Interfragmentary Wires Research Articles

Mechanical testing of paraosseous clamp-cerclage stabilization compared to interfragmentary wiring and combination technique in L-shape acrylic plate simulate to canine mandibular fracture

The purpose of this research was to comparison of the mechanical strength of the three different stabilization techniques in canine mandibular models. An L-shaped acrylic plate to replicate the mandible of a middle-sized dog was used as a canine mandibular fracture model. The research compared the strength of 3 fixation techniques: interfragmentary wiring, paraosseous clamp-cerclage stabilization, and a combination of both techniques. Each method was tested using 6 acrylic samples and measuring the maximum pressure load on the rostral mandible model using a Hounsfield H50KS testing machine. Statistical analysis was used to summarize the maximum load results from each method. The strengths of the interfragmentary wiring technique and the combination technique were not significantly different, while the paraosseous clamp-cerclage stabilization technique had significantly less strength than the other two techniques. The acrylic samples simulated the mandibular bone in a medium-sized breed dog because there are variable sizes and conformations of the mandible. This method was used to help neutralize other confounding factors associated with using real bone. In conclusion, the combination technique of interfragmentary wiring and paraosseous clamp-cerclage was the best method that can be used for increased stabilization of mandibular fixation. This technique was useful for facilitating stabilization of a mandible at a lower cost compared with the bone plate and screw method.

Utility of forming the occlusal and mandibular units with interfragmentary wires in mandibular comminuted fractures

Utility of forming the occlusal and mandibular units with interfragmentary wires in mandibular comminuted fractures

Feline skull injuries: Treatment goals and recommended approaches.

Skull trauma in cats, which includes fractures of the mandible and maxilla, as well as temporomandibular joint (TMJ) conditions, is frequently encountered in general practice. Head trauma requires immediate attention and the initial approach should be focused on stabilisation of the patient and evaluation of the major body systems, including respiratory and cardiovascular assessment, and neurological and ophthalmic examination. The head, oral occlusion and the patient's ability to open and close the mouth should be carefully evaluated. Once the cat is stable enough for anaesthesia, diagnostic imaging is essential to assess for skull injuries. Radiography may be helpful, although some conditions may be difficult to visualise due to soft tissue and bony structure superimposition. CT is a more sensitive technique for detecting skull injuries. A variety of stabilisation techniques have been described in the feline patient, and repair goals focus on restoration of the animal's oral function, while ensuring adequate dental occlusion, minimal invasiveness and morbidity, and pain relief. Surgical repair of mandibular and maxillary fractures may variously involve interdental wiring, interarcade wiring or suture, use of interfragmentary wires, plate and screw fixation, external skeletal fixation and use of dental acrylic. Decision-making with regard to treatment options depends on dental occlusion, type and location of the fracture, fracture stability and pain. This review, directed at general practitioners working with cats, describes the relevant anatomy of the feline skull, the most common mandibular, maxillary and TMJ conditions, and their recommended management.

Fractures of the metabones and phalanges in dogs and cats

Metabone and phalangeal fractures are common in dogs and cats and are most often caused by external trauma, although stress fractures frequently occur in racing Greyhounds. Fractures of the metabones and phalanges are commonly open, due to the paucity of overlying soft tissue. The diagnosis can usually be made based on a thorough orthopaedic examination and radiography of the affected area, often including oblique and traction views. Although controversial, general indications for surgery include fractures of both the third and fourth metabones, and basilar, articular, distal diaphyseal and open fractures of any of the metabones. Surgical management is also recommended for unstable fractures of the phalanges or fractures of the head or base, as long as the fragment size is sufficiently large for implant purchase. For fractures of either the metabones or phalanges, surgical treatment is generally recommended for sporting and racing dogs, in order to facilitate a full return to function. Treatment options include external coaptation; intramedullary pinning; tension band, cerclage or interfragmentary wiring; lag screws; bone plates; and external skeletal fixation. Prospective randomised controlled studies comparing treatment options for metabone and phalangeal fractures are required before recommendations regarding the optimum treatment modality can be made.

Supplementary Technique for Unstable Clavicle Shaft Fractures: Interfragmentary Wiring and Temporary Axial K-Wire Pinning.

BackgroundTreatment of unstable clavicle fractures remains a challenge for orthopedic surgeons, but the evolution of treatment strategies has allowed for reliable results with minimal complications. Although several surgical options exist, open reduction with plating remains the treatment of choice for clavicle fractures. The purpose of this study is to determine an easy way to achieve successful preplating reduction while minimizing surrounding soft tissue damage during treatment of midshaft fractures of the clavicle.MethodsA retrospective study included all consecutive adult patients operated on by a single surgeon for acute displaced clavicular midshaft fracture between January 2010 and October 2014. Hybrid technique with interfragmentary cerclage wiring, temporary axial K-wire pinning, or their combination was used in all patients. The demographic data and clinical outcomes, including operation time, union time, restoration of anatomy, shoulder functional score, and complications were evaluated.ResultsThere were 54 male and 19 female patients, with an average age of 39.3 years (range, 18 to 77 years) for males and 58.3 years (range, 39 to 77 years) for females. They were followed up for 24 months (range, 12 to 44 months). All patients had reliable bone union after surgery using interfragmentary cerclage wiring and temporary axial K-wire fixation; fracture union was obtained at an average of 11.7 weeks (range, 8 to 21 weeks) postoperatively. Additionally, there was no postoperative loss of fracture reduction or plate loosening. At the final follow-up, all patients had regained excellent functional outcomes.ConclusionsThe cognizant effort to achieve anatomic reduction without surrounding soft tissue insult before definitive plating allows excellent radiologic and functional outcomes. Interfragmentary cerclage wiring and temporary axial K-wire pinning can overcome difficulties associated with unstable clavicle fractures to allow proper fracture reduction. In this article, we introduce a concise technique for achieving the desired outcomes reliably and efficiently when treating unstable clavicle midshaft fractures.

The use of orthopaedic wire for fracture fixation in companion animals

Orthopaedic wire is widely used in companion animal fracture repair. It is mainly applied as an auxiliary fixation method, in combination with other orthopaedic implants, and rarely as the sole method of fixation. The most frequently used types of orthopaedic wire are those with both ends straight, and the AO/ASIF wire, which has an "eye" twisted into one end of it, whereas the other end is straight. The wire should be applied tighdy and secured into place, either by a twist knot or by the use of a locking loop, respectively. Three types of wiring can be seen: fullcerclage wire, tension band wire and interfragmentary wires (cruciate or hemi-cerclage). The understanding of the proper principles of orthopaedic wire application and of the limitations of its use with fracture management is crucial. When applied properly and in the correct circumstances, orthopaedic wire is an effective mean of fracture fixation.

Repair of flail chest using interfragmentary wiring and stability augmentation with basket-weave fashion sutures in a toy breed dog: a case report

Repair of flail chest using interfragmentary wiring and stability augmentation with basket-weave fashion sutures in a toy breed dog: a case report

Surgical Correction of Pseudo-flail Chest Using Interfragmentary Wiring, Latissimus Dorsi Flap, and External Splinting in a Dog

A 7-year-old intact female Maltese dog presented with a history of bite wounds. Physical examination revealed labored breathing, four puncture wounds with subcutaneous emphysema of the thorax, and paradoxical respiratory movement of the right thoracic wall. On radiography, a segmental fracture of the right 7th rib and a single fracture of the 8th rib were evident on the dorsal thorax. An inward displacement of the fractured segment and contusion of the right caudal lung lobe were identified with computed tomography. A diagnosis of pseudo-flail chest was made. Exploratory thoracotomy revealed a full-thickness muscular defect, a marked discoloration of the right caudal lung lobe, a segmental fracture of the right 7th rib, and a single fracture of the right 8th rib. Necrotic tissues were removed using surgical debridement. The fractured 7th and 8th ribs were corrected using a single interfragmentary wiring technique. The thoracic wall was reconstructed using the latissimus dorsi muscle flap. Additional thoracic stabilization using a thermoplastic splint was applied to correct paradoxical respiratory movement. The external splint was removed 4 weeks postoperatively. There was no evidence of respiratory abnormalities 18 months postoperatively.

Treatment and Stabilization of Beak Symphyseal Separation Using Interfragmentary Wiring and Provisional Bis-Acryl Composite.

Treatment and Stabilization of Beak Symphyseal Separation Using Interfragmentary Wiring and Provisional Bis-Acryl Composite.

Allografting in Locked Nailing and Interfragmentary Wiring for Humeral Nonunions

In this prospective study, we compared outcomes after repair of humeral nonunions when morsellized fresh-frozen allograft or autograft was used to augment repair by intramedullary nailing. Sixty-five patients with humeral shaft nonunions of greater than 6 months' duration and gross instability at the nonunion site were included and treated by locked nailing, interfragmentary wiring, and bone grafting. Graft type was determined by patient preference. Outcomes assessed included union rate and functional recovery of the arm. Secondary end points included operative blood loss, operation time, hospital stay, time to fracture healing, and complications. Twenty-eight patients with autografts and 36 with allografts were followed up more than 2 years. The baseline conditions of the two groups were similar. The autograft group had greater blood loss and longer operative time than the allograft group. The autograft group also had a longer hospital stay. The healing rate, time to healing, and functional scores did not differ between these two groups. In the autograft group, 43% reported pain and limited mobility as a result of the donor site. We concluded that when used in association with locked nailing for humeral nonunions, allografts can achieve treatment results similar to autografts but without donor site complications. Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

Imaging and Management of a Caudal Mandibular Fracture in an Immature Dog

Interfragmentary wire surgical technique was used to repair a caudal mandibular fracture in a 15-week-old Labrador Retriever dog. Computed tomographic imaging aided the diagnosis and treatment planning for the application of this method. Abnormal tooth development of caudal molar teeth was related to the traumatic event and/or surgical technique. The strategically important mandibular first molar tooth was maintained. The fracture fixation method used in this case provided early return to function and radiographic evidence of expected fracture healing during a 10-month period despite wire displacement secondary to tooth eruption.

Two Surgical Approaches to Fracture Malunion Repair

Two birds were presented with malunion fractures. The first was a young toco toucan (Ramphastos toco) with malunion of the tarsometatarsus that was treated by an opening-wedge corrective osteotomy and an acrylic-pin external skeletal fixator (type II) to stabilize the osteotomy. The second bird was an adult southern caracara (Caracara plancus) with radial and ulnar malunion that was treated by closing-wedge osteotomies. Stabilization of the osteotomy sites was accomplished through a bone plate fixed cranially on the ulna with 6 cortical screws and an interfragmentary single wire in radius. In both cases, the malunion was corrected, but the manus of the southern caracara was amputated because of carpal joint luxation that induced malposition of the feathers.

Evaluation of ilial screw loosening after triple pelvic osteotomy in dogs: 227 cases (1991–1999)

To investigate factors influencing screw loosening after triple pelvic osteotomy (TPO) and ischial wire stabilization of the acetabular segment. Retrospective case series. Animals-227 dogs with congenital hip dysplasia or subluxated hip joints. Medical records and radiographs of 227 dogs that underwent 332 TPO procedures were evaluated, and data pertaining to screw type, plate position, sacral screw engagement, use of ischial interfragmentary wires, and pelvic alignment were assessed for associations with screw loosening. Complications developed in 96 of the 332 (29%) procedures. Cancellous screws without sacral engagement were associated with the lowest frequency (6%) of loosening, compared with cancellous and cortical screws engaging the sacrum and cortical screws that did not engage the sacrum. Frequency of screw loosening increased when cortical or cancellous screws engaged the sacrum and when cortical screws were used. In dogs that had surgery bilaterally, the first limb on which TPO was performed had a higher frequency of screw loosening than the second limb. Pelvic alignment loss was greatest (5.4 degrees ) when the 3 most cranial screws were loosened. Loss of pelvic alignment was significantly different between dogs that underwent surgery and had complications and those that underwent surgery and did not have complications in association with loosening of 1, 2, and 3 screws. TPO screw loosening was multifactorial and related to stability of the affected ilium, screw type, and screw position. Placing cancellous screws that do not engage the sacrum in pelvic osteotomy plate positions 1 through 3 may decrease the number of screws that loosen.

Biomechanical and clinical effects of adding interfragmentary wiring to locked nailing for humeral nonunions.

The use of locked nailing for the treatment of humeral nonunions is threatened by the potential of initial instability which may result in residual fracture gap and motion and is detrimental to fracture healing. This study investigated the biomechanical and clinical effects of adding interfragmentary wiring to reduce the initial instability in the treatment of humeral nonunion. The biomechanical study compared the mechanical properties of 3 fixation methods: locked nail alone, with staple, and with interfragmentary wiring. Composite humeri were transected to simulate nonunion and were retrograde nailed. Nail-bone constructs were examined by non-destructive bending tests and destructive torsional tests. The initial instability, fixation stiffness and strength were measured and compared. The clinical study compared 21 nonunions treated by locked nailing alone and 30 nonunions treated by locked nailing with interfragmentary wiring. The indication for wiring was persistent nonunion gap or motion during operation. The union rate, time to union, functional recovery of the adjacent joints and the time for functional recovery were compared between the treatment groups. Biomechanically, in both bending and torsional tests, locked nailing with a staple or wiring resulted in significantly less initial instability than locked nailing alone. Test results for bending stiffness, torsional stiffness, or torsional strength did not differ significantly among the 3 fixation methods. In the clinical study, interfragmentary wiring had the advantage of providing tight nonunion compression, which was beneficial for nonunion healing and promoted early postoperative exercise. Patients treated with locked nailing with interfragmentary wiring had significantly shorter time to union and faster shoulder functional recovery (p < 0.05). Adding interfragmentary wiring was an effective and safe procedure in humeral nonunions treated with locked nailing.

Complications of locked nailing in humeral shaft fractures.

The purpose of this study was to investigate the complications of humeral locked nailing. Between 1994 and 2000, 161 humeral shaft fractures (98 acute fractures and 63 delayed unions or nonunions) in 159 patients treated with humeral locked nails were followed up for an average of 25.4 months. There were 89 men and 70 women, with an average age of 53.5 years. Acute fractures included 68 closed, 18 type I, 8 type II, 3 type IIIA, and 1 type IIIB open fractures. Thirty-six nonunions had previous operations. In general, acute fractures were treated with closed nailing and nonunions were treated with open nailing with bone grafting. Since 1998, interfragmentary wiring has been added in nonunions to compress the fracture. In total, 30 patients had 31 significant complications. Nine of them were persistent nonunions, six from acute fractures and three from nonunions. Fracture gap was associated with a significantly higher risk of nonunion. The risk of operative comminution was significantly higher in retrograde nailing, and operative comminution resulted in a significantly higher risk of nonunion. Seven of the nine nonunions underwent revisional nailing and achieved eventual union. Removal of the protruded screws was performed in two cases. Other complications included shoulder impairment, elbow impairment, angular malunion, and post-nailing radial nerve palsy. Many complications of humeral locked nailing can be prevented by improving the implant design or surgical techniques. The patients with persistent nonunion can be reliably treated by revisional nailing and bone grafting.

Locked nailing with interfragmentary wiring for humeral nonunions.

Locked nailing for humeral nonunions is threatened by residual fracture gap and fracture motion. This article describes the clinical experience of using interfragmentary wiring to solve these problems. Interfragmentary wiring was used in 21 consecutive humeral nonunions treated with humeral locked nails. The average age of patients was 49.5 years, with an average nonunion duration of 14.4 months. Eighteen patients had previous operations. Nonunions were located at the proximal third in 4, the middle third in 10, and the distal third in 7. Antegrade nailing was used in 11 and retrograde nailing in 10. Sixteen nonunions were nailed with 8-mm nails and five with 7-mm nails. Interfragmentary wiring was applied to either the posterior or the lateral cortex of humeri in a figure-of-eight configuration. Bone grafting was performed in all and average follow-up time was 22 months. With a single operation, all patients achieved osseous union in, on average, 18.3 weeks. One patient with segmental nonunion suffered acute renal failure 4 months after operation, but fracture healing was not affected. Wire infection occurred in one patient with preoperative infection at the nail entry site and was treated by implant removal. Other complications including two transient radial nerve palsies and one brachial artery injury did not affect the final outcome. At follow-up, all but four patients had complete recovery of shoulder flexion and abduction. The average postoperative Neer score (91.1 points) was significantly better than the average preoperative score (65.5 points). All but three patients had complete recovery of elbow motion. Interfragmentary wiring, a safe procedure if properly performed, could effectively decrease the residual fracture gap and fracture motion in locked nailing of humeral nonunions. Further biomechanical studies and prospective, randomized, controlled studies are warranted.

A Comparative Study of Two Different Fixation Techniques in the Management of Tibial Metaphyseal Fracture in Dogs

Suryawanshi, S.B., Maiti, S.K. and Singh, G.R. 2001. A comparative study of two different fixation techniques in the management of tibial metaphyseal fracture in dogs. J. Appl. Anim. Res., 20: 89–97. In ten clinically healthy dogs, divided equally in two groups (A and B), unilateral metaphyseal transverse fracture was created, in the proximal tibia under general anaesthesia. The fracture was then immobilized with cross intramedullary pin fixation in group A and single pin fixation in group B, alongwith interfragmentary wiring. These two different fixation techniques were compared based on intra-operative, clinical, radiological, haemato-biochemical, histopathological and functional studies of the test stifle joints. Clinical observations and radiographs taken on different intervals revealed excellent fracture fixation and faster healing in group A. Extension and flexion angles of stifle joints improved steadily and, reached near normal by day 60 in group A, however, in group B, it remained significantly low till the end of observation period. Organic components of the callus at fracture site markedly increased in groups A than B. Histopathological examination revealed complete healing alongwith remodeling at the fracture site of animals of group A, whereas delayed/non-union was observed in animals of group B. It may be concluded that single pinning is not enough to immobilise the fracture site for proper healing.

Evaluation of four interfragmentary Kirschner wire configurations as a component of screw/wire/polymethylmethacrylate fixation for acetabular fractures in dogs.

The biomechanical contribution of the interfragmentary Kirschner wire as a component of composite fixation for acetabular fracture repair was subjectively and objectively evaluated. Acetabular osteotomies were repaired using the screw/wire/polymethylmethacrylate (SWP) composite fixation with or without one of three configurations of Kirschner wire in 32 hemipelves obtained from 16 dogs. Reduction, assessed objectively and subjectively, was unaffected by Kirschner wire placement. Hemipelves repaired with Kirschner wire(s) were subjectively more stable prior to application of polymethylmethacrylate when manually assessed in multiple planes. Consistent incremental increases in stiffness, yield load, and maximum load sustained that were observed during biomechanical testing were not significant, with the exception that hemipelves repaired with two Kirschner wires had significantly greater yield loads than hemipelves repaired without Kirschner wires. The subjective results of this study support the use of at least one interfragmentary Kirschner wire to maintain reduction prior to polymethylmethacrylate application; however, fracture configuration and location may dictate the number and pattern of interfragmentary Kirschner wires used to maintain reduction prior to application of the polymethylmethacrylate. The objective results and observations made during biomechanical testing suggest that use of one or more interfragmentary Kirschner wires may enhance stability after polymethylmethacrylate application.

Métodos de fixação de fraturas mandibulares em cães: resistência mecânica à compressão

Foi testada a resistência mecânica à compressão em 30 hemimandíbulas coletadas de cadáveres caninos. Dez. hemimandíbulas foram mantidas íntegras (grupo 1 = controle). As outras 20 foram submetidas inicialmente a fraturas oblíquas simples, entre o segundo e terceiro pré-molares e, posteriormente, imobilizadas por meio do emprego de resina acrílica aplicada diretamente sobre as superfícies dentárias em conjunto com o fio metálico interdental (grupo 2) ou interfragmentar (grupo 3). A análise estatística mostrou diferença significativa entre os grupos (Gl&gt;G2&gt;G3). Foi possível concluir que o método empregado no grupo 2, além de ser menos invasivo e não ter o perigo de danificar as raízes dentárias, é mecanicamente mais resistente do que o utilizado no grupo 3.

Use of Cyanoacrylate in Facial Bone Fractures

It is not uncommon to encounter multiple bone fragments during open reduction of facial bone fractures. When these fragments are few and their size large, there is no problem. However, multiple, small, and thin bone fragments are difficult to handle, making accurate reduction with interfragmentary wires problematic. This is frequently encountered in fractures of the anterior maxillary wall, orbital floor, orbital roof, and frontal sinus. Therefore, many surgeons reconstruct the larger segments and discard the smaller segments. In this study, 10 patients who sustained facial fractures with multiple, small, and thin fragments were treated with tissue adhesive (n-butyl-2-cyanoacrylate). Postoperative three-dimensional computed tomography scans demonstrated excellent reconstruction following this technique.