Pullout strength of 2.0 mm cancellous and cortical screws in synthetic bone.

OBJECTIVE: To determine whether 2.0 mm cancellous screws are superior to 2.0 mm cortical screws when inserted into cancellous and bicortical bone. STUDY DESIGN: Biomechanical study. METHODS: The 2.0 mm cancellous screws and 2.0 mm cortical screws were inserted according to the recommended guidelines in synthetic cancellous and bicortical blocks. Fifteen screw-block constructs per group were tested to failure in axial pullout. Axial pullout strength and yield strength were calculated. Data were analyzed using a one-way ANOVA. RESULTS: The 2.0 mm cortical screws achieved lower axial pullout strength than 2.0 mm cancellous screws in cancellous blocks. The 2.0 mm cortical screws achieved greater pullout strength than 2.0 mm cancellous screws in bicortical blocks. CONCLUSION: The 2.0 mm cancellous screws may offer a biomechanical advantage in bone with thin cortices (<1 mm thick), whereas 2.0 mm cortical screws may be preferred in cortical bone with cortices measuring at least 1 mm in thickness.

In vitro acute load to failure and eyelet abrasion testing of a novel veterinary screw-type mini-anchor design.

OBJECTIVE: To determine acute load to failure (ALF) and suture abrasion (SA) at 0° and 90° for a novel screw-type mini-anchor design. STUDY DESIGN: Biomechanical in vitro study. SAMPLE POPULATION: Synthetic bone. METHODS: Twenty mini-anchors were inserted into synthetic bone blocks assigned to 1 of 2 groups (0° ALF, 90° ALF). Pullout was performed at 5 mm/min. ALF, yield strength and stiffness were calculated. SA constructs were created with 4 groups of 5 anchors each with either 30 lb nylon leader line (NLL), 40 lb NLL, #2 Fiberwire or #5 Fiberwire. SA was performed at 0° and 90° with a sinusoidal wave form at 0.5 Hz and 10 N load for 1000 cycles or until failure. Data were summarized as mean ± SD. ALF data were analyzed using t-tests. SA data were analyzed using log rank, Tukey-adjusted pairwise comparisons and sign tests. Significance was set at P = .05. RESULTS: Mean ± SD ALF at 0° and 90° was 431.8 ± 70.8 N and 683 ± 48.7 N, respectively. 90° ALF was significantly higher. Yield strength and stiffness were not significantly different at 0° and 90°. #5 and #2 Fiberwire survived significantly more cycles than 40 lb and 30 lb NLL at 90°. At 0°, 30 lb NLL survived significantly less cycles than either Fiberwire size. Suture orientation did not have a significant effect on SA for Fiberwire constructs. CONCLUSION: The novel mini-anchor has ALF comparable to other mini-anchors. Fiberwire survived more cycles in the novel anchor eyelet than NLL and FW suture orientation in the eyelet did not affect SA.

Radiographic localization and isometry of the origin and insertion of the canine cranial cruciate ligament.

OBJECTIVE: To radiographically define the anatomic origin and insertion of the cranial cruciate ligament translated to the lateral radiographic projection of the stifle (CrCL-Lo and CrCL-Li, respectively), to correlate these landmarks for identification of the CrCL-Lo intraoperatively, and to compare the isometry of the CrCL-Lo to the lateral fabella. STUDY DESIGN: Experimental study. SAMPLE POPULATION: Pelvic limbs (n = 12) from dogs weighing 13-26 kg. METHODS: A radiographic quadrant method was used to localize the CrCL-Lo. Mediolateral radiographic projections of each stifle were taken through a range of motion. Maximum percent change in length between each tibial marker and femoral marker during range of motion determined isometry. RESULTS: The CrCL-Lo is located at the caudal 33% and distal 50% of the lateral femoral condyle using Blumensaat's line or a line from the origin of the long digital extensor (LDE) to the lateral fabella, with no significant difference (P = .766) between the 2 reference lines. The CrCL-Li is located at the proximal 20% of the tibial plateau. No significant difference (P < .05) in isometry was found between the CrCL-Lo and lateral fabella. CONCLUSION: The CrCL-Lo is located at the caudal 1/3 and distal ½ of the lateral femoral condyle. The CrCL-Lo and lateral fabella are not significantly different in isometry when used as a proximal anchor point in extracapsular stifle stabilization.

Evaluation of a transcondylar toggle system for stabilization of the cranial cruciate deficient stifle in small dogs and cats.

OBJECTIVE: To evaluate use of a transcondylar toggle system (TCTS) for stabilization of the cranial cruciate ligament (CrCL) deficient stifle in small dogs and cats. STUDY DESIGN: Prospective clinical study. ANIMALS: Small dogs (<7 kg; n=14) and cats (2) with CrCL-associated lameness of <3 months duration and a tibial plateau angle <32 degrees. METHODS: Affected animals had an extracapsular CrCL repair using the TCTS. Lameness score, muscle atrophy, osteoarthritis (OA) score, and range of motion (ROM) were evaluated preoperatively, and at 6 weeks and 7-10 months postoperatively. RESULTS: Operative time was 75 +/- 16 minutes. Fifty-six percent required >1 bone tunnel attempts. One dog required revision at 2 weeks because of suture loosening. All stifles were stable at 6 weeks postoperatively. Fifteen animals were available for follow-up (7-10 months). Lameness improved significantly at 6 weeks (P<.0001), whereas muscle atrophy was worse at 6 weeks (P=.008) but improved at 7-10 months (P<.0001). OA scores were unchanged at 6 weeks (P=.08) but were significantly worse at 7-10 months (P<.0001). ROM remained unchanged at 6 weeks (P=1) and 7-10 months (P=.6). CONCLUSIONS: The medially placed toggle provides a reliable short-term proximal anchor for the extracapsular suture with outcomes similar to other extracapsular techniques. The aiming device and drill bit are not recommended in their current form. CLINICAL RELEVANCE: The TCTS appears to be a well-tolerated technique for proximal suture anchoring in extracapsular CrCL repair in small dogs and cats where instrumentation and anatomic constraints preclude other techniques.

Outcome of elective cholecystectomy for the treatment of gallbladder disease in dogs.

OBJECTIVE To determine mortality rates for dogs undergoing cholecystectomy and variables associated with failure to survive to hospital discharge. DESIGN Retrospective cohort study. ANIMALS 70 dogs that underwent cholecystectomy for biliary tract disease at a companion animal referral hospital from 2009 through 2015. PROCEDURES Medical records of dogs were reviewed and data collected; dogs with biliary diversion surgery were excluded. Included dogs were grouped by whether cholecystectomy had been elective (ie, dogs with no or mild clinical signs, with no indication of biliary obstruction, or that initially underwent surgery for a different procedure) or nonelective (ie, dogs with icterus and questionable patency of the biliary system). Mortality rates (proportions of dogs that failed to survive to hospital discharge) were compared between various groups. RESULTS 45 (64%) dogs were included in the elective group and 25 (36%) in the nonelective group. Group mortality rates were 2% (1/45) and 20% (5/25), respectively, and differed significantly. Overall mortality rate was 9% (6/70). Serum albumin concentration was significantly lower and serum alanine aminotransferase activity and total bilirubin concentration were significantly higher in nonsurviving versus surviving dogs. Dogs with vomiting, signs of lethargy or anorexia, icterus, or azotemia were less likely to survive than dogs without these signs. CONCLUSIONS AND CLINICAL RELEVANCE Dogs that underwent elective cholecystectomy had a considerably lower mortality rate than previously reported. Elective cholecystectomy may be an appropriate recommendation for dogs with early signs of biliary disease to avoid the greater mortality rate associated with more advanced disease and nonelective cholecystectomy.

One-stage revision of an infected cementless total hip replacement.

A two-year-old, 44 kg dog with a right Helica cementless total hip replacement (THR) was radiographically diagnosed with implant loosening eight months after the index total hip replacement procedure. Subsequent synoviocentesis and synovial fluid culture revealed a methicillin-resistant coagulase-negative Staphylococcus spp infection of the right THR. A one-stage revision using a hybrid BFX cementless acetabular cup and CFX cemented femoral stem was performed. Vancomycin and micro-silver antimicrobial powder impregnated cement were used in the revision. At re-evaluation 27 months following the revision procedure, the patient did not exhibit any signs of lameness. Radiographic images confirmed stable implants, with bone ingrowth into the cup and no signs of implant loosening. Our report demonstrates the success of a one-stage THR revision when faced with a multi-drug resistant periprosthetic infection, when combined with the use of micro-silver antimicrobial powder and culture-based antibiotic impregnated cement therapy.

Biomechanical evaluation of polymethyl methacrylate with the addition of various doses of cefazolin, vancomycin, gentamicin, and silver microparticles.

OBJECTIVES: Numerous studies have examined the biomechanics of polymethyl methacrylate (PMMA) with added antibiotics, but direct comparison between studies is difficult. Our purpose was to evaluate the effects of the addition of antibiotic drugs and silver on compressive and bending strength of PMMA. Our null hypothesis was that there would be no significant difference in the compressive strength or bending strength of PMMA with the addition of silver or varying amounts of antibiotic drugs. METHODS: Polymethyl methacrylate was mixed with cefazolin, gentamicin, vancomycin, or silver; the control was PMMA alone. Antibiotic groups contained 20 g PMMA and 0.5 g, 1 g, 2 g, or 3 g of antibiotic. Silver groups had 0.25 g silver powder alone added to 20 g PMMA or silver with PMMA and 0, 0.5 g or 1 g of antibiotic. Samples underwent four-point bending and compression testing in air at room temperature and prevailing humidity. Pairwise comparisons between groups and to the ASTM and ISO standards were performed. RESULTS: Compression: All antibiotic and silver groups were weaker than the control. Samples with cefazolin tended to be stronger than other antibiotic groups with equivalent doses of antibiotic. All groups were above the ASTM standard, except 3 g vancomycin. Four-point bending: The addition of antibiotics did not significantly affect bending strength in groups with lower doses of antibiotics. The silver + PMMA group was weaker than the control. No groups were significantly below the ISO standard except the 3 g vancomycin group. CLINICAL SIGNIFICANCE: The addition of antibiotic or silver decreased the biomechanical strength in all samples, but not below the ASTM or ISO standard for most groups. The addition of cefazolin appears to affect strength the least, while high doses of vancomycin alter strength the most.

Effect of pilot hole diameter and tapping on insertion torque and axial pullout strength of 4.0-mm cancellous bone screws.

OBJECTIVE: To evaluate the effects of pilot hole diameter and tapping on insertion torque and axial pullout strength of 4.0-mm cancellous bone screws in a synthetic canine cancellous bone substitute. SAMPLE: 75 synthetic cancellous bone blocks (15 blocks/group). PROCEDURES: For groups 1 through 5, screw size-pilot hole diameter combinations were 3.5-2.5 mm (cortical screws), 4.0-2.5 mm, 4.0-2.5 mm, 4.0-2.0 mm, and 4.0-2.0 mm, respectively. Holes were tapped in groups 1, 2, and 4 only (tap diameter, 3.5, 4.0, and 4.0 mm, respectively). One 70-mm-long screw was inserted into each block; in a servohydraulic materials testing machine, the screw was extracted (rate, 5 mm/min) until failure. Mean group values of maximum insertion torque, axial pullout strength, yield strength, and stiffness were determined. RESULTS: Mean maximum insertion torque differed significantly among the 5 groups; the group 5 value was greatest, followed by group 3, 4, 2, and 1 values. Group 3, 4, and 5 axial pullout strengths were similar and significantly greater than the group 2 value; all values were significantly greater than that for group 1. Group 5 and 4 yield strengths were similar and significantly greater than the group 3, 2, and 1 values. Stiffness in group 3 was similar to group 4 and 2 values but significantly greater than the group 5 value; all values were significantly greater than that for group 1. CONCLUSIONS AND CLINICAL RELEVANCE: These synthetic cancellous bone model findings suggested that tapping a 2.0-mm-diameter pilot hole when placing a 4.0-mm screw is the optimal insertion technique.