Canine Tibiae Research Articles

Determination of the Mechanical Medial Proximal Tibial Angle Using a Tangential Radiographic Technique

To assess whether there is a difference in the mechanical medial proximal tibial angle (mMPTA) measured on a tangential caudocranial (tCdCr) radiographic projection versus a straight caudocranial (sCdCr) projection before and after inducing a varus deformity in the proximal tibia. In vitro study. Cadaveric canine tibiae (n=4 pair). For each tibia, a mediolateral radiographic projection was performed and the tibial plateau angle was measured. sCdCr and tCdCr radiographic projections were obtained and the mMPTA measured. A varus deformity was created in the proximal aspect of the tibia and sCdCr and tCdCr projections were repeated and mMPTA measured. mMPTA for tCdCr was statistically different from mMPTA for the sCdCr projection for the varus tibiae (P<.05). There was no significant difference in the mMPTA measured on the sCdCr projections before and after creation of a varus deformity (P>.05). There was a significant difference in mMPTA measured on the tCdCr projection before and after creation of a varus deformity (P<.05). Varus deformity in the mMPTA was identified on tCdCr projections of the varus tibiae whereas it was not identified on sCdCr projections. Tangential radiographic projections of the tibial plateau may be useful for evaluating varus deformities involving the articular surface of the tibia and should be performed during preoperative evaluation of angular limb deformities involving the proximal aspect of the tibia and for tibial plateau leveling osteotomy (TPLO) planning.

Canine Investigation of rhBMP-2, Autogenous Bone Graft, and rhBMP-2 With Autogenous Bone Graft for the Healing of a Large Segmental Tibial Defect

The purpose of this study was to compare the effects of bone morphogenetic protein, bone morphogenetic protein with autogenous bone graft (ABG), and ABG alone on the healing of a large bone defect in the canine tibia. Fifteen 45- to 55-lb canines were randomly assigned to 1 of 5 treatment groups, 3 per group. The groups included (1) recombinant human bone morphogenetic protein (rhBMP-2, 0.43 mg/mL)/absorbable collagen sponge (ACS) + collagen/ceramic matrix (CCM), (2) rhBMP-2 (0.22 mg/mL) ACS + CCM, (3) rhBMP-2 (0.43 mg/mL) ACS + ABG, (4) rhBMP-2 (0.22 mg/mL) ACS + ABG, and (5) ABG alone. A 5-mL defect was created in the right tibia and fixed with a 4.5 mm locking plate and 1 of the grafts described above implanted. X-rays were taken biweekly for 12 weeks and evaluated for radiographic union. Representative histology was also examined. All defects treated with rhBMP-2 (any combination) healed at 6.0 +/- 0.9 weeks. None of the ABG alone-treated defects were healed at 12 weeks. Dogs receiving rhBMP-2/ACS + CCM healed at 5.7 +/- 0.8 weeks, whereas rhBMP-2/ACS + ABG defects healed at 6.3 +/- 0.8 weeks. Histology showed healing consistent with 12-week radiologic results. Large segmental defects in canine tibiae can be effectively healed with stable fixation and rhBMP-2/ACS + ABG or CCM. These conclusions may offer insight into the clinical treatment of segmental defect nonunions in the human.

A biodegradable scaffold for the treatment of a diaphyseal bone defect of the tibia

The aim of this study was to compare angiogenesis and osteogenesis occurring within 8.0 mm diaphyseal defects created in canine tibiae treated using autograft or a biodegradable bone scaffold. All tibiae were reamed to 7.0 mm and fixed with a 6.5-mm statically locked intramedullary nail. Each of the 18 canines as allotted to one of three treatment groups: (1) left empty (N = 5), (2) treated with iliac crest autograft (N = 6), or (3) treated with a PLGA/calcium phosphate biodegradable scaffold (N = 7). Fluorescent markers were given at successive time periods: calcein green at 6 weeks, xylenol orange at 9 weeks, and tetracycline at 11 and 14 weeks. Animals were sacrificed at 15 weeks and their legs were perfused with a radio opaque compound. Samples were analyzed using Micro CT, bright-field microscopy and fluorescent microscopy. Scaffold samples were found to have significantly greater bone formation (p = 0.015) and blood vessel formation (p < 0.001) at their osteotomy sites than autograft samples. Bone formation rate in the periosteum was significantly greater in the autograft samples than the scaffold samples for all time periods. Bone formation at the osteotomy site was found to be significantly greater when associated with greater blood vessel formation (p = 0.026). The PLGA/calcium phosphate biodegradable scaffold we have employed supports angiogenesis within a segmental tibial defect that has adequate soft tissue coverage.

A biodegradable scaffold for the treatment of a diaphyseal bone defect of the tibia

The aim of this study was to compare angiogenesis and osteogenesis occurring within 8.0 mm diaphyseal defects created in canine tibiae treated using autograft or a biodegradable bone scaffold. All tibiae were reamed to 7.0 mm and fixed with a 6.5-mm statically locked intramedullary nail. Each of the 18 canines as allotted to one of three treatment groups: (1) left empty (N = 5), (2) treated with iliac crest autograft (N = 6), or (3) treated with a PLGA/calcium phosphate biodegradable scaffold (N = 7). Fluorescent markers were given at successive time periods: calcein green at 6 weeks, xylenol orange at 9 weeks, and tetracycline at 11 and 14 weeks. Animals were sacrificed at 15 weeks and their legs were perfused with a radio opaque compound. Samples were analyzed using Micro CT, bright-field microscopy and fluorescent microscopy. Scaffold samples were found to have significantly greater bone formation (p = 0.015) and blood vessel formation (p < 0.001) at their osteotomy sites than autograft samples. Bone formation rate in the periosteum was significantly greater in the autograft samples than the scaffold samples for all time periods. Bone formation at the osteotomy site was found to be significantly greater when associated with greater blood vessel formation (p = 0.026). The PLGA/calcium phosphate biodegradable scaffold we have employed supports angiogenesis within a segmental tibial defect that has adequate soft tissue coverage.

Biomechanical Comparison of Two Alternative Tibial Plateau Leveling Osteotomy Plates with the Original Standard in an Axially Loaded Gap Model: An In Vitro Study

To compare the axial compression stiffness of osteotomized canine tibiae stabilized with Slocum, Securos, or Synthes plates after a tibial plateau leveling osteotomy (TPLO) procedure. In vitro, paired comparison of cadaveric tibial constructs subjected to mechanical testing under an axial load. Canine tibiae (n=16 pairs) from skeletally mature male and female dogs of various breeds (18-55 kg). Tibial pairs (n=16) were randomly assigned to 1 of 2 study cohorts (n=8 pairs/cohort): cohort 1, tibial osteotomy stabilization with a Slocum or a Securos plate, or cohort 2, tibial osteotomy stabilization with a Slocum or a Synthes plate. One tibia from each pair was stabilized with 1 of each plate design assigned to the cohort after TPLO. A 3.2 mm osteotomy gap was maintained during plate application in all constructs. Load and axial displacement were recorded while constructs were loaded to 2000 N in axial compression. Failure loads were not reported because no distinct yield point or failure point was evident within the load range for many specimens. Failure modes were recorded for each construct, and photographs of typical failures were obtained. Stiffness (N/mm) was calculated from load-displacement curves. Paired comparisons of mean stiffness were performed within study groups using a paired t-test. Significance was set at P<.05. The mean construct stiffnesses for the Slocum (383+/-183 N/mm) and Securos (258+/-64.1 N/mm) constructs were not significantly different (P=.164; power=0.566). The mean construct stiffness for the Synthes constructs (486+/-91.0 N/mm) was significantly greater than that of the Slocum constructs (400+/-117 N/mm); P=.0468. Modes of failure for the Slocum (16/16) and Securos (8/8) constructs included plastic deformation of the implant with valgus deformity combined with fibular luxation (2/16 Slocum; 1/8 Securos) or fibular fracture (2/16 Slocum; 4/8 Securos). Most Synthes constructs underwent elastic deformation (7/8). One Synthes construct fractured in the sagittal plane through the tibial plateau depression at the point of load application. The Slocum and Securos plate/tibia construct have similar stiffness, whereas the Synthes/tibia constructs are significantly stiffer than the Slocum/tibia constructs. Modes of fixation failure observed in this model were consistent with TPLO fixation failures observed clinically. Construct stiffness in axial load varies with implant type. Implants that confer higher stiffness to the construct may result in greater fixation stability in tibial metaphyseal osteotomies.

A device for performing whole bone torsional testing in a single-axis linear motion testing machine

To design a device for the conversion of linear to rotational motion and to use it in order to determine torsional properties of canine tibiae in a universal tension/compression testing machine. A fixture incorporating a cable and pulley at one end and a guide block and rail assembly at the other was used to test 10 whole canine tibiae to failure in torsion at 1 degrees/s. The device produced spiral fractures in all tibiae. Torsional strength and stiffness were 13.9 +/- 1.4 N m and 0.53 +/- 0.07 N m/degree, respectively. This inexpensive device can be used to evaluate the mechanical properties of long bones after various interventions to improve fracture healing. The device can be adapted for use with any single-axis linear motion testing machine. Assessment of fracture healing often includes loading to failure in torsion (1-5). Torsional testing is typically performed using a biaxial servohydraulic testing machine or similar sophisticated electromechanical equipment. Due to its high cost, many researchers do not have such equipment at their disposal. However, uniaxial tension-compression testing machines are widely available. Therefore, a device that can be used to perform torsional testing in a tension-compression machine would be beneficial. In this study we present a custom fixture for converting the vertical linear motion of a universal testing machine to rotational motion and validate its performance in torsional testing of canine tibiae.

In vitro mechanical evaluation of torsional loading in simulated canine tibiae for a novel hourglass-shaped interlocking nail with a self-tapping tapered locking design

To describe a novel interlocking nail (ILN) and locking system and compare the torsional properties of constructs implanted with the novel ILN or a standard 8-mm ILN (ILN8) by use of a gap-fracture model. 8 synthetic specimens modeled from canine tibiae. An hourglass-shaped ILN featuring a tapered locking mechanism was designed. A synthetic bone model was custom-made to represent canine tibiae with a 50-mm comminuted diaphyseal fracture. Specimens were repaired by use of a novel ILN or an ILN8 with screws. Specimens were loaded for torsional measurements. Construct compliance and angular deformation were compared. Compliance of the ILN8 was significantly smaller than that of the novel ILN. Mean +/- SD maximum angular deformation of the ILN8 construct (23.12 +/- 0.65 degrees) was significantly greater, compared with that of the novel ILN construct (9.45 +/- 0.22 degrees). Mean construct slack for the ILN8 group was 15.15 +/- 0.63 degrees, whereas no slack was detected for the novel ILN construct. Mean angular deformation for the ILN8 construct once slack was overcome was significantly less, compared with that of the novel ILN construct. Analysis of results of this study suggests that engineering of the locking mechanism enabled the novel hourglass-shaped ILN system to eliminate torsional instability associated with the use of current ILNs. Considering the potential deleterious effect of torsional deformation on bone healing, the novel ILN may represent a biomechanically more effective fixation method, compared with current ILNs, for the treatment of comminuted diaphyseal fractures.

In vitro biomechanical comparison of a plate-rod combination–construct and an interlocking nail–construct for experimentally induced gap fractures in canine tibiae

To compare structural properties of a plate-rod combination-bone construct (PRCbc) and interlocking nail-bone construct (ILNbc) by use of an experimentally induced gap fracture in canine tibiae. 12 paired canine tibiae. Specimens were implanted with a plate-rod combination consisting of a 3.5-mm, limited-contact, dynamic-compression plate combined with an intramedullary rod or 6-mm interlocking nail. Ostectomy (removal of 10-mm segment) was performed. Paired constructs were loaded for bending, compression, or torsion measurements (4 constructs/group). Compliance was determined by fitting regression lines to the load-position curves at low (initial compliance) and high (terminal compliance) loads. Bending compliances did not differ significantly between constructs. For the ILNbc, initial compliance was greater than terminal compliance in compression and torsion. Initial compliance and terminal compliance for the PRCbc were similar in compression and torsion. Initial compliance in compression and torsion was greater for the ILNbc, compared with initial compliance for the PRCbc. Maximum deformations in bending and compression were similar between constructs; however, maximum torsional angle was significantly greater for the ILNbc, compared with values for the PRCbc. The study documented that for an experimentally induced gap fracture in canine tibiae, a plate-rod combination is a significantly less compliant fixation method in torsion and compression, compared with an interlocking nail. Considering the deleterious effects of torsional deformation on bone healing, a plate-rod combination may represent a biomechanically superior fixation method, compared with an interlocking nail, for the treatment of dogs with comminuted tibial diaphyseal fractures.

COMPUTED TOMOGRAPHIC DETERMINATION OF TIBIAL TORSION IN THE DOG

The goal of this study was to develop a method for computed tomographic (CT) measurement of tibial torsion, and to compare this technique with direct anatomic measurement of tibial torsion in cadaveric canine tibiae. Paired hind limbs of 10 cadaveric dogs were mounted on a custom-designed limb holding apparatus. One-millimeter thick, contiguous, transverse CT slices were obtained from the distal femur to the proximal tibia and 2 mm CT slices were obtained from the distal tibia to the proximal tarsus. The tibiae were freed of soft tissues and digital photographic images of the proximal and distal articular surfaces were obtained with the camera lens aligned perpendicular to the long axis of the tibia. Multiple proximal and distal tibial axes were identified on the images; two proximal and two distal axes were found to be repeatable in all specimens in both the direct and CT methods. The torsion angle was calculated by determining the difference between the axis angles for each pair of proximal and distal axes. There was no significant difference in torsion angle identified between the direct photographic and CT method for any pair of proximal and distal axes. CT determination of tibial torsion is a rapid and accurate method, and warrants investigation in clinical patients.

Effect of a transpositional muscle flap on VEGF mRNA expression in a canine fracture model.

The effect of sepsis on neovascularization in fractures that follows open fractures is important to the understanding of bone and soft-tissue healing. An animal model was designed that mimics the open fracture and the clinical repair of the human, high-energy open fracture. Vascular endothelial growth factor (VEGF) mRNA levels in canine bone samples were determined in samples from days 0 and 7. Canine right tibiae were fractured with a penetrating, captive-bolt device and then repaired in a standard clinical fashion using an interlocking intramedullary nail. Animals were subject to one of the following experimental protocols: tibial fracture (group I, n = 3); tibial fracture and Staphylococcus aureus inoculation at the fracture site (group II, n = 3); and tibial fracture and S. aureus inoculation with a rotational gastrocnemius muscle flap (group III, n = 3). Bone samples were harvested on days 0 and 7 and prepared for reverse transcriptase polymerase chain reaction assay. Primers for VEGF were commercially prepared and assay products were sequenced. The assay products were associated with Genebank VEGF mRNA sequences. VEGF mRNA levels increased significantly in the fracture-alone group from day 0 to day 7 (n = 3, p < 0.05). In the fracture and S. aureus group (group I), VEGF mRNA expression decreased 79 percent (p < 0.05). In animals with fractures inoculated with S. aureus and a transpositional muscle flap (group III), VEGF mRNA expression was increased 38 percent from day 0 to day 7 (p < 0.05) and was similar to the increase observed in the fracture-alone group. These results demonstrate that S. aureus decreased the normal increase of VEGF mRNA expression during bone wound healing. Use of the transpositional muscle flap in the presence of S. aureus increased VEGF mRNA expression over time to the expression pattern observed in the fracture-alone group. This experimental model demonstrates that specific biological signals and cellular pathways are influenced by bacterial infection and type of surgical closure.

A test of two methods of radiographically deriving long bone cross‐sectional properties compared to direct sectioning of the diaphysis

AbstractNumerous studies have made use of cross‐sectional geometry to describe the distribution of cortical bone in long bone diaphyses. Several methods can be used to measure or estimate cross‐sectional contours. Direct sectioning (DSM) of the diaphysis is not appropriate in most curatorial contexts, and is commonly substituted with methods based upon bi‐planar radiography: a latex cast method (LCM) or an eccentric elliptical method (EEM). Previous studies have demonstrated that the EEM provides accurate estimates of area measurements, while providing less accurate estimates of second moments of area (Biknevicius &amp; Ruff, 1992; Runestad et al., 1993; Lazenby, 1997). The LCM has been commonly employed, as a way to estimate section contours more accurately, yet the validity of this method has not been adequately documented. This study measures the agreement of these methods against DSM of long bone diaphyses using 21 sections of canine tibiae derived from a study of total hip arthroplasty. The accuracy and agreement of these methods is evaluated using reduced major axis regression, paired sample t‐tests and tests for agreement (Bland &amp; Altman, 1986). The results illustrate that the LCM provides a reasonable estimate of cross‐sectional dimensions, producing cross‐sectional properties that are on average within 5% of properties derived from the DSM. The EEM is found to provide adequate estimates of true cross‐sectional areas, but poor estimates of second moments of area. The use of the LCM is supported for all cross‐sectional properties, but the EEM is only accurate in total area, cortical area and percent cortical area estimates. Copyright © 2002 John Wiley &amp; Sons, Ltd.

The Effects of Dynamization and Destabilization of the External Fixator on Fracture Healing: A Comparative Biomechanical Study in Dogs

This study compared the effects of axial dynamization and staged destabilization on fracture healing. Bilateral midshafts of canine tibiae were osteotomized and fixed with an external fixator. The hind limbs were divided into two groups: the destabilized group in which the fixator's stiffness was progressively reduced over time and the axially dynamized group in which the fixator was axially dynamized. The healed tibiae were tested for 3-point bending in the anteroposterior plane. The biomechanical tests performed 2 months postoperatively revealed that the side with the destabilized fixator was more rigid than the side with the axially dynamized fixator, but the differences were insignificant (P=.20). This study showed staged destabilization of the fixator's stiffness was as effective on the enhancement of fracture healing as axial dynamization.

High and low pressure pulsatile lavage of contaminated tibial fractures: an in vitro study of bacterial adherence and bone damage.

This study was designed to examine the effect of pulsatile irrigation on microscopic bone architecture and its time-dependent efficacy in removing adherent slime-producing bacteria from cortical bone. Using an in vitro model, ten-millimeter transverse cut sections from five human tibiae were contaminated with Staphylococcus aureus and subjected to either high pressure pulsatile lavage (HPPL; seventy pounds per square inch, normal saline) or low pressure pulsatile lavage (LPPL; fourteen pounds per square inch, normal saline) or served as controls. Alteration of bony architecture was quantified by using a previously described ordinal scale and histomorphometric analysis of each transverse cut section of tibia. To assess the time-dependent effectiveness of pulsatile lavage in removing adherent bacteria from bone, ten-millimeter transverse cut sections from ten canine tibiae were contaminated with S. aureus and subjected to high or low pressure pulsatile lavage immediately or after one, three, or six hours. Scanning electron microscopy and bacterial cultures were used to assess the removal of adherent bacteria. HPPL resulted in significantly greater macroscopic damage than was seen with LPPL or in controls (ANOVA, p < 0.001). Histomorphometry revealed that HPPL was associated with significantly larger and more numerous fissures or defects in the cortical bone when compared with low pressure irrigation (p < 0.001). However, high and low pressure lavage were associated with similar degrees of periosteal separation from the cortical bone surface (p = 0.87). Both high and low pressure lavage were effective in removing adherent bacteria from bone at three hours irrigation delay, but only high pressure lavage removed adherent bacteria from bone at six hours delay. In this in vitro study, compared with HPPL, LPPL led to less structural damage and was equally effective in removing bacteria within three hours debridement delay; however, the efficacy of LPPL at six hours debridement delay is questionable. This finding may have clinical significance in the development of infection following open tibial fractures.

Ultrasound for the early diagnosis of tibial fracture healing after static interlocked nailing without reaming: histologic correlation using a canine model.

Ultrasound is thought to be clinically useful in evaluating bone formation through its presumed identification of fracture callus. However, documentation of the actual histology of the tissue identified by ultrasound has been lacking. The purpose of this study was to determine the histologic composition of the hyperechoic tissue "seen" by ultrasound. Unilateral fractures were created in eight canine tibias and then fixed by using locked intramedullary nailing without reaming. The limbs were studied at two, three, four, six, and eight weeks postoperatively with plain radiographs, ultrasound, and ultrasound-directed needle biopsy. The presence of a hyperechoic ultrasound signal was found to have a 100 percent correlation with the presence of hard fracture callus biopsy tissue. In addition, fracture union by ultrasound criteria significantly predated radiographic fracture union (5.6 vs. 7.3 weeks, p = 0.05). These results support and provide a scientific basis for the clinical use of ultrasound to assess tibial fracture healing following static interlocked nailing without reaming.

Holding Power of 3.5 mm Versus 4.0 mm Screw Applications Placed in Stripped 2.7 mm Screw Sites

SummaryMechanical stripping of orthopaedic screws is a complication that can occur during plate fixation of fractures. This report compares the holding power of 3.5 mm cortical and 4.0 mm cancellous orthopaedic screws inserted as a salvage technique in stripped 2.7 mm screw sites in cadaver bone. Both 3.5 mm and 4.0 mm orthopaedic screws were applied with and without tapping to stripped screw sites in the diaphysis of mature canine tibiae. Mechanical testing of the pull-out force required to extract these screws showed that all of the applications have comparative holding powers, but the 4.0 mm screw had significantly greater holding power when compared with the 3.5 mm screw. Tapping the stripped screw site, prior to placing the 3.5 mm or 4.0 mm screw, did not significantly affect the holding power. The 4.0 mm cancellous screw has the advantages of significantly greater holding power and less interference with the 2.7 mm dynamic compression plate, when compared to the 3.5 mm cortical screw.The holding power of 3.5 mm cortical and 4.0 mm cancellous orthopaedic screws placed tapped and untapped into 2.7 mm stripped screw sites in post-mortem canine tibiae were compared. All applications had comparable holding power, but with the 4.0 mm screw the holding power was significantly greater. Tapping stripped screw sites did not have any significant effect on holding power.

Streaming potentials in gap osteotomy callus and adjacent cortex. A pilot study.

This study documented streaming potentials generated in vivo by maturing osteotomy calluses in 10 canine tibiae. Gap osteotomies were allowed to heal for 6 or 12 weeks and were stabilized by an external fixator. Then, with the dogs under anesthesia, electrical measurements were made from 3 silver-silver chloride electrodes placed surgically in direct contact with the callus, with adjacent cortical bone, and with the medullary canal (reference electrode). Streaming potentials were recorded during step loading and sinusoidal bending (0.1-30 Hertz) as the tibia was deformed by 2 threaded pins coupled to a servohydraulic device. Streaming potentials were generated at callus and adjacent cortical sites, but the magnitude was greater on the immature, flexible callus, where bending strain was concentrated; as the callus became increasingly rigid, strain and streaming potential magnitude were distributed more evenly over the callus and adjacent cortical fragments. When normalized to surface strain, mean streaming potential per strain was less dependent on the microscopic structure, although on individual specimens streaming potential per strain at callus and adjacent cortical bone sites tended to increase with decreasing porosity. Despite a wide variation in data in this pilot series, these observations are consistent with the natural history of callus maturation: the maximum magnitude of streaming potentials in callus appears to decrease as the strain gradient across the site decreases, whereas streaming potentials normalized to strain increase as bone matures and becomes more dense.

In vitro biomechanical and histological assessment of pilot hole diameter for positive-profile external skeletal fixation pins in canine tibiae.

This study was conducted to evaluate the effect of pilot hole (PH) diameter (0, 1.5, 2.0, 2.7, 3.1, 3.3, 3.5, and 3.7 mm) on the biomechanical and microstructural performance of positive-profile threaded external skeletal fixation pins (3.18 mm inner diameter, 3.97 mm outer diameter) using cadaveric canine tibiae. Eight pins per pilot hole diameter (four pins per bone) were used to assess differences in end-insertional torque and pin pull-out strength. Histological evaluation of eight bicortical pin tracts per pilot hole diameter was accomplished using computer-interfaced videomicroscopy on specimens processed using a bulk-staining technique. Compared with no predrill, use of 2.7 mm PH increased end-insertional torque and pull-out strength by 25% and 13.5%, respectively. No significant differences were observed in biomechanical variables for the PH diameter range of 2.0 to 3.1 mm. Compared with no predrill, use of a 3.1 mm PH increased thread area by 18%. Microfracturing around the threads decreased as PH diameter increased. Damage to the interface at the entry and exit sites of both near and far cortices also decreased as PH diameter increased. It was concluded that predrilling a PH whose diameter approximates, but does not exceed the inner diameter of the positive profile pin will not only improve initial pin stability compared with no predrilling, but it will also reduce microstructural damage that may lead to excessive bone resorption and premature pin loosening.

The Use of Growth Factors to Increase the Rate of Regenerate Consolidation

Two types of growth factors were used in an attempt to improve the quality of the regenerate bone in canine tibias after Ilizarov lengthening. Mechanical testing, biochemical analysis and histology did not demonstrate appreciable differences between the treated and the control limbs.

Noninvasive Determination of Bone Stiffness for Distraction Osteogenesis by Quantitative Computed Tomography Scans

Apparent density of canine tibial specimens was correlated to measured quantitative computed tomography (QCT) numbers, and a conversion equation was derived. Finite element analysis models of canine tibiae were constructed using spatial coordinates of converted QCT data. Two QCT-derived finite elemental analysis models were constructed for a pair of matched tibiae: one lengthened 15% by distraction osteogenesis and one contralateral control. Two equations relating the modulus of elasticity to apparent density were used. These models were then verified mechanically by measuring strains of the two specimens under applied load. Equation I correlated best with measured strains in the less-dense regenerate bone of the distracted tibia (R2 = 0.914, p = 0.0028, n = 6); Equation II performed best in the denser control tibia (R2 = 0.820, p = 0.0129, n = 6). These results demonstrate that the stiffness of tubular bones, including cortical and heterogenous cancellous structure, can be accurately predicted by a noninvasive QCT scan.

Ex vivo biomechanics of Kirschner-Ehmer external skeletal fixation applied to canine tibiae.

The purpose of this study was to determine the respective contribution of each of the following parameters to the compressive, bending, and torsional rigidity of the Kirschner-Ehmer (KE) external fixation splint as applied to canine tibiae with an osteotomy gap: bilateral versus unilateral splints; increasing the number of fixation pins; altering the diameter of fixation pins and side bars; decreasing side bar distances from the bone; increasing pin separation distances in each pin group; decreasing distances between pin groups; altering pin clamp orientation; and altering side bar conformation. Bilateral splints were 100% (mean) stiffer than unilateral splints, with stiffness enhanced to the greatest extent in mediolateral bending and torsion. Increasing pin numbers stiffened both bilateral (mean, 41%; 8 versus 4) and unilateral splints (mean, 14%; 8 versus 4). Medium KE splints were 85% (mean) stiffer than small KE splints. Decreasing side bar distances to the bone from 1.5 cm to 1.0 cm to 0.5 cm increased stiffness of both bilateral and unilateral splints by a mean of 13% to 35%. Widening pin spacing from 1.67 cm to 2.5 cm increased stiffness in craniocaudal bending only (56% increase, bilateral splints; 73% increase, unilateral splints). Decreasing the distance between pin groups from 5.84 cm to 2.5 cm increased stiffness in torsion between 23% (unilateral splints) and 45% (bilateral splints) and decreased stiffness of unilateral splints by 29% in craniocaudal bending. Altering pin clamp configuration so that the bolts of the clamp were inside the side bar rather than outside the side bar increased stiffness in axial compression only (73% increase, bilateral splints; 54% increase, unilateral splints). Conforming the lateral side bar to the tibiae increased only axial compressive stiffness by 77% but was no different than placing the clamps inside the side bars of an unconformed bilateral splint. These results quantify the relative importance of specific parameters affecting KE splint rigidity as applied to unstable fractures in the dog.