Biomechanical Comparison of Three Repair Methods for Proximal Femoral Physeal Fractures in Shear and Tension

D. M. Tillson; J. K. Roush; R. M. McLaughlin; E. M. Gaughan; R. M. DeBowes

doi:10.1055/s-0038-1633086

Veterinary and Comparative Orthopaedics and Traumatology, Table of Contents

Vet Comp Orthop Traumatol 1994; 07(04): 136-139
DOI: 10.1055/s-0038-1633086

Original Research

Schattauer GmbH

Biomechanical Comparison of Three Repair Methods for Proximal Femoral Physeal Fractures in Shear and Tension

D. M. Tillson

¹From the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA

,

J. K. Roush

¹From the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA

,

R. M. McLaughlin

¹From the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA

,

E. M. Gaughan

¹From the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA

,

R. M. DeBowes

¹From the Department of Clinical Sciences, College of Veterinary Medicine, Kansas State University, Manhattan, Kansas, USA

› Author Affiliations

Abstract

Summary

Proximal femoral physeal fractures were created in femora harvested from 64 immature dogs and repaired with one of three repair techniques. Techniques used included a single lag screw placed distal to the trochanter, three divergent pins from below the trochanter, and two screws placed from the articular surface of the femoral head. The re-paired fractures were tested in tension and shear for strength and stiffness. The strength and stiffness were recorded by a hydraulic testing machine and the mode of failure was determined by visual inspection. Fractures repaired with a single lag screw and with the two screws were significantly stronger in tension than those repaired with multiple pins. Significant differences were not found between the repair techniques for shear strength or stiffness in neither tension nor shear. The modes of failure differed between the repair techniques.

Three techniques of proximal femoral physeal fracture repair; a single screw from below the greater trochanter, three divergent pins, and two screws placed from the articular sur-face, were tested in tension and shear. Fractures, created on in vitro femora, repaired with a single lag screw and the two screws, were significantly stronger in tension than those repaired with multiple pins. Significant differences were not found between the repair techniques for shear strength or stiffness in neither tension nor shear.

Keywords

Proximal femoral physeal fracture - biomechanical testing - physis - dogs

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References

References
1 Berzon JL. The classification and manage-ment of epiphyseal plate fractures. JAAHA 1980; 16: 651-8.
2 Salter RB, Harris WR. Injuries involving the epiphyseal plate. J Bone Joint Surg 1963; 45-A: 587-622.
3 DeCamp CE, Probst CW, Thomas MW. Internal fixation of femoral capital physeal injuries in dogs: 40 cases (1979-1987). J Am Vet Med Assoc 1989; 194: 1750-4.
4 Lee R. Proximal femoral epiphyseal separation in the dog. J Small Anim Pract 1976; 11: 669-79.
5 Marretta SM, Schrader SC. Physeal injuries in the dog: a review of 135 cases. J Am Vet Med Assoc 1983; 182: 708-10.
6 Schroeder EF. Recent progress in canine orthopedic surgery. North Amer Vet 1939; 20: 54-61.
7 Schroeder EF. The treatment of fractures in dogs. North Amer Vet 1933; 14: 27-31.
8 Denny HR. Simultanous epiphyseal separation and fractures of the neck and greater trochanter of the femur in the dog. J Small Anim Pract 1971; 12: 613-21.
9 Cawley AJ, Archibald J, Ditchfield WJB. Fractures of the neck of the femur in the dog: a technique for repair of fractures of the femoral neck. J Am Vet Med Assoc 1956; 129: 354-8.
10 Milton JL. Fractures of the femur. In: Textbook of Small Animal Surgery, 2nd ed. Slatter D. ed. Philadelphia: WB Saunders; 1993: 1805-16.
11 Brinker WO, Piermattei DL, Flo GL. Hand-book of Small Animal Orthopedics and Fracture Treatment. 2nd ed. Philadelphia: WB Saunders Company; 1990
12 Nunamaker DM. Fractures and dislocations of the hip joint. In: Textbook of Small Animal Orthopedics. Newton CD, Nunamaker DM. eds Philadelphia: JB Lippincott Company; 1985: 403-14.
13 Gilmore DR. Internal fixation of femoral fractures. In: Current Techniques in Small Animal Surgery, 3rd ed. Bojrab MJ. ed. Philadelphia: Lea and Febiger; 1990: 682-94.
14 Gibson KL, van Ee RT, Pechman RD. Femoral capital physeal fractures in dogs: 34 cases (1979-1989). J Am Vet Med Assoc 1991; 198: 886-90.
15 Aron DN, Kaddatz LA, Dueland R. A review of reduction and internal fixation of proximal femoral fractures in the dog and man. JAAHA 1979; 15: 455-62.
16 Hulse DH, Wilson JW, Abdelbaki YZ. Revascularization of femoral capital physeal fractures following surgical fixation. J Vet Orthop 1981; 2: 50-7.
17 Kuzma A, Sumner-Smith G, Miller C, McLaughlin R. A technique of repair of femoral capital epiphyseal fractures in the dog. J Small Anim Pract 1989; 30: 444-8.
18 Newton GT. Sciatic impairment following proximal femoral physeal fracture: Two case reports. JAAHA 1989; 25: 239-42.
19 Daly WR. Femoral head and neck fractures in the dog and cat: a review of 115 cases. Vet Surg 1978; 2: 29-38.
20 Belkoff SM, Millis DL, Probst CW. Biomechanical comparison of three internal fixations for treatment of slipped capital femoral epiphysis in immature dogs. Am J Vet Res 1992; 53: 2136-40.
21 Belkoff SM, Millis DL, Probst CW. Biomechanical comparison of 1-screw and 2-divergent pin internal fixations for treatment of slipped capital femoral epiphysis, using specimens obtained from immature dogs. Am J Vet Res 1993; 54: 1770-3.
22 Hulse DH, Wilson JW, Butler HC. Use of the lag screw principle for stabilization of femoral neck and femoral capital epiphyseal fractures. JAAHA 1974; 10: 29-36.
23 Sumner-Smith G. Observations on epiphyseal fusion of the canine appendicular skeleton. J Small Anim Pract 1966; 7: 303-11.
24 Anderson WD, Schlotthauer CF, Janes JM. Method for treatment of fractures of the head of the femoral neck in the dog. I. An experimental study. J Am Vet Med Assoc 1953; 158-60.
25 Chung SMK, Batterman SC, Brighton CT. Shear strength of the human femoral capital epiphyseal plate. J Bone Joint Surg 1976; 58-A: 94-103.
26 Evans HE, Christensen GC. Miller’s anatomy of the dog. 2nd ed. Philadelphia: WB Saunders Company; 1979
27 DeYoung DJ, Probst CW. Methods of internal fracture fixation; General principles. In: Textbook of Small Animal Surgery, 2nd ed. Slatter D. ed. Philadelphia: WB Saunders; 1993: 1610-31.
28 Pardo AD. Methods of internal fracture fixation; Cerclage wiring and tension band fixation. In: Textbook of Small Animal Surgery, 2nd edn. Slatter D. ed. Philadelphia: WB Saunders; 1993: 1631-41.
29 Hulse DH, Hyman B. Fracture biology and biomechanics. In: Textbook of Small Animal Surgery, 2nd ed. Slatter D. ed. Philadelphia: WB Saunders; 1993: 1595-1603.
30 Springer ER, Lachiewicz PF, Gilbert JA. Internal fixation of femoral neck fractures: a comparison biomechanical study of Knowles pins and 6.5 mm cancellous screws. Clin Orthop 1991; 267: 85-92.
31 Perren SM. Primary bone healing. In: Disease Mechanisms in Small Animal Surgery, 2nd ed. Bojrab MJ. ed. Philadelphia: Lea & Febiger; 1993: 662-70.
32 Lambrechts NE, Verstraete FJM, Sumner-Smith G. et al. Internal fixation of femoral neck fractures in the dog - an in vitro study. VCOT 1993; 6: 188-93.