An experimental study of small-joint compression arthrodesis.

Arthrodesis of the interphalangeal and metacarpophalangeal joints is a technically demanding procedure with significant failure rates. A method of compression arthrodesis that was developed by one of the authors (RWB) using a compression clamp and crossed Kirschner wires is reported. This technique has been used without complication in the successful arthrodesis of 125 consecutive interphalangeal and metacarpophalangeal fusions by two of the authors (RWB and JAIG). An in vivo model of small-joint arthrodesis was then developed using the rabbit humeroulnar joint to compare this method of compression clamp arthrodesis with the tension band technique. Biomechanical testing at both 2 and 8 weeks postoperatively showed compression clamp arthrodesis to compare favorably with the tension band technique.

Screw omission and the stability of posterior pedicle screw constructs for short-segment stabilization.

To determine the net contribution of a spinal construct to stability, and whether extending the construct to another level in situations in which a defective pedicle cannot have a screw inserted, we performed biomechanical tests in which we evaluated three-, four-, and five-level synthetic spinal constructs in which the location and number of pedicle screws were varied above and below a vertebrectomy defect. We subjected all constructs to axial, compression, lateral bending, flexion, extension, and torsional forces with the use of an Instron biaxial machine. Left-right symmetrical constructs were more stable than asymmetrical ones. Three-level constructs were statistically stiffer than the longer ones in compression, left bending, and flexion. Torsional stability, however, was greater in the longer constructs. Five-level constructs with both end screws in place had greater torsional stiffness than when they were missing a screw. In vertebrectomy defects, if four screws cannot be placed across it, then the engagement of two screws is indicated. The stability provided by a single screw at a spinal level is minimal. Additional screws augment the purchase of the construct in the bone; however, they do not afford further protection to the defect.

Mechanical characterization of a totally intramedullary gradual elongation nail.

An intramedullary gradual elongation nail (Albizzia) capable of fulfilling the function of traditional intramedullary nails while providing the gradual, controlled distraction of an external fixator was designed for progressive lengthening of lower limbs. In this study, the biomechanics of the gradual elongation nail were compared with several intramedullary nails: Grosse & Kempf, Russell-Taylor, AO, and Laffay. Bending stiffness, torsional stiffness, ultimate bending strength, and torsional strength were determined using the American Society for Testing and Materials standard F383-73 as a guide. The results show that in unextended and elongated conditions, the gradual elongation nail has torsional stiffness (1-5 Nm2) comparable with the AO nail (2 Nm2) and bending stiffness (41-89 Nm2), ultimate bending (246 Nm), and torsional (28-37 Nm) strengths within the ranges obtained for other intramedullary nails (27-105 Nm2, 167-298 Nm, and 2-100 Nm, respectively). Additionally, the low torque required to lengthen the device under a 500 N load (3 Nm) and the low longitudinal stiffness because of the active dynamization system with bimodal load deformation characteristics (80-120 N/mm initial, 600-800 N/mm secondary) produce a device with almost no torsional and longitudinal stress shielding. From a biomechanical point of view, this single, completely implantable device is a safe, viable, and efficacious alternative to external fixation for progressive lengthening of lower limbs.

The mechanical role of laminar hook protection of pedicle screws at the caudal end vertebra.

Biomechanical studies have shown hooks to be superior to pedicle screws in pull-out, especially in osteoporosis. This study evaluates the possible increase in stiffness of pedicle screws provided by laminar hooks while applying non-destructive forces to a vertebrectomy model assembled with Compact Cotrel Dubousset (CCD) instrumentation. Synthetic vertebrae were employed in a three-level vertebrectomy model. CCD screw-based three-level constructs with and without sublaminar hooks in the caudal element were tested in flexion, extension, compression, lateral bending, and torsion. There was no statistically significant advantage in adding inferior laminar hooks to a caudal end vertebra that had bilateral pedicle screws in any of the testing modes. Torsional stability, however, was augmented, but not significantly. Torsional instability and osteoporotic bone may be the clinical justifications for adding laminar hooks below screws in the caudal end vertebra.

A biomechanical evaluation of internal lumbar laminoplasty: the preservation of spinal stability during laminectomy for degenerative spinal stenosis.

The long-term success of surgical management of spinal stenosis by decompressive lumbar laminectomy is predicated partly by the maintenance of intervertebral stability. Excessive bone removal, especially of the pars interarticularis, may predispose the spine to iatrogenic segmental instability and spondylolisthesis. Removal of too little bone may be inadequate to relieve stenotic or radicular symptoms. Wide decompression with concomitant arthrodesis has been advocated, but arthrodesis compounds the surgical complexity and increases the risks of surgical treatment. Internal lumbar laminoplasty obviates the problem of too little or too much bone removal in the surgical management of spinal stenosis. The spinal canal is enlarged internally by an undercutting facetectomy performed through a narrow central laminectomy. The pars interarticularis is left completely intact. Twenty five adult human cadaveric spinal units were subjected to biomechanical testing following hemilaminectomy, total laminectomy, internal laminoplasty, partial facetectomy, or disk transection and internal laminoplasty. Analysis was performed after video and computer acquisition of data from specimen testing on an Instron machine. Internal laminoplasty demonstrated more intrinsic stability than the other surgical procedures.

An in vitro biomechanical study of a multiplanar circular external fixator applied to equine third metacarpal bones.

The biomechanical characteristics of a 4-ring circular multiplanar fixator applied to equine third metacarpal bones with a 5 mm mid-diaphyseal osteotomy gap were studied. Smooth Steinmann pins, either 1/8 inch, 3/16 inch, or 1/4 inch, were driven through pilot holes in the bone in a crossed configuration and full pin fashion and fastened to the fixator rings using cannulated fixation bolts. The third metacarpal bone fixator constructs were tested in three different modes (cranial-caudal four-point bending, axial compression, and torsion). Loads of 2,000 N were applied in bending and axial compression tests and a load of 50 N x m was applied during testing in torsion. Fixator stiffness was determined by the slope of the load displacement curves. Three constructs for each pin size were tested in each mode. Comparisons between axial stiffness, bending stiffness, and torsional stiffness for each of the three different pin sizes were made using one-way analysis of variance. There was no visually apparent deformation or permanent damage to the fixator frame, and no third metacarpal bone failure in any of the tests. Plastic deformation occurred in the 1/8 inch pins during bending, compression, and torsion testing. The 3/16 inch and 1/4 inch pins elastically deformed in all testing modes. Mean (+/-SE) axial compressive stiffness for the 1/8 inch, 3/16 inch, and 1/4 inch pin fixator constructs was: 182 +/- 16 N/mm, 397 +/- 21 N/mm, and 566 +/- 8.7 N/mm; bending stiffness was 106 +/- 3.3 N/mm, 410 +/- 21 N/mm, and 548 +/- 12 N/mm; and torsional stiffness was 6.15 +/- 0.82 N x m/degree, 7.14 +/- 0.0 N x m/degree, and 11.9 +/- 1.0 N x m/degree respectively. For statically applied loads our results would indicate that a 4-ring fixator using two 1/4 inch pins per ring may not be stiff enough for repair of an unstable third metacarpal bone fracture in a 450 kg horse.

Comparison of a suture technique with the modified Kessler method: resistance to gap formation.

We performed an in vitro study using canine flexor tendons to compare the tensile properties of a suture technique for flexor tendon repair with the standard modified Kessler technique. The technique employs a central wire loop that connects the two transverse limbs of the modified Kessler suture. Both techniques were studied with and without a Lembert epitendinous stitch. The technique combined with an epitendinous suture provided the strongest resistance to gap formation, and its load at gap initiation was 100% greater than the load in tendons repaired with the modified Kessler and an epitendinous suture. Because of its increased resistance to gap formation, this suture technique may provide a safer margin for controlled early active motion after flexor tendon repair.

In vivo evaluation of collagen-coated Dacron fiber in bone.

To evaluate the influence of type I collagen and hydroxyapatite coatings on the ability of Dacron fiber to achieve biologic fixation to bone, tows with the following coatings were evaluated in vivo: avian collagen (A); an avian collagen/hydroxyapatite composite (AH); bovine tendon collagen (B); a bovine tendon collagen/hydroxyapatite composite (BH); and plain (uncoated) Dacron tow (C). The Dacron tows were placed unstressed in the cancellous bone of both lateral femoral condyles of rabbits. Tissue reaction to each kind of Dacron tow was evaluated histopathologically, histomorphometrically and biomechanically. Inflammatory reaction was apparent around the AH and BH Dacron fibers at 2 weeks. There was no such reaction in the A, B, and C specimens, thus implicating the hydroxyapatite particles as the cause. At later time periods specimens A, B, and C all induced new bone formation. Direct contact between the Dacron fibers and trabecular bone was apparent in A and B. The pull-out strength of the B fibers was higher than the controls at a statistically significant level, but there was no significant difference between any of the other specimens and C (controls). There was no significant difference between any coating and controls at 8 or 16 weeks. Dacron fibers coated with bovine tendon collagen exhibited the best biocompatibility to bone and improved the anchoring to bone in the early time intervals by maintaining direct contact between Dacron fibers and trabecular bone.(ABSTRACT TRUNCATED AT 250 WORDS)

Pullout strength comparison of two methods of orienting screw insertion in the lateral masses of the bovine cervical spine.

We undertook a biomechanical study to compare the pullout strength of 3.5-mm AO screws placed in two different orientations within the bovine cervical spine. The first set of screws were oriented obliquely and passed through the lateral mass, as recommended by the AO group. The orientation of the second set was anterior to posterior through the lateral mass, as recommended by Roy-Camille. All screw holes were drilled and tapped by a spinal surgeon experienced with both techniques. Pullout force was measured on an Instron materials testing machine using a self-centering screw-holding chuck and loading rate of 0.833 mm/sec. Although the bone strength in the Roy-Camille orientation was greater (46.7 N/mm versus 36.1 N/mm, p < 0.05), the overall mean pullout force for the AO orientation was greater (607 N versus 471 N, p < 0.025) due to the longer length of bone available for screw purchase (17.0 mm versus 10.3 mm).

A biomechanical study of tendon adhesion reduction using a biodegradable barrier in a rabbit model.

Adhesion formation associated with tendon surgery is a widespread problem in which a healing tendon becomes adherent via scar tissue to surrounding structures such as bone, muscle, skin, tendon sheath, or other tendons. A model is described in which adhesions were generated reproducibly between the plantaris and Achilles tendons of the rabbit using a partial tenotomy, a Bunnel suture, and immobilization. Using this model, the effect of an absorbable barrier, INTERCEED (TC7), on adhesion formation was investigated. This material, which is a fabric comprised of oxidized regenerated cellulose, was found to diminish significantly the extent and severity of intertendinous adhesions, assessed both mechanically and histologically. No evidence of a foreign body reaction was observed.