm broad LC-DCP (5.5-LC-DCP) was applied to the dorsal surface of 1 randomly selected bone from each pair. One 8-hole, 4.5 mm broad LC-DCP (4.5-LC-DCP) was applied dorsally to the contralateral bone from each pair. Plates and screws were applied using standard ASIF techniques. All MC3 bones had mid-diaphyseal osteotomies. Mean test variable values for each method were compared using a paired t-test within each group. Significance was set at P<.05. RESULTS Mean yield load, yield bending moment, composite rigidity, failure load and failure bending moment under 4-point bending, single cycle to failure, of the 5.5-LC-DCP fixation were significantly greater (P<.024) than those of the 4.5-LC-DCP fixation. Mean cycles to failure for 4-point bending was significantly (P<.05) greater for the 4.5-LC-DCP fixation compared with the 5.5-LC-DCP fixation. Mean yield load, mean composite rigidity, and mean failure load in torsion for the 5.5-LC-DCP fixation was not significantly different (P>.05) than those with the 4.5-LC-DCP fixation. CONCLUSION 5.5-LC-DCP fixation was superior to 4.5-LC-DCP fixation in resisting the static overload forces under palmarodorsal 4-point bending. There was no significant difference between 5.5-LC-DCP fixation and 4.5-LC-DCP fixation in resisting static overload forces under torsion; however, the 5.5-LC-DCP offers significantly less stability (80% of that of the 4.5-LC-DCP) in cyclic fatigue testing. CLINICAL RELEVANCE The results of this in vitro study may provide information to aid in the selection of a biological plate for long bone fracture repair in horses.

An In Vitro Biomechanical Comparison of Equine Proximal Interphalangeal Joint Arthrodesis Techniques: An Axial Positioned Dynamic Compression Plate and Two Abaxial Transarticular Cortical Screws Inserted in Lag Fashion Versus Three Parallel Transarticular Cortical Screws Inserted in Lag Fashion

OBJECTIVES To compare in vitro monotonic biomechanical properties of an axial 3-hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (DCP-TLS) with 3 parallel transarticular 5.5 mm cortical screws inserted in lag fashion (3-TLS) for the equine proximal interphalangeal (PIP) joint arthrodesis. STUDY DESIGN Paired in vitro biomechanical testing of 2 methods of stabilizing cadaveric adult equine forelimb PIP joints. SAMPLE POPULATION Cadaveric adult equine forelimbs (n=15 pairs). METHODS For each forelimb pair, 1 PIP joint was stabilized with an axial 3-hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion and 1 with 3 parallel transarticular 5.5 mm cortical screws inserted in lag fashion. Five matching pairs of constructs were tested in single cycle to failure under axial compression, 5 construct pairs were tested for cyclic fatigue under axial compression, and 5 construct pairs were tested in single cycle to failure under torsional loading. Mean values for each fixation method were compared using a paired t-test within each group with statistical significance set at P<.05. RESULTS Mean yield load, yield stiffness, and failure load under axial compression and torsion, single cycle to failure, of the DCP-TLS fixation were significantly greater than those of the 3-TLS fixation. Mean cycles to failure in axial compression of the DCP-TLS fixation was significantly greater than that of the 3-TLS fixation. CONCLUSION The DCP-TLS was superior to the 3-TLS in resisting the static overload forces and in resisting cyclic fatigue. CLINICAL RELEVANCE The results of this in vitro study may provide information to aid in the selection of a treatment modality for arthrodesis of the equine PIP joint.

A mechanical comparison of equine proximal interphalangeal joint arthrodesis techniques: an axial locking compression plate and two abaxial transarticular cortical screws versus an axial dynamic compression plate and two abaxial transarticular cortical screws.

OBJECTIVES To compare in vitro monotonic biomechanical properties of an axial 3-hole, 4.5 mm narrow locking compression plate (ELCP) using 5.0 mm locking screws and 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (ELCP-TLS) with an axial 3-hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (DCP-TLS) for equine proximal interphalangeal (PIP) joint arthrodesis. DESIGN Experimental. ANIMAL POPULATION Cadaveric adult equine forelimbs (n = 18 pairs). METHODS For each forelimb pair, 1 PIP joint was stabilized with an axial ELCP using 5.0 mm locking screws and 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion and 1 PIP joint with an axial 3-hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion. Six matching pairs of constructs were tested in single cycle to failure under axial compression, 6 construct pairs were tested for cyclic fatigue under axial compression, and 6 construct pairs were tested in single cycle to failure under torsional loading. Mean values for each fixation method were compared using a paired t-test within each group with statistical significance set at P < .05. RESULTS Mean yield load, yield stiffness, and failure load under axial compression, single cycle to failure, of the DCP-TLS fixation were significantly greater than those of the LCP-TLS fixation. There was no significant difference between the mean number of cycles to failure in axial compression of the LCP-TLS and the DCP-TLS fixations. Mean yield load, yield stiffness, and failure load under torsion, single cycle to failure, of the LCP-TLS fixation were significantly greater than those of the DCP-TLS fixation. CONCLUSION The DCP-TLS construct provided significantly greater stability under axial compression in single cycle to failure than the ELCP-TLS construct, the ELCP-TLS construct provided significantly greater stability under torsional loading in single cycle to failure than the DCP-TLS construct, and there was no significant difference in stability between the 2 constructs for cyclic loading under axial compression.

In Vitro Biomechanical Comparison of a Modified 5.5 mm Locking Compression Plate Fixation with a 5.5 mm Locking Compression Plate Fixation of Osteotomized Equine Third Metacarpal Bones

OBJECTIVES To compare number of cycles to failure for palmarodorsal 4-point bending of a modified 5.5 mm broad locking compression plate (M5.5-LCP) fixation with a 5.5 mm broad LCP (5.5-LCP) fixation used to repair osteotomized equine third metacarpal (MC3) bones. STUDY DESIGN In vitro biomechanical testing. ANIMAL POPULATION Adult equine cadaveric MC3 bones (n=6 pairs). METHODS An 8-hole, M5.5-LCP, obtained by having a 1.0 mm thickness removed from the bone contact portion of the 5.5-LCP, was applied to the dorsal surface of 1 randomly selected MC3 from each pair, and an 8-hole, 5.5-LCP was applied dorsally to the contralateral bone from each pair using a combination of cortical and locking screws. Plates and screws were applied using standard ASIF techniques to MC3 bones with a mid-diaphyseal osteotomy. MC3 constructs had palmarodorsal 4-point bending cyclic fatigue testing. Mean cycles to failure for each method were compared using a paired t-test within each group. Significance was set at P<.05. RESULTS Mean±SD cycles to failure of the M5.5-LCP fixation (188,641±17,971) was significantly greater than that of the 5.5-LCP fixation (166,497±15,539). CONCLUSION M5.5-LCP fixation was superior to 5.5-LCP fixation of osteotomized equine MC3 bones in resisting cyclic fatigue under palmarodorsal 4-point bending. CLINICAL RELEVANCE This suggests that biological plate fixation is not the ideal choice for osteotomized equine MC3 bones.

Compressive Forces Achieved in Simulated Equine Third Metacarpal Bone Lateral Condylar Fractures of Varying Fragment Thickness with Acutrak Plus Screw and 4.5 mm AO Cortical Screws

OBJECTIVES To compare compression pressure (CP) of 6.5 mm Acutrak Plus (AP) and 4.5 mm AO cortical screws (AO) when inserted in simulated lateral condylar fractures of equine 3rd metacarpal (MC3) bones. STUDY DESIGN Paired in vitro biomechanical testing. SAMPLE POPULATION Cadaveric equine MC3 bones (n=12 pair). METHODS Complete lateral condylar osteotomies were created parallel to the midsagittal ridge at 20, 12, and 8 mm axial to the epicondylar fossa on different specimens grouped accordingly. Interfragmentary compression was measured using a pressure sensor placed in the fracture plane before screw placement for fracture fixation. CP was acquired and mean values of CP for each fixation method were compared between the 6.5 mm (AP) and 4.5 mm (AO) for each group using a paired t-test within each fracture fragment thickness group with statistical significance set at P<.05. RESULTS AO screw configurations generated significantly greater compressive pressure compared with AP configurations. The ratio of mean CP for AP screws to AO screws at 20, 12, and 8 mm, were 21.6%, 26.2%, and 34.2%, respectively. CONCLUSION Mean CP for AP screw fixations are weaker than those for AO screw fixations, most notably with the 20 mm fragments. The 12 and 8 mm groups have comparatively better compression characteristics than the 20 mm group; however, they are still significantly weaker than AO fixations. CLINICAL RELEVANCE Given that the primary goals of surgical repair are to achieve rigid fixation, primary bone healing, and good articular alignment, based on these results, it is recommended that caution should be used when choosing the AP screw for repair of lateral condylar fractures, especially complete fractures. Because interfragmentary compression plays a factor in the overall stability of a repair, it is recommended for use only in patients with thin lateral condyle fracture fragments, as the compression tends to decrease with an increase in thickness.

Distal Interphalangeal Joint Arthrodesis in Seven Cattle Using the Acutrak Plus Screw

OBJECTIVES To report a technique for arthrodesis of the distal interphalangeal joint (DIPJ) with two 6.5 mm Acutrak Plus (AP) compression screws from a solar approach and outcome in 7 cattle. STUDY DESIGN Case series. ANIMALS Cattle (n=7) with DIPJ arthritis. METHODS Retrieved data from medical records of cattle that had undergone DIPJ arthrodesis using 2 AP screws via a solar approach were signalment, history, clinical signs, preoperative blood work, preoperative radiographs, complications, postoperative radiographs, and postoperative lameness evaluation. Outcomes, assessed by owner interview 6-26 months after surgery, were classified as excellent, good, or poor. RESULTS Fusion of the DIPJ was evident by 6 months. All cattle returned to full function with minimal lameness and normal appearance to the distal aspect of the limb. Four thoracic limbs and 3 pelvic limbs were affected; 3 medial and 4 lateral claws. Complications included moderate lameness associated with implants (n=2) that resolved after screw removal. CLINICAL RELEVANCE Use of the AP screw system in cattle is an excellent option for DIPJ arthrodesis with minimal postoperative morbidity and excellent return to function.

An In Vitro Biomechanical Comparison of Equine Proximal Interphalangeal Joint Arthrodesis Techniques: Two Parallel Transarticular Headless Tapered Variable Pitch Screws Versus Two Parallel Transarticular AO Cortical Bone Screws Inserted in Lag Fashion

OBJECTIVES To compare the mean number of cycles to failure under axial compression of equine proximal interphalangeal (PIP) joint arthrodesis constructs created by 2 parallel transarticular Acutrak Plus screws (AP-TS) or 2 parallel transarticular 5.5 mm cortical screws inserted in lag fashion (AO-TLS). STUDY DESIGN Paired in vitro biomechanical testing of 2 methods of stabilizing cadaveric adult equine forelimb PIP joints. SAMPLE POPULATION Cadaveric adult equine forelimbs (n=5 pairs). METHODS For each forelimb pair, 1 PIP joint was stabilized with AP-TS and 1 with AP-TLS. The 5 construct pairs were tested for cyclic fatigue under axial compression. Mean number of cycles to failure for each fixation method were compared by a paired t-test within each group with statistical significance set at P<.05. RESULTS The mean number of cycles to failure under axial compression for AO-TLS fixation and AP-TS fixation were 57,723±8488 and 35,322±4698, respectively. CONCLUSION The AO-TLS was superior to the AP-TS in resisting cyclic fatigue under axial compression.

Assessment of tuber coxae bone biopsy in the standing horse

Objective: To describe a biopsy technique in standing horses with minimal morbidity that consistently provides a substantial bone biopsy with intact, undamaged architecture. Study Design: Experimental, prospective study. Animals: Ten Thoroughbred horses. Methods: Biopsies were obtained from the tuber coxae of 10 sedated, standing horses using an oscillating saw. Bilateral biopsies, separated by 60 days, were evaluated with micro‐computed tomography (microCT). The first biopsy was prepared for decalcified histology; the second for undecalcified histology. Both biopsies were evaluated qualitatively for histologic quality. Results: The biopsy technique did not result in any significant complications, was well tolerated and all biopsies were of good histologic quality. Conclusion: Cortical and trabecular bone biopsies can be successfully collected from the tuber coxa using a simple technique that creates minimal morbidity and allows sequential samples to be collected. The biopsies were larger than those described previously, provided adequate bone for multiple histologic sections, and had intact, undamaged architecture on examination with microCT and light microscopy.

Evaluation of peer teaching and deliberate practice to teach veterinary surgery: COMPTON ET AL.

OBJECTIVE To assess the impact of peer teaching and deliberate practice on surgical skills acquisition and retention in first- and second-year veterinary students. STUDY DESIGN Randomized, prospective, comparative study. SAMPLE POPULATION Eighteen first-year and 25 second-year students from 1 college of veterinary medicine who had previously demonstrated proficiency in basic surgical skills. METHODS Forty-three participants were divided into 3 groups: the test group (group A, n = 15), who participated in a structured peer-assisted learning program using deliberate practice; the time-practice control group (group B, n = 15), who participated in an unstructured peer-supported environment; and the assessment-only control group (group C, n = 13), who participated in the assessments. Participants performed a subcutaneous mass removal on a cadaver model and were assessed via a global rating system. Three assessment points were evaluated: pretraining, immediate posttraining, and retention. RESULTS The number of participants who achieved acceptable or excellent grand total scores in group A increased after training. Among all participants, 22% in group A, 35% in group B, and 38% in group C did not achieve an acceptable total score at the retention assessment. CONCLUSION The study population improved in skill level and retention through the use of standardized video and peer instruction with attention to effective learning strategies, particularly deliberate practice. CLINICAL SIGNIFICANCE Use and enhancement of the format introduced in this study could augment veterinary surgical education.