Transfixation Pins Research Articles

Repair of femoral fractures in calves via external skeletal fixator with intramedullary pin tie-in.

To describe the success rate and associated complications of external skeletal fixator/intramedullary pin tie-in for calf femoral fracture fixation. Clinical retrospective. Ten calves, less than 30 days old, with diaphyseal/metaphyseal femoral fractures. Medical records were reviewed from the University of Wisconsin from 2000 to 2020. Fractures were repaired using open reduction and fixation. An intramedullary Steinman pin was placed, exiting near the greater trochanter, and utilized for fracture reduction. Bicortical transfixation pins were placed distal and proximal to the fracture site. Poly(methyl methacrylate) (PMMA)-filled tubing connected the transfixation pins and proximal intramedullary pin, creating a Type 1a external skeletal fixator (ESF) tie-in. Follow up was obtained via medical records and phone interviews. Short-term survival rate was 7/10 (70%). Postanesthetic death occurred once. Postoperative complications occurred in all remaining cases. The most common findings were transfixation pin tract lucency and lameness (6/9 cases), implant dysfunction (5/9 cases), and infection (4/9 cases). Three of five cases with long-term follow up survived; all went on to productive careers. Although patients were prone to postoperative complications, short-term survival was comparable to previous reports. The external skeletal fixator/intramedullary (ESF/IM) pin tie-in is less expensive and offers comparable success rates to other methods, providing a lower cost option for calf femoral fracture repair.

Effects of Transfixation Pin Positioning on the Biomechanical Properties of Acrylic External Skeletal Fixators in a Fracture Gap Model.

The aim of this study was to evaluate the biomechanical effects of transfixation pin positioning in acrylic columns of external skeletal fixators (ESF). Twenty-four type I acrylic ESF were built simulating a fracture gap-model. Transfixation pins were placed centric (n = 12) or eccentric at ¼ of the column diameter (n = 12) in the acrylic columns. Six constructs from each group were subjected to axial compression and four-point bending tests. Stiffness, yield load and mode of failure were recorded. Stiffness was not influenced by centring (p = 0.373), but it was higher in four-point bending than in axial compression (p < 0.001). Pin positioning had no influence on the yield (p = 0.535) and failure loads (p = 0.715) in axial compression, nor on the yield load in bending (p = 0.135). Eccentric pin positioning decreased failure loads by 28% in bending (p < 0.001). Eccentric position of transfixation pins within the acrylic columns alters the biomechanical properties of type I ESF constructs. While acrylic offers several advantages, when forming the columns, frame strength will be optimized if pins are centrally located.

Ex vivo postimplantation biomechanical properties of a press-fit cementless femoral stem with transfixation pin for canine total hip replacement.

To compare ex vivo postimplantation biomechanical characteristics of 3 implants for canine total hip replacement: a cementless press-fit femoral stem with a pin in the femoral neck (p-pfFS), a press-fit cementless femoral stem without this pin (pfFS), and a cemented femoral stem (cFS). 18 cadaveric femurs from 9 dogs. Femurs were assigned randomly to 3 groups, and biomechanical testing was performed by measuring vertical displacement during cyclic loading and resistance to failure with compression parallel to the longitudinal axis of the femur. Force-displacement curves were assessed for failure tests, and work necessary for failure was calculated. No significant differences were observed in vertical displacement during cyclic loading (P = .263) or work necessary for failure (P = .079). Loads to failure for cFS and p-pfFS implants were significantly greater than that for the pfFS, but no significant difference in load to failure was observed between cFS and p-pfFS implants (P = .48). Cementless femoral stems with a transfixation pin offer significantly greater immediate resistance to failure to compressive loads parallel to the longitudinal axis of the femur than standard cementless stems, and a level of stability comparable to that of cemented stems. p-pfFS implants may be valuable in total hip replacement, potentially reducing the risk of fracture during the early postoperative period prior to osteointegration.

Nonpathological phalangeal fractures in cattle: 17 cases (2004-2020).

To characterize clinical findings and outcomes for cattle with nonpathological phalangeal fractures. 17 cattle with nonpathological phalangeal fractures. Medical records of a teaching hospital were reviewed to identify cattle treated for nonpathological phalangeal fracture between May 2004 and May 2020. Information extracted from the records of study-eligible animals included signalment, history, clinical and diagnostic imaging findings, treatment, and survival to hospital discharge. Long-term outcome was assessed by telephone communication with owners. 9 bulls and 8 heifers or cows (age range, 1 to 7 years) of various breeds and uses were evaluated. Five of the 9 bulls were bucking stock, which were overrepresented in the study population. Seven animals had 8 distal phalanx fractures; 10 animals had 11 proximal phalanx fractures. Eight animals were treated by application of a hoof block on the unaffected adjacent digit, 7 animals were treated with a distal limb (n = 6) or transfixation pin (1) cast in addition to a hoof block, 1 animal was treated with a hoof trim to elevate and alleviate weight bearing on the affected digit, and 1 animal was euthanized immediately after diagnosis. Sixteen animals survived to hospital discharge. Follow-up was obtained for 12 animals, of which 9 returned to functionable use and 3 were culled. Results suggested cattle with a nonpathological phalangeal fracture have a favorable prognosis for return to function following application of a hoof block to the unaffected adjacent digit with or without a distal limb cast.

Radius and ulnar fracture in a Holstein-Friesian heifer repaired by transfixation pinning and casting

ホルスタイン種の雌育成牛（238 日齡，体重247kg）における左橈尺骨骨幹の非開放性斜骨折と診断した症例について，貫通固定ピンとフルリムキャストを用いた貫通固定ピンキャスト（TPC）法による治療を行った．術中は塩酸キシラジンの静脈内投与（0.2mg/kg）で仰臥位保定後，塩酸メデトミジンの定量持続点滴（20μg/kg/hr）にて鎮静を維持し，2% リドカイン10mℓによる腕神経叢ブロックで疼痛管理した．患肢の牽引と骨把持鉗子により骨折端を合わせて固定し，整形外科用パワードリルを用いて直径4.0mm の貫通固定ピンを，骨折端を挟む遠位および近位側橈骨骨幹にピンを各2 本，近位および遠位骨の骨折端および骨折面を貫通するようにピン3 本をそれぞれ貫通させた．さらにその上からフルリムキャストを巻き，キャスティングテープ表面から露出したピンは約4cm で切断し，即時重合レジンで各ピンの切断部を被覆・結合した．手術時間は80 分であった．症例は覚醒後すぐに起立歩行可能であり同日中に退院，単房で個別飼育とし，術後1 週間の抗生物質製剤投与を行った．術後48日目にX線所見にて明瞭な仮骨形成を認めたため，手根関節以下の遠位側のキャスティングテープ部分を切断・除去した．術後81 日目にキシラジン鎮静下でTPC 全てを除去し治癒とした．治療期間中および治療後の起立歩行は問題なく，その後の発育も順調であった．牛の橈骨骨折では内固定で高い治癒率が報告されているが治療にかかるコスト，手術時間および難易度，術後合併症のリスクにおいてTPC は内固定よりも生産動物である本症例にメリットを与えた．牛の骨折治療では体重が予後に影響を与え，さらにTPC では使用する貫通固定ピンの太さ・本数・配置ならびにフレームであるキャストの長さが，骨折端の安定性や固定の強度に影響を与える．体重が重い個体の橈骨骨折をTPC にて治療した報告は限られており，本症例は今後の治療の際の良いモデルとなった．

The Effect of Reducing the Bone to Cast Distance in an Equine Transfixation Pin Cast: An Ex Vivo Biomechanical Study.

The aim of this study was to evaluate the effect of reducing the bone to cast distance on the resistance of the pin to cyclic loading in equine transfixation pin casts. Eleven pairs of cadaveric equine third metacarpal bones were prepared and one 6.3/8.0 mm transfixation pin was placed in standard fashion 10 mm proximal to the distal physeal scar into each bone. One metacarpus of each pair was tested with a distance of 10 mm (10 mm group) and the contralateral metacarpus with a distance of 20 mm (20 mm group) between the outer cortex of the bone and the fixation of the pin. Eight pairs were tested using a simplified test set-up in which the pins were fastened at both ends to polyoxymethylene-copolymer sleeves. The pins of the remaining three pairs of bones were incorporated into a fibreglass cast. All specimens were tested under cyclic loading until failure of the pin in axial compression. All pins failed uni- or bilaterally at clinically relevant load levels. Pins of the 10 mm group endured significantly (p < 0.05) higher load levels and total number of cycles until failure compared with the pins of the 20 mm group. The distance between the bone surface and the cast at the location of pin insertion has a significant effect on resistance of the pins to cyclic loading. Therefore, the amount of padding applied underneath an equine transfixation pin cast can have an influence on the overall stability and durability of the construct.

Functional Evaluation of Anterior Cruciate Ligament Reconstruction – Comparison of Two Graft Fixation Techniques in the Femoral Tunnel

Background. There are several fixation techniques and devices available for ACL reconstruction, which differ significantly in their efficacy. There are no studies in the literature comparing femoral transfixation pins (Rigidfix) and adjustable loop (Rigidloop) devices. We compared the outcomes of these devices in our study.Methods. A retrospective observational cohort study was done between November 2017 and June 2019. Of the total 95 cases, initial 47 patients had undergone graft fixation with Rigidfix and the subsequent 48 underwent fixation with Rigidloop. Clinical and functional evaluation of these patients was done at one-year follow-up and the results were compared.Results. The two groups were homogenous demographically. Though better outcome and functional scores were noted in the Rigidfix group, these observations were not statistically significant. Two Rigidloop cases had side to side difference in KT-1000 reading of > 5 mm with a fair outcome.Conclusions. Fixation of the hamstring autograft on the femoral side using Rigidfix cross pin and Rigidloop adjustable suspensory devices provide statistically comparable stability. The Lysholm grading and IKDC-2000 functional scores between both the groups were similar at one-year follow-up and hence can be used interchangeably intraoperatively if a need arises without any consequences

Comparison of torsional properties between a Fixateur Externe du Service de Santé des Armées and an acrylic tie-in external skeletal fixator in a red-tailed hawk (Buteo jamaicensis) synthetic tibiotarsal bone model.

To compare the torsional mechanical properties of 2 external skeletal fixators (ESFs) placed with 2 intramedullary pin (IP) and transfixation pin (TP) size combinations in a model of raptor tibiotarsal bone fracture. 24 ESF-synthetic tibiotarsal bone model (polyoxymethylene) constructs. Synthetic bone models were fabricated with an 8-mm (simulated fracture) gap. Four types of ESF-synthetic bone model constructs (6/group) were tested: a FESSA with a 1.6-mm IP and 1.6-mm TPs, a FESSA with a 2.0-mm IP and 1.1-mm TPs, an acrylic connecting bar with a 1.6-mm IP and 1.6-mm TPs, and an acrylic connecting bar with a 2.0-mm IP and 1.1-mm TPs. Models were rotated in torsion (5°/s) to failure or the machine angle limit (80°). Mechanical variables at yield and at failure were determined from load deformation curves. Effects of overall construct type, connecting bar type, and IP and TP size combination on mechanical properties were assessed with mixed-model ANOVAs. Both FESSA constructs had significantly greater median stiffness and median torque at yield than both acrylic bar constructs; FESSA constructs with a 1.6-mm IP and 1.6-mm TPs had greatest stiffness of all tested constructs and lowest gap strain at yield. No FESSA constructs failed during testing; 7 of 12 acrylic bar constructs failed by fracture of the connecting bar at the interface with a TP. Although acrylic bar ESFs have been successfully used in avian patients, the FESSA constructs in this study were mechanically superior to acrylic bar constructs, with greatest benefit resulting from use with the larger TP configuration.

Insertional characteristics of three types of transfixation pin taps in third metacarpal bones from equine cadavers.

To compare heat generation and mechanical bone damage achieved with 2 tapered and 1 cylindrical transfixation pin taps in third metacarpal bones from equine cadavers. 18 pairs (36 specimens) of third metacarpal bones from euthanized horses with no known metacarpal disease. In each bone, an investigator drilled 3 holes for placement of a 6.3-mm cylindrical transfixation pin, a 6.3-mm tapered pin using a prototype tapered tap, and a 6.3-mm tapered pin using a revised tapered tap. One bone of each pair was tapped by hand and the other with an electric drill. Temperatures of the drill bits, reamers, and taps were measured and used to compare heat generation among tap groups and tapping methods (hand vs power tapping). Macrodamage (all bone pairs) and microdamage (6 bone pairs) were assessed. The revised tapered tap resulted in less heat generation and less total thread microdamage, compared with the prototype tapered and cylindrical taps. Power tapping created less bone damage but higher temperatures than did hand tapping for all bone groups. The revised tap design for tapered pin insertion was superior to the prototype tap design and yielded similar or less bone damage than achieved with cylindrical pin insertion in equine third metacarpal bone specimens. We recommend careful hand tapping for tapered pin insertion rather than power tapping, which generated greater heat. The revised tapered tap could be expected to perform better than a cylindrical pin tap in terms of thermal and mechanical microdamage and should be used for insertion of tapered transfixation pins.

Surgical treatment of a complicated distal tibia epiphyseal Salter–Harris type I fracture in a yearling

SummaryThis article describes the management of a complicated distal epiphyseal Salter–Harris type I fracture of the left tibia in a yearling horse. Closed reduction and internal fixation was attempted in the first surgery using tension band wires. Due to fracture instability 2 weeks after surgery, a full‐limb transfixation pin cast was applied to the tibia and maintained for 7 weeks to prevent further fracture displacement and to achieve axial alignment. The full‐limb cast was maintained for a total of 12 weeks, including the time with the transfixation pin cast. Cast sores and tendon laxity resolved without further complications. Ten months after the first surgery, the fracture had radiographically healed, and the horse was sound at the walk and trot in a straight line.

Finite Element Analysis of Six Transcortical Pin Parameters and Their Effect on Bone-Pin Interface Stresses in the Equine Third Metacarpal Bone.

The objectives of this study were to validate a finite element model of the equine distal limb transfixation cast and to determine the effect of six transcortical pin parameters on bone-pin interface (BPI) stresses in the third metacarpal bone. A transfixation cast finite element model was developed from a computed tomography scan of the third metacarpal bone and modelled pin elements. The model was validated by comparing strain measured around a 6.3-mm transfixation pin in the third metacarpal bone with the finite element model. The pin parameters of diameter, number, location, spacing, orientation and material were evaluated by comparing a variety of pin configurations within the model. Pin diameter and number had the greatest impact on BPI stress. Increasing the diameter and number of pins resulted in lower BPI stresses. Diaphyseal pin location and stainless-steel pins had lower BPI stresses than metaphyseal location and titanium alloy pins, respectively. Offset pin orientation and pin spacing had minimal impact on BPI stresses during axial loading. The results provide evidence that diameter and number are the main pin parameters affecting BPI stress in an equine distal limb transfixation cast. Configurations of various pin size and number may be proposed to reduce BPI stresses and minimize the risk of pin related complications. Further refinement of these models will be required to optimize pin configurations to account for pin hole size and its impact on overall bone strength.

Closing wedge ostectomy with transfixation pin-cast stabilization for correction of angular limb deformities of the metatarsophalangeal region in four cattle.

4 calves were evaluated because of lameness and an angular limb deformity of the metatarsophalangeal region. 3 calves (ages, 5 days, 10 days, and 1 month) had a congenital varus deformity of the metatarsophalangeal region characterized by medial subluxation of the first phalanx of digits 3 and 4 at the metatarsophalangeal joints. A 6-month-old heifer had a valgus deformity of the metatarsophalangeal region secondary to a malunion of a Salter-Harris type II fracture. The degree of deformity angulation ranged from 16° to 54° for the 4 patients. A closing wedge ostectomy with transfixation pin-cast application was performed on the affected limb of all 4 patients. The ostectomy healed with only minor complications (disuse osteopenia distal to the transfixation pins [n = 4] and cast sores [1]) that were easily resolved with no long-term adverse effects. Duration of follow-up for the 4 patients ranged from 6 to 17 months, and the owners reported satisfactory ambulation with no (n = 2) or only mild (2) residual lameness in the affected limb. Results suggested that a closing wedge ostectomy with transfixation pin-cast stabilization is an alternative for management of angular limb deformities of the metatarsophalangeal region in cattle. Such treatment improved the quality of life for all 4 patients. However, 2 of the 4 patients had congenital deformities confirmed to be heritable. There are ethical concerns associated with treating animals with heritable disorders, and exhibition and breeding of such animals should be avoided.

Long bone fractures in cattle: A retrospective study of treatment and outcome in 194 cases

The present retrospective study investigated the localization, cause, treatment and healing of long bone fractures in cattle. Over a period of ten years, medical records of 194 cattle of all ages with a long bone fracture, presented at the Clinic for Ruminants with Ambulatory and Herd Health Services at LMU Munich, were evaluated. The majority of patients (n = 131, 67.5%) were younger than two weeks of age. Of these, 118 calves sustained the fracture on the day of birth (60.8%). An obstetrical assistance was found in 57.4% (n = 58) of birth-related cases as a fracture cause. The femur was most frequently affected in calves aged up to two weeks (n = 35; 26.7%). The second most frequent fractures occurred in the metacarpus (n = 31; 22.9%) in this age group, followed by metatarsus (n = 28; 21.4%) and tibia (n = 27; 20.6%). Fractures of the antebrachium (n = 9; 6.9%) and the humerus were rare (n = 1; 0.8%). A total of 194 patients were diagnosed with 50 femur fractures (25.8%), 53 metacarpal fractures (27.3%), 43 metatarsal fractures (22.2%), 30 tibial fractures (15.5%), 11 antebrachial fractures (5.7%) and 7 humeral fractures (3.6%). Of the 194 animals, 78 (40.2%) had to be euthanized, 42 of them (53.8%) without treatment. In 150 patients, treatment was initiated, of which 110 patients (73.3%) were dismissed healthy from the clinic. Among the conservative treatment methods were stall rest, casts, casts combined with a U-shaped metal rail (walking casts) and the Thomas splint. Surgical therapy (internal fixation with plates or screws, transfixation pin casts) was used to treat 65 animals (33.5%). While 86.9% (74 out of 85) of the conservatively treated animals left the clinic alive, it were only 58.1% (36 out of 65) animals after surgical treatment. In the newborn calves, colostrum supply had a significant effect on the success of the treatment. If the gamma-glutamyl transferase concentration was below 200IU/L in the calves aged under 4 days, the healing rate was significantly different from the cure rate of sufficiently immunized patients (26.9% (7 out of 26) vs. 65.3% (47 out of 72), P = 0.001).

Extension-block pinning to treat bony mallet finger: Is a transfixation pin necessary?

Extension-block pinning is a popular treatment for mallet fractures, but it is associated with several pitfalls. Of note, transfixation Kirschner wires used to fix the distal interphalangeal (DIP) joint may cause iatrogenic nail bed injury, bone fragment rotation, chondral damage, or osteoarthritis. The objective of this study was to determine whether a transfixation pin was necessary for extension-block pinning in the treatment of bony mallet fracture. Patients were treated with a pin-orthosis extension-block technique if they had been diagnosed with a type IVB mallet fracture according to Doyle's classification. Radiological outcomes were evaluated based on postoperative X-ray results, and functional outcomes were evaluated using Crawford's criteria. Thirteen patients (9 males and 4 females) with a mean age of 26 years were included. The mean time between the injury and surgery was 3.3 days, and the mean follow-up period was 8.2 months (range: 4-12 months). Radiographic bone union was achieved in all patients within an average of 5.1 weeks (range: 5-6 weeks). At the final follow-up, the DIP joint had an average degree of flexion of 76.1° (range: 65°-80°) and an average extension deficit of 3.84° (range: 0°-15°). According to Crawford's criteria, 8 patients had excellent results, 4 patients had good results, and 1 patient had a fair result. No patient reported pain at the final follow-up. Satisfactory clinical and radiological outcomes were obtained with the pin-orthosis extension-block technique. Future prospective and randomized studies are justified to confirm the efficacy of this technique.

Clinical findings, treatment, and outcome in 11 dairy heifers with breakdown injury due to interosseous medius muscle rupture.

To describe the diagnosis, treatment, and prognosis of fetlock breakdown due to interosseus medius muscle rupture in cattle. Retrospective clinical study. Dairy heifers with unilateral or bilateral interosseus medius muscle rupture (n = 11). Breakdown injury due to rupture of the interosseus medius muscle was documented clinically, radiographically, and ultrasonographically. Breakdown was bilateral in 4 heifers (3 in forelimbs, 1 in hind limbs) and unilateral in 7 (all hind limbs). One heifer with severe bilateral hind limb breakdown was slaughtered and the remaining 10 were treated by transfixation pin cast (1 heifer), box rest (n = 2), and/or a cast and splint (7). Hyperextension of the fetlock and hyperflexion of the proximal interphalangeal joints during weight bearing were characteristic for interosseus muscle breakdown. Ultrasonographically, the origin and body of the interosseus muscle and the branches to the sesamoid bones were primarily affected by the rupture. Conservative treatment was successful (used for their intended purpose) in 8 of 9 heifers with a median lifespan of 32 months after discharge from the clinic (range 6-83). Rupture of the interosseus medius muscle in young cattle may be more common than previously suggested in the literature. Imaging with ultrasound allowed more detailed localization of lesions of the musculo-tendinous structure. Interosseus medius muscle rupture had a favorable prognosis when treated conservatively in these heifers.

Emerging Trends in Anterior Cruciate Ligament Reconstruction.

Anterior cruciate ligament (ACL) reconstruction is one of the most commonly performed and researched orthopedic procedures. As technology and comparative research have advanced, surgical practices have changed to achieve a superior outcome. Our group performed a survey of orthopedic surgeons to evaluate current practice trends and techniques as a follow-up to similar surveys performed in 1999 and 2006. In a survey between 2013 and 2014 consisting of 35 questions regarding the surgical technique, graft choice, fixation method, and perioperative care in ACL reconstruction was sent electronically to the members of the American Orthopaedic Society of Sports Medicine and the Arthroscopy Association of North America. Responses were recorded and compared with previous results. Survey responses were received from 824 active surgeons. Of the respondents, 89.4% are subspecialty trained, 98% of which in sports medicine. Preoperatively, full-knee extension was the only "very significant" factor in surgical timing. Approach preference via an arthroscopic-assisted single-incision approach predominated (89%)-similar to earlier results. Bone-patellar-tendon-bone use decreased relative to hamstring allograft at 45 and 41%, respectively. Tibial tunnel placement shifted anteriorly and femoral tunnel placement shifted posterosuperiorly as compared with the results obtained 5 years ago. Femoral drilling through a low medial portal was preferred in 47% of responses, increased from 15%. Preferred fixation on both the tibial and femoral sides was either metal or bioabsorbable interference screws. The use of transfixation pins and other devices decreased. Postoperative rehab protocols did not significantly change, 68.7% preferred full-weight bearing, 55% using a range of motion knee brace locked in extension, 66.4% starting physical therapy 1 week postoperatively, with unrestricted activity at 6 to 9 months. Overall, an increasing trend toward using hamstring autograft and drilling the femoral tunnel through an accessory portal in primary ACL reconstruction was observed. This may reflect recent literature supporting more anatomic reconstruction of the ACL. Considerations including deep venous thrombosis prophylaxis, brace use, timing of surgery, weight-bearing restrictions, physical therapy, graft choice in athletes, and return to activity remained largely unchanged.

Current status of ACL reconstruction in Germany.

Reconstruction of the anterior cruciate ligament (ACL) is characterized by a variety of possibilities concerning its implementation. Different choices for grafts, fixation methods and tunnel positioning, as well as diverse technical tools are available and have clinical significance. Besides specific pre- and post-operative procedures, different indications for surgery and further surgeon-/clinic-related factors add variability to the treatment. In response to the lack of descriptive statistics about the implementation of these factors and the increasing numbers of ACL reconstructions this study has been conducted to display the current state of the treatment for ACL tears throughout Germany. 709 clinics with surgical and orthopedic departments were provided an online-questionnaire that surveyed their statistical records (e.g. annually implemented operations, number of surgeons, duration of operations), implemented techniques (e.g. choice of grafts, construction of drilling tunnel, tibial/femoral fixation) and personal assessment (e.g. frequency/cause of graft failure, frequency/handling of infection). The response rate was 22% (n=155). Based on the statistical records a specialized group within the respondents was identified, enabling a cross-comparison between high- and low-volume surgeons. On average, the German orthopedic surgeons in the clinics surveyed annually performs 35 ACL reconstructions, with each operation lasting an average of 67min. After subdividing the data with references to annually performed surgeries into high- and low-volume-surgeons, differences and common features between the subgroups become apparent. Differences between high- and low-volume-surgeons, respectively, show shorter duration of both ACL reconstructions (55 vs. 71min) and revision ACL reconstructions (75 vs. 90min), higher membership rates in professional associations (83 vs. 38% have at least one membership), more frequent implementation of stability examinations (47 vs. 21%) and different frequencies of femoral drilling techniques (using the anterolateral portal in 71 vs. 54%). With reference to evaluating operation dates, choosing grafts and assessing reasons for graft failure both groups share commonalities, as well as regarding the predominant use of monofixation for femoral fixation (88% of the participants-mainly with endobutton in 38% and transfixation pin in 27%) and for tibial fixation (81% of the participants-mainly with bioabsorbable screw in 60%). The treatment of ACL tears in the group of German clinics studied is characterized by a variety of surgical possibilities. This condition might reflect the entirety of clinics reconstructing ACL in Germany. For the first time, a descriptive statistical survey was implemented to display this variety and to provide insight into the current status quo. Within the entirety of surgeons implementing ACL reconstruction a specialized subgroup with a particular expertise seems to exist.

Comparison of 2 Equine Transfixation Pin Casts and the Effects of Pin Removal

To (1) compare strain on the dorsal aspect of the proximal phalanx (P1) between 2 types of transfixation pin casts (TPC) and (2) evaluate the change in strain as the pins are removed. Experimental. Equine cadaver forelimbs (n = 10 pair). Each limb of a pair was assigned to 1 of 2 TPC constructs. Construct 1 consisted of a TPC with 2 positive profile, centrally threaded pins placed in the distal aspect of the third metacarpus (MC3) and construct 2 had 4 smooth Steinmann pins placed similarly. A strain gauge was mounted on P1 and axial compression (444.8-5337.9 N) applied. One forelimb of each pair was tested as a control with no construct in place. The 2 TPC groups were retested after removal of 1 proximal (n = 5 limbs) or distal (n = 5) pin from construct 1, and 2 proximal (n = 5) or distal (n = 5) pins from construct 2. Limb specimens were retested after all pins had been removed. There was a significant decrease in strain between both TPC constructs and the non-casted control at all loads except 444.8 N. There was no significant difference in strain reduction between the 2 TPC constructs. After proximal pin removal there was a 7% (construct 1) and 10% (construct 2) increase in strain. When distal pins were removed there was a 0.5% (construct 1) and 1% (construct 2) increase in strain. The difference between proximal and distal pin removal was only statistically different from each other at high loads. Both constructs provided equivalent reduction in strain. Removal of the proximal pin(s) increased the strain.

Transfixation Pinning and Casting of a Comminuted Metacarpal Fracture in a 870 kg Bull

To report metacarpal fracture repair in a bull. Clinical report. Simmental bull (n = 1; 870 kg). A comminuted right metacarpal fracture was repaired using 2 transfixation pins (6 mm diameter) through the distal metaphysis and diaphysis of the radius and a full limb synthetic resin cast. Slight bending of both pins occurred 1 day after surgery. Both pins were loose and removed at 31 days and a full-limb cast reapplied. The cast was changed at approximately -4 week intervals. On day 50, the right carpus had moderate overextension and a valgus deformity. An exercise program was started on day 62, and on day 110, the cast was replaced with a Robert-Jones-bandage. At 130 days there was circumferential callus formation and the bull was discharged. At 6.5 months, overextension of the right carpus had resolved and carpal valgus had improved. The bull returned to at 7.5 months after surgery, and was successfully used for 4 years. For highly valuable cattle like this breeding bull, a surgical treatment of such a fracture should be attempted despite a primarily poor prognosis.

Use of a modified transfixation pin cast for treatment of comminuted phalangeal fractures in horses

To (1) report a modified transfixation pin cast technique, using dorsal recumbency for fracture reduction, distal positioning of the pins in the epiphysis and distal metaphysis, and a hybrid cast, combining plaster of Paris (POP) and fiberglass casting, and (2) report outcome in 11 adult horses. Case series. Adult horses (n = 11) with comminuted phalangeal fractures. Horses were anesthetized and positioned in dorsal recumbency. The phalangeal fracture was reduced by limb traction using a cable attached to the hoof. Screw fixation in lag fashion of fracture fragments was performed when possible. Transfixation casting was performed using two 6.3 mm positive profile centrally threaded pins with the 1st pin placed in the epiphysis of the metacarpus/tarsus at the center of, or slightly proximal to, the condylar fossa and the 2nd one 3-4 cm proximal. A hybrid cast was applied. Forelimbs were involved in 9 horses and the hind limb in 2. Pins were maintained for a minimum of 6 weeks. No pin loosening was observed at the time of removal (6-8 weeks). A pony fractured the distal aspect of the metacarpus at the proximal pin. Nine horses survived (82%); none of the horses developed septic arthritis despite the distal location of the distal pin, close to the fetlock joint. This modified transfixation pin casting technique was associated with good pin longevity and could reduce the risk of secondary pin hole fractures and pin loosening.