Biomechanical comparison of pin and tension-band wire fixation with a prototype locking plate fixation in a transverse canine patellar fracture model

Summary

Objective: To compare a locking plate (LP) with pin and tension-band wire (pin/TBW) for fixation of mid-patellar transverse fractures.

Materials and methods: Cadaveric canine stifle joints from 10 adult mixed breed dogs (23–36 kg) were used. Mid-patellar transverse osteotomies were randomly stabilized (in pairs) with either pin/TBW or a prototype LP. Cyclic loads (1 Hz, 500 cycles) at 100% body weight (90°-135° stifle joint extension), were applied. Survival or failure of constructs was defined as <2 mm fracture gap distraction at 500 cycles, or ≥ 2 mm fracture gap distraction at the number of cycles sustained, respectively. Number of cycles at failure and distraction gap were compared with a paired Student’s t-test, and a survival analysis performed with a Mantel-Cox test. All constructs that survived cyclic testing were tested in single cycle load to failure (1.0 mm/sec; 110° stifle joint extension); yield strength was compared with a Wilcoxon rank sum test. Significance was set at p <0.05.

Results: All 10/10 LP and three out of 10 pin/ TBW fixations survived cyclic testing. Survival analysis, number of cycles at failure, and distraction gap all were significantly different between the two groups (p = 0.0011, p = 0.0013, and p <0.0001, respectively). Construct yield strength was not significantly different (p = 0.1273).

Conclusions: The failure mode with pin/TBW was consistently similar to failures observed clinically. The LP demonstrated consistent, reliable and stable fixation.

This work was performed at the Biomechanics Orthopedic Research Laboratory, Cummings School of Veterinary Medicine at Tufts University, North Grafton, MA, USA.

Keywords

Biomechanical testing - orthopaedic implant - fracture gap - canine - patella

• References

• 1 Arnoczky SP, Tarvin GB. Surgery of the stifle: the patella (part II). Compend Contin Educ Pract Vet 1980; 2: 200-207.
• 2 Tomlinson J. Fractures of the patella. In Johnson AL, Houlton JEF, Vannini R. editors. AO Principles of Fracture Management in Dogs and Cats. 1st ed. Davos Platz, Switzerland: Georg Thieme Verlag; 2005. pg 305-310
• 3 Carpenter JE, Kasman RA, Patel N. et al Biomechanical evaluation of current patella fracture fixation techniques. J Orthop Trauma 1997; 11: 351-356.
• 4 Melvin JS, Mehta S. Patellar fractures in adults. J Am Acad Orthop Surg 2011; 19: 198-207.
• 5 Wild M, Eichler C, Thelen S. et al Fixed-angle plate osteosynthesis of the patella- an alternative to tension wiring?. Clin Biomech 2010; 25: 341-347.
• 6 Kowaleski MP, Boudrieau RJ, Pozzi A. Stifle Joint. In Tobias KM, Johnston SA. editors Veterinary Surgery Small Animal. 1st ed. St Louis, Missouri: Elsevier; 2012. pg 991-993
• 7 Piermattei DL, Flo GL, DeCamp C. Fracture of the femur and the patella. In Piermattei DL. Flo GL. editors Brinker, Piermattei, and Flo's Handbook of Small Animal Orthopedics and Fracture Repair. 4th ed Philadelphia, PA: Saunders; 2006. pg 557-560
• 8 Vasseur PB. Stifle joint. In Slatter D. editor. Textbook of Small Animal Surgery. 3rd ed. Philadelphia, PA: Saunders; 2003. pg 2090-2133
• 9 Burvant JG, Thomas KA, Alexander R. et al Evaluation of methods of internal fixation of transverse patella fractures: a biomechanical study. J Orthop Trauma 1993; 8: 147-153.
• 10 Bostman O, Kiviluoto O, Santavirta S. et al Fractures of the patella treated by operation. Arch Orthop Trauma Surg 1983; 102: 78-81.
• 11 Fortis AP, Milis Z, Kostopoulos V. et al Experimental investigation of the tension band in fractures of the patella. Injury 2002; 22: 489-493.
• 12 Rabalais RD, Burger E, Lu Y. et al Comparison of two tension-band fixation materials and techniques in transverse patella fractures: a biomechanical study. Orthop 2008; 31: 1-5.
• 13 Weber MJ, Janecki CJ, McLeod P. et al Efficacy of various forms of fixation of transverse fractures of the patella. J Bone Joint Surg Am 1980; 62: 215-220.
• 14 Betts CW, Walker M. Lag screw fixation of a patellar fracture. J Small Anim Pract 1975; 16: 21-25.
• 15 Abercromey RH. Patella and fabellae. In Coughlan A, Miller A. editors. BSAVA Manual of Small Animal Fracture Repair and management anagement. Cheltenham, UK: BSAVA; 1998. pg 293-301
• 16 Alvarenga J. Patellar fracture in the dog. Mod Vet Pract 1973; 7: 43-44.
• 17 Denny HR, Butterworth SJ. The stifle. In Denny HR, Butterworth SJ. editors. A Guide to Canine and Feline Orthopaedic Surgery. 4th ed. Oxford, UK: Blackwell Science; 2000. pg 512-554
• 18 Harari JS, Person M, Berardi C. Fractures of the patella in dogs and cats. Compend Contin Educ Pract Vet 1990; 12: 1557-1562.
• 19 McCurnin DM, Slusher R. Tension band wiring of a fractured patella. Vet Med Sm Anim Clin 1975; 70: 1321-1323.
• 20 White RA. Bilateral patellar fracture in a dog. J Sm Anim Pract 1977; 18: 261-265.
• 21 Miller MA, Liu W, Zurakowski D. et al Factors predicting failure of patella fixation. J Trauma Acute Care Surg 2012; 72: 1051-1055.
• 22 Smith ST, Cramer KE, Karges DE. et al Early complications in the operative treatment of patella fractures. J Orthop Trauma 1997; 11: 183-187.
• 23 Thelen S, Schneppendahl J, Jopen E. et al Biomechanical cadaver testing of a fixed-angle plate in comparison to tension wiring and screw fixation in transverse patella fractures. Injury 2012; 43: 1290-1295.
• 24 Thelen S, Schneppendahl J, Baumgärtner R. et al Cyclic long-term loading of a bilateral fixed-angle plate in comparison with tension band wiring with K-wires or cannulated screws in transverse patella fractures. Knee Surg Sports Traumatol Arthrosc 2013; 21: 311-317.
• 25 Wild M, Thelen S, Jungbluth P. et al Fixed angle plates in patella fractures - A pilot cadaver study. Eur J Med Res 2011; 16: 41-46.
• 26 Matejčić A, Smiljanić B, Bekavac-Bešlin M. et al The basket plate in the osteosynthesis of communited fractures of distal pole of the patella. Injury 2006; 37: 525-530.
• 27 Jöckel JA, Brunner A, Thormann S. et al Elastic stabilisation of proximal humeral fractures with a new percutaneous angular stable fixation device (ButtonFix®): a preliminary report. Arch Orthop Trauma Surg 2010; 130: 1397-1403.
• 28 Bogner R, Hübner C, Matis N. et al Minimally-invasive treatment of three- and four-part fractures of the proximal humerus in elderly patients. J Bone Joint Surg Br 2008; 90: 1602-1607.
• 29 Duda GN, Epari DR, Babst R. et al Mechanical evaluation of a new minimally invasive device for stabilization of proximal humeral fractures in elderly patients: A cadaver study. Acta Orthop 2007; 78: 430-435.
• 30 Cheng JT, Zhang M. A serrated jaw clamp for tendon gripping. Med Eng Phys 2006; 28: 379-382.
• 31 American Society for Testing and Materials. Standard Specification and Test Method for Metallic Bone Plates, ASTM F382-99 (Reapproved 2003). In 2003 Annual Book of ASTM Standards. West Conshoohocken, PA: ASTM; 2003
• 32 Schnabel B, Scharf M, Schwieger K. et al Biomechanical comparison of a new staple technique with tension band wiring for transverse patella fractures. Clin Biomech (Bristol, Avon) 2009; 24: 855-859.
• 33 Hughes SC, Stott PM, Hearnden AJ. et al A new and effective tension-band braided polyester suture technique for transverse patellar fracture fixation. Injury 2007; 38: 212-222.
• 34 Luna-Pizarro D, Amato D, Arellano F. et al Comparison of a technique using a new percutaneous osteosynthesis device with conventional open surgery for displaced patella fractures in a randomized controlled trial. J Orthop Trauma 2006; 20: 529-535.
• 35 Brill W, Hopf T. Biomechanical study of various osteosynthesis procedures in transverse patella fractures. Unfallchirurg 1987; 90: 162-172.
• 36 Baran O, Manisali M, Cecen B. Anatomical and biomechanical evaluation of the tension band technique in patellar fractures. Int Orthop 2009; 22: 1113-1117.
• 37 Scilaris TA, Grantham JL, Prayson MJ. et al Biomechanical comparison of fixation methods in transverse patella fractures. J Orthop Trauma 1998; 12: 356-359.
• 38 Neat BC, Kowaleski MP, Litsky AS. et al Mechanical evaluation of pin and tension-band wire factors in an olecranon osteotomy model. Vet Surg 2006; 35: 398-405.
• 39 Hammond J, Ruland R, Hogan C. et al Biomechanical analysis of a transverse olecranon fracture model using tension band wiring. J Hand Surg Am 2012; 37: 2506-2511.
• 40 John J, Wagner WW, Kuiper JH. Tension-band wiring of transverse fractures of patella. The effect of side of wire twists and orientation of stainless steel wire loop: a biomechanical investigation. Int Orthop 2007; 31: 703-707.
• 41 Reilly DT, Martens M. Experimental analysis of the quadriceps muscle force and patello-femoral joint reaction force for various activities. Acta Orthop Scand 1972; 43: 126-137.
• 42 Kim HJ, Fernandez JW, Akbarshahi M. et al Evaluation of predicted knee-joint muscle forces during gait using an instrumented knee implant. J Orthop Res 2009; 27: 1326-1331.
• 43 Kutzner I, Heinlein B, Graichen F. et al Loading of the knee joint during activities of daily living measured in vivo in five subjects. J Biomech 2010; 43: 2164-2173.
• 44 Kim J, Kazmierczak KA, Breur GJ. Comparison of temporospatial and kinetic variables of walking in small and large dogs on a pressure-sensing walkway. Am J Vet Res 2011; 72: 1171-1177.
• 45 Bertram JE, Lee DV, Case HN. et al Comparison of the trotting gaits of Labrador Retrievers and Greyhounds. Am J Vet Res 2000; 61: 832-838.
• 46 Kurtz SM, Devine JN. PEEK biomaterials in trauma, orthopedic, and spinal implants. Biomaterials 2007; 28: 4845-4869.
• 47 Pflum MA, Shelburne KB, Torry MR. et al Model prediction of anterior cruciate ligament force during drop-landings. Med Sci Sports Exerc 2004; 36: 1949-1958.