Surgical findings and outcome for dairy cattle with jejunal hemorrhage syndrome: 31 cases (2000-2007).

OBJECTIVE: To describe signalment; surgical findings; short-, medium-, and long-term outcome; and recurrence rate for cattle undergoing celiotomy because of jejunal hemorrhage syndrome (JHS) and to analyze risk factors associated with outcome and recurrence. DESIGN: Retrospective case series. ANIMALS: 31 dairy cattle with JHS. PROCEDURES: Medical records were analyzed. Follow-up information was obtained from owners of cattle surviving until discharge. RESULTS: 18 of 31 (58%) cattle undergoing celiotomy survived to initial discharge. Fifteen (48%) and 13 (42%) were alive 6 and 12 months after discharge, respectively. All 5 deaths within 12 months after discharge were attributed to JHS recurrence. Survival time was 12 to 85 months for the 13 long-term survivors. Six of 7 that died > 12 months after celiotomy did so for reasons unrelated to JHS. Recurrence rate among short-term survivors was 7 of 18; 1 of these survived long-term. A significant proportion of affected cattle were Brown Swiss, compared with proportions for other breeds. Manual massage of the bowel to break down clots was associated with a significantly higher short-term survival rate than was enterectomy or enterotomy. Medium- and long-term survival rate was higher in cattle referred 24 to 48 hours after onset of signs. Length of obstructing blood clots was not associated with outcome. Other factors were not significantly associated with recurrence. CONCLUSIONS AND CLINICAL RELEVANCE: Survival rates were higher than those in other reports. Prompt celiotomy and resolution by use of manual massage were associated with higher survival rates. In this population, JHS recurred in 7 of 18 short-term survivors.

Effects of thermal energy on chondrocyte viability.

OBJECTIVE: To determine the critical temperature that reduces chondrocyte viability and evaluate the ability of chondrocytes to recover after exposure to the critical temperature. SAMPLE POPULATION: Cartilage explants obtained from the humeral heads of 30 sheep. PROCEDURES: In a randomized block design, 318 full-thickness cartilage explants were collected from 30 humeral heads of sheep and cultured for up to 14 days. On the first day of culture (day 0), explants were subjected to temperatures of 37 degrees , 45 degrees , 50 degrees , 55 degrees , 60 degrees , or 65 degrees C for 5 minutes by heating culture tubes in a warming block. The ability for chondrocytes to recover after exposure to the critical temperature was determined by evaluating viability at days 0, 1, 3, 7, and 14 days after heating. Images were analyzed by use of confocal laser microscopy. RESULTS: Analysis of images revealed a significant decrease in live cells and a significant increase in dead cells as temperature increased. Additionally, the deepest layer of cartilage had a significantly lower percentage of live cells, compared with values for the 3 most superficial layers. Chondrocytes did have some ability to recover temporarily after the initial thermal insult. CONCLUSIONS AND CLINICAL RELEVANCE: A strong relationship exists between increasing temperature and cell death, with a sharp increase in chondrocyte death between 50 degrees and 55 degrees C. Chondrocytes in the deepest cartilage layer are most susceptible to thermal injury. The threshold of chondrocyte recovery from thermal injury is much lower than temperatures reached during chondroplasty by use of most radiofrequency energy devices.

Comparison of techniques for determination of chondrocyte viability after thermal injury.

OBJECTIVE: To compare 2 methods of quantitating chondrocyte viability and to determine chondrocyte response to thermal injury over time. SAMPLE POPULATION: 108 stifle joints from 54 adult rats. PROCEDURES: Cartilage from the distal aspect of the femur was treated ex vivo with radiofrequency energy at a probe setting that would result in immediate partial-thickness chondrocyte death; untreated sections served as controls. Explants were cultured, and cell viability was compared by use of lactate dehydrogenase (LDH) histochemical staining and calcein AM and ethidium homodimer-1 confocal laser microscopy (CLM) cell viability staining. Terminal deoxynucleotidyl transferase-mediated X-dUTP nick end labeling (TUNEL) was used to detect apoptosis. All labeling studies were performed 0, 1, 3, 7, 14, and 21 days after treatment. RESULTS: In the treated tissues, a greater percentage of viable cells were found with CLM, compared with LDH staining. This result contrasted that of control tissues in which LDH staining indicated a greater percentage of live cells than CLM. The greatest number of TUNEL-positive chondrocytes was present at day 3, declining at later time intervals. CONCLUSIONS AND CLINICAL RELEVANCE: CLM and LDH histochemistry techniques yield different absolute numbers of live and dead cells, resulting in differing percentages of live or dead cells with each technique. These differences may be related to the enzymes responsible for activation in each technique and the susceptibility of these enzymes to thermal injury. Results of TUNEL indicate that apoptosis contributes to chondrocyte death after thermal injury, with a peak signal identified 3 days after insult.

In vivo study on the short-term effect of radiofrequency energy on chondromalacic patellar cartilage and its correlation with calcified cartilage pathology in an equine model.

Chondromalacia can cause joint pain and synovial effusion with the potential for developing into osteoarthritis. Thermal chondroplasty using radiofrequency energy (RFE) has been reported to be superior to mechanical debridement for treating chondromalacia. We compared short-term changes in biomechanical properties of articular cartilage after treatment with monopolar (mRFE) or bipolar RFE (bRFE) or mechanical debridement (MD) on experimentally created grade II chondromalacia patellae. Chondromalacia patellae was created arthroscopically in both patellae of 15 ponies. Ten months after surgery, each patella was randomly assigned to one of four experimental groups: sham operated, untreated control; MD; bRFE; and mRFE. Animals were euthanized 6 months after treatment and fresh osteochondral sections were collected from the treated area, the border of the chondromalacic and nonchondromalacic area, and from two untreated areas for analysis of mechanical properties. The same areas were harvested from an additional six untreated ponies. The aggregate modulus (H(A)), Poisson's ratio (nu(s)), and permeability (k) were determined for each area under creep indentation, and cartilage thickness was measured with a needle probe. The relation between zone of calcified cartilage (ZCC) and mechanical properties of hyaline cartilage (HC) was assessed histomorphometrically. Treated areas of all four groups had inferior mechanical properties compared at the same location. The treated and border areas had significantly lower H(A) values than the untreated areas. Permeability values showed significant differences between bRFE and other treated groups. Chondromalacic areas showed thinning of cartilage compared to nonchondromalacic areas. Biomechanical properties of the injured cartilage were inferior to nonchondromalacic cartilage regardless of the treatment type. mRFE had the highest stiffness value compared to other treatments and significantly higher values than MD. A significant correlation was observed between the mechanical properties of HC and ZCC thickness.

Repair of femoral capital physeal fractures with 7.0 mm cannulated screws in cattle: 20 cases (1988-2002).

OBJECTIVE: To evaluate long-term outcome of repair of femoral capital physeal fractures with 70 mm cannulated screws in juvenile bulls that weighed >350 kg (770 lb). DESIGN: Retrospective study. ANIMALS: 20 bulls. PROCEDURE: Medical records of affected cattle were identified and reviewed. Follow-up information was obtained by means of a written questionnaire, 1 to 15 years after discharge, from the veterinarians who supervised the postoperative care at bull stud facilities. RESULTS: Mean age and body weight at time of repair were 19 months (range, 11 to 27 months) and 513 kg (1128.6 lb; range, 364 to 720 kg [800.8 to 1584 lb]), respectively. Surgical repair was performed with 70 mm cannulated screws. A second surgery to replace malpositioned implants was required in 1 bull. Fourteen of the 20 bulls were considered serviceable for semen collection after surgical repair, and persistent lameness was evident in 11 of the 14. Mean duration for bulls to become serviceable was 5.5 months (range, 2 to 11 months). Age, weight, duration of injury at the time of repair, and degree of reduction did not have a significant effect on whether surgical repair was successful. Six bulls remained severely lame and were euthanatized. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that surgical repair of femoral capital physeal fractures in adolescent bulls with 70 mm cannulated screws placed in lag fashion has a good prognosis for long-term function in a semen collection facility.

Prolonged-fresh preservation of intact whole canine femoral condyles for the potential use as osteochondral allografts.

Defects in articular cartilage are often repaired with fresh osteochondral grafts. While fresh allografts provide viable chondrocytes, logistic limitations require surgical implantation within seven days of graft harvest. Here, we provide information on cold preservation of whole intact osteochondral materials that retains cartilage cell viability and function, and histologic and biochemical integrity for 28 days. Canine femoral condyles were obtained and stored at 4 degrees C for 14, 21 or 28 days. At the end of the storage period, cartilage was assessed for cell viability, 35S uptake, proteoglycan content and histologic parameters. The most noticeable histologic change was reduced Safranin-O near the cartilage surface with 14 days of cold preservation, but had recovered with 21 and 28 days. Cartilage thicknesses did not vary significantly. Cell viability was >95% at 14 days, 75-98% at 21 days and reduced to 65-90% at 28 days. Cell function measures showed that the level of 35SO4 incorporation was suppressed in samples stored at 4 degrees C. However, no significant differences were seen among groups at 14, 21 or 28 days of cold preservation. This data has implications for tissue banking protocols for osteochondral allograft material obtained for transplantation suggesting that cold preserved allograft material be implanted within 28 days.

Ex vivo investigation of the use of hydrothermal energy to induce chondrocyte necrosis in articular cartilage of the metacarpophalangeal and metatarsophalangeal joints of horses.

OBJECTIVE: To evaluate the use of hydrothermal ablation of articular cartilage for arthrodesis in horses through investigation of the effects of joint lavage with physiologic saline (0.9% NaCI) solution (80 degrees C) for various treatment times on chondrocyte viability in the articular cartilage of the metacarpophalangeal and metatarsophalangeal joints of cadaveric horse limbs. Sample Population-7 pairs of metacarpophalangeal and 8 pairs of metatarsophalangeal joints from 8 Thoroughbreds. PROCEDURE: The horses were euthanatized for reasons unrelated to musculoskeletal disease. On a random basis, 1 joint of each pair underwent intra-articular lavage for 5, 10, or 15 minutes with heated saline solution (80 degrees C); the other joint underwent sham treatment of similar duration with saline solution at 22 degrees C (control). Cartilage samples from the distal articular surface of metacarpus III (or metatarsus III), the proximal surface of the proximal phalanx, and the lateral and medial proximal sesamoid bones were assessed for chondrocyte viability via confocal microscopy and viability staining following enzymatic digestion. RESULTS: Compared with the control joints, findings of both viability assays indicated that the percentage of sites containing viable chondrocytes in heat-treated joints was decreased. Treatment hazard ratios of 0.048 (confocal microscopy) and 0.2 (digestion assay) were estimated. Histologically, periarticular soft tissues had minimal detrimental effects after heat treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Ex vivo intra-articular lavage with saline solution at 80 degrees C resulted in the death of almost all articular chondrocytes in the joint. This technique may be a satisfactory method for extensive cartilage ablation when performing arthrodesis by minimally invasive techniques.

Percutaneous injection of recombinant human bone morphogenetic protein-2 in a calcium phosphate paste accelerates healing of a canine tibial osteotomy.

BACKGROUND: In this study, we evaluated the capacity of a single percutaneous injection of recombinant human bone morphogenetic protein-2 (rhBMP-2) delivered in a rapidly resorbable calcium phosphate paste (alpha-BSM) to accelerate bone-healing in a canine tibial osteotomy model. We hypothesized that the osteotomy sites would heal faster after percutaneous delivery of rhBMP-2/alpha-BSM than they would after injection of alpha-BSM alone or after no treatment. METHODS: Bilateral tibial osteotomy was performed and the sites were stabilized with external fixators in sixteen dogs. Four hours after the surgery, one limb of each dog was treated with a single percutaneous injection of rhBMP-2/alpha-BSM paste or an equal volume of alpha-BSM alone. There were eight limbs in each group, and the osteotomy site in the contralateral limb served as an untreated control. The results were evaluated with serial radiography and force-plate analysis at four and eight weeks after surgery and with mechanical testing and histologic examination at eight weeks after the surgery. RESULTS: At four and eight weeks after the osteotomy and treatment, the scores for radiographic union were significantly greater for the rhBMP-2/alpha-BSM-treated limbs than they were for the alpha-BSM-treated or untreated, control limbs (p < 0.05). The callus area in the rhBMP-2/alpha-BSM-treated limbs was significantly greater than that in the alpha-BSM-treated and untreated, control limbs at four and eight weeks postinjection (p < 0.05). The time-integrated vertical force for the rhBMP-2-treated limbs was significantly greater than that for their contralateral controls at four weeks and significantly greater than that for the treated and control limbs of the alpha-BSM-treated dogs at four and eight weeks after the surgery (p

Comparison of surgical techniques for synovectomy in New Zealand White rabbits with induced inflammatory arthritis.

OBJECTIVE: To compare effects of synovectomy performed by use of monopolar radiofrequency energy (MRFE) versus mechanical debridement in rabbits with induced inflammatory arthritis. ANIMALS: 25 mature female New Zealand White rabbits. PROCEDURE: Inflammatory arthritis was induced in both femoropatellar joints of each rabbit. Joints then were treated by mechanical debridement or MRFE treatment or served as sham-operated controls. Rabbits were euthanatized 2 weeks or 3 months after surgery. Biopsy specimens of synovium were analyzed by use of light microscopy. RESULTS: At 2 weeks after surgery, samples from MRFE-treated joints had fewer plasma cells and more heterophils than the other 2 groups and more lymphocytes than sham-operated controls, whereas samples from mechanically debrided joints had greater numbers of lymphocytes and heterophils than sham-operated controls. At 3 months after surgery, samples from MRFE-treated joints had fewer plasma cells than sham-operated controls, more heterophils than mechanically debrided and sham-operated controls, and more macrophages than mechanically debrided joints. There was no difference in synovial ablation, synovial proliferation, or fibrosis among the 3 groups at 2 weeks or 3 months after surgery. CONCLUSIONS AND CLINICAL RELEVANCE: Analysis of results of this study documented a similar degree of synovial ablation when comparing use of MRFE to mechanical debridement. In rabbits with this method of induced inflammatory arthritis, there were no detectable benefits of MRFE or mechanical debridement on the synovium, compared with results for sham-operated control joints, at 2 weeks and 3 months after surgery for most of the synovial variables evaluated.

Effect of focused and radial extracorporeal shock wave therapy on equine bone microdamage.

OBJECTIVES: To determine whether bone microcracks are altered after application of focused and radial extracorporeal shock wave therapy (ESWT) to the equine distal limb. STUDY DESIGN: An ex vivo experimental model. SAMPLE POPULATION: A contralateral limb specimen was obtained from 11 Thoroughbred racehorses with a unilateral catastrophic injury. Distal limb specimens were also obtained from 5 non-racing horses. METHODS: Three separate skin-covered bone segments were obtained from the mid-diaphysis of the metacarpus (MC3) or metatarsus (MT3). Focused (9,000 shockwaves, 0.15 mJ/mm2, 4 Hz) and radial (9,000 shockwaves, 0.175 mJ/mm2, 4 Hz) ESWT treatments were randomized to the proximal and distal segments and the middle segment was used as a treatment control for pre-existing microcracks. After treatment, bone specimens were bulk-stained with basic fuchsin and microcracks were quantified in transverse calcified bone sections. RESULTS: ESWT had small but significant effects on microcracks. Microcrack density (Cr.Dn) and microcrack surface density (Cr.S.Dn) were increased after focused ESWT, whereas Cr.Le was increased after radial ESWT. In racing Thoroughbreds, Cr.Le increased with increased number of races undertaken. Cr.Dn and Cr.S.Dn were not significantly influenced by the number of races undertaken. CONCLUSION: ESWT has small but significant effects on bone microcracking ex vivo. CLINICAL RELEVANCE: These preliminary data suggest that ESWT has the potential to increase bone microcracking in equine distal limb bone in vivo. Such effects may be more pronounced in Thoroughbreds that are actively being raced, because in vivo microcracking increases with increased number of races undertaken.

Fixation technique influences the monotonic properties of equine mandibular fracture constructs.

OBJECTIVE: To determine the optimal fixation technique for equine interdental space fractures by evaluating the biomechanical characteristics of 4 fixation techniques. STUDY DESIGN: In vitro randomized block design. SAMPLE POPULATION: Twenty-seven adult equine mandibles. METHODS: Mandibles with interdental osteotomies were randomly divided into 4 fixation groups (n = 6/group). Fixation techniques were the following: (1) dynamic compression plates (DCP), (2) external fixator (EF), (3) external fixator with interdental wires (EFW), and (4) intraoral splint with interdental wires (ISW). Three intact (nonosteotomized) mandibles were tested as controls. Mandibles were subjected to monotonic cantilever bending until failure. Angular displacement data (radians) were derived from continuously recorded gap width measurements provided by extensometers placed across the osteotomy site. Osteotomy gap width data (mm) at 50 and 100 Nm were selected for standardized comparison of gap width before the yield point and failure point, respectively of all constructs tested. Stiffness (Nm/radian), yield strength (Nm), and failure strength (Nm) were determined from bending moment-angular displacement curves and were compared using ANOVA with appropriate post hoc testing when indicated. Radiographs were obtained prefixation, postfixation, and posttesting. RESULTS: Bending stiffness, yield, and ultimate failure loads were greatest for intact mandibles. Among osteotomized mandibles, stiffness was greatest for DCP constructs (P <.05) and was not significantly different among EF, EFW, and ISW constructs. Yield load was greatest for ISW constructs (P <.05) and was not significantly different among DCP and EFW constructs. Yield and ultimate failure loads were lowest (P <.05) and osteotomy gap width at 50 and 100 Nm were greatest for EF constructs (P =.09 and P <.05, respectively). There was no significant difference in failure loads and osteotomy gap widths among DCP, EFW, and ISW constructs (P <.05). Failure occurred through the screw-bone interface (DCP), acrylic splint (ISW), acrylic connecting bar and/or pin-bone interface (EF, EFW), and wire loosening (EFW). All 3 intact mandibles fractured through the vertical ramus at its attachment to the testing apparatus. CONCLUSIONS: Among osteotomized mandibles, DCP fixation had the greatest stiffness under monotonic bending to failure; however, the relatively low yield value may predispose it to earlier failure in fatigue testing without supplemental fixation. Techniques using tension-band wiring (EFW and ISW) were similar to DCP constructs in yield, failure, and osteotomy displacement, whereas EF constructs were biomechanically inferior to all other constructs. CLINICAL RELEVANCE: DCP fixation is most likely the most stable form of fixation for comminuted interdental space fractures. However, for simple interdental space fractures, ISW fixation may provide adequate stability with minimal invasiveness and decreased expense. Tension-band wiring significantly enhances the strength of type II external skeletal fixators and should be used to augment mandibular fracture repairs.

The basic science of thermally assisted chondroplasty.

Thermal chondroplasty provides a visually enticing effect on articular cartilage, but the long-term effects of thermal modification and injury to articular cartilage must be understood before the technology is applied to cartilage and chondrocytes in a clinical setting.

Lavage solution temperature influences depth of chondrocyte death and surface contouring during thermal chondroplasty with temperature-controlled monopolar radiofrequency energy.

BACKGROUND: Although radiofrequency energy can smooth and contour cartilage surface, it has deleterious effects on chondrocyte viability. HYPOTHESIS: Monopolar thermal chondroplasty in a 37 degrees C lavage solution, as compared with a 22 degrees lavage solution, will reduce chondrocyte death and result in greater smoothing of the articular cartilage surface. STUDY DESIGN: Controlled laboratory study. METHODS: Sixteen chondromalacic samples from patients undergoing total knee arthroplasty were divided into two groups: 22 degrees C and 37 degrees C lavage solution. Each sample was divided into two equal parts and half of each group was treated for 10 seconds and the other half for 15 seconds. RESULTS: Confocal laser microscopy demonstrated that the depth of chondrocyte death in the 37 degrees C lavage solution group was significantly less (range, 200 to 340 microm) than that in the 22 degrees C solution group for both 10- and 15-second treatment times. Scanning electron microscopy demonstrated that the cartilage surface in the 37 degrees C lavage solution group was smoother than that in the 22 degrees C solution group for the 10-second treatment time. Energy delivery power in the 37 degrees C lavage solution group was significantly lower than in the 22 degrees C solution group for both treatment times. CONCLUSIONS: Thermal chondroplasty with 37 degrees C lavage solution resulted in less depth of chondrocyte death and produced smoother surfaces than with 22 degrees C solution for 10 seconds of treatment. CLINICAL RELEVANCE: Less chondrocyte death would permit increased use of thermal chondroplasty.

Thermal chondroplasty with bipolar and monopolar radiofrequency energy: effect of treatment time on chondrocyte death and surface contouring.

PURPOSE: The purpose of this study was to evaluate chondrocyte viability and surface contouring of articular cartilage using confocal laser microscopy (CLM) and scanning electron microscopy (SEM), respectively, during different treatment time intervals with monopolar and bipolar radiofrequency energy (RFE). TYPE OF STUDY: In vitro analysis using chondromalacic human cartilage. METHODS: Forty-two fresh osteochondral sections from patients undergoing partial or total knee arthroplasties were used to complete this study. Each of 36 sections was divided into 2 distinct 1-cm(2) regions that were treated with either bipolar or monopolar RFE. Six sections were maintained as untreated controls. Six RF treatment time intervals were evaluated: 5, 10, 15, 20, 30, and 40 seconds (6 specimens per time interval per group). After treatment, each specimen was processed for CLM and SEM. RESULTS: CLM demonstrated that the depth of chondrocyte death in the monopolar RFE treatment group was significantly less than the bipolar group at each of the same time intervals (P <.05). SEM showed that each RFE device began to contour and smooth the articular surface after 15 seconds of treatment. CONCLUSIONS: When applying thermal chondroplasty, a broad treatment time range could result in variable degrees of cartilage smoothness and significant chondrocyte death.

Thermometric determination of cartilage matrix temperatures during thermal chondroplasty: comparison of bipolar and monopolar radiofrequency devices.

PURPOSE: To compare cartilage matrix temperatures between monopolar radiofrequency energy (mRFE) and bipolar RFE (bRFE) at 3 depths under the articular surface during thermal chondroplasty. We hypothesized that cartilage temperatures would be higher at all cartilage depths for the bRFE device than for the mRFE device. TYPE OF STUDY: Randomized trial using bovine cartilage. METHODS: Sixty osteochondral sections from the femoropatellar joint of 15 adult cattle were used for this study. Using a custom jig, fluoroptic thermometry probes were placed at one of the following depths under the articular surface: 200 microm, 500 microm, or 2,000 microm. RF treatment was performed either with fluid flow (F) (120 mL/min) or without fluid flow (NF) (n = 5/depth/RFE device/flow; total specimens, 60). Irrigation fluid temperature was room temperature (22 degrees C). Thermometry data were acquired at 4 Hz for 5 seconds with the RF probe off, for 20 seconds with the RF probe on, and then for 15 seconds with the RF probe off. During RF treatment, a 0.79-cm2 area (1.0-cm diameter) of the articular surface centered over the thermometry probe was treated in a paintbrush manner in noncontact (bRFE) or light contact (mRFE). RESULTS: Thermal chondroplasty with bRFE resulted in higher cartilage matrix temperatures compared with mRFE for all depths and regardless of fluid flow. Bipolar RFE resulted in temperatures of 95 degrees C to 100 degrees C at 200 microm and 500 microm under the surface, with temperatures of 75 degrees C to 78 degrees C at 2,000 microm. Fluid flow during bRFE application had no effect at 200 microm. Monopolar RFE resulted in temperatures of 61 degrees C to 68 degrees C at 200 microm, 54 degrees C to 70 degrees C at 500 microm under the surface, and 28 degrees C to 30 degrees C at 2,000 microm below the surface. A significant effect of fluid flow during mRFE application occurred at 200 microm (NF, 61 degrees C; F, 63 degrees C) and 500 microm (NF, 53 degrees C; F, 68 degrees C). CONCLUSIONS: In this study, we found significant differences between bRFE and a temperature-controlled mRFE device with regard to depth of thermal heating of cartilage in vitro. Bipolar RFE resulted in matrix temperatures high enough (>70 degrees C) to kill cells as deep as 2,000 microm under the articular surface. Fluid flow during thermal chondroplasty had the effect of significantly increasing cartilage matrix temperatures at 200 and 500 microm with the mRFE device. During thermal chondroplasty, bRFE creates greater matrix temperature elevations at equivalent depths and treatment duration than does mRFE. Excessive temperatures generated deep within the cartilage matrix could cause full-thickness chondrocyte death, in vivo.

Arthrodesis of the equine proximal interphalangeal joint: a biomechanical comparison of two 7-hole 3.5-mm broad and two 5-hole 4.5-mm narrow dynamic compression plates.

OBJECTIVE: To compare the biomechanical characteristics and mode of failure of two different dynamic compression plate (DCP) techniques for proximal interphalangeal joint (PIPJ) arthrodesis in horses. STUDY DESIGN: Randomized block-design blocking on horse (1-5), method of fixation (two 7-hole, 3.5-mm broad DCP vs two 5-hole, 4.5-mm narrow DCP), side (left, right), and end (front, hind). Constructs were loaded to failure in 3-point bending in a dorsal-to-palmar (plantar) direction. SAMPLE POPULATION: Ten paired limbs from 5 equine cadavers. METHODS: Two 7-hole, 3.5-mm broad dynamic compression plates (bDCP) were used in 1 limb of a pair, and two 5-hole 4.5-mm narrow dynamic compression plates (nDCP) were used on the contralateral limb. Plates were positioned abaxially across the dorsomedial and dorsolateral aspect of the PIPJ. Arthrodesis constructs were loaded (19 mm/s) in 3-point bending in a dorsal-to-palmar (plantar) direction using a materials-testing machine. Composite stiffness, yield point, and maximal bending moment at failure were obtained from bending moment-angular deformation curves. Data were analyzed using ANOVA, X(2) analysis, and Fisher's exact tests; the power of the test was calculated when differences were not significant. RESULTS: There were no significant differences in composite stiffness (P >.05; power = 0.8 @ delta = 21.9%), yield point (P >.05; power = 0.8 @ delta = 34.4%), or maximal bending moment (P >.05; power = 0.8 @ delta = 17.8%) between the two fixation techniques. For bDCP constructs, 11% (15 of 140) of the 3.5-mm screws were damaged; 7 of the screw heads pulled through plates where the plates bent, 1 screw head broke off, and 7 screws were bent or pulled out of the phalanx. For nDCP constructs, 8% (8 of 100) of the 4.5-mm screws were damaged; 1 screw head pulled through a plate, 1 screw head broke off, and 6 screws were bent or pulled out of the phalanx. CONCLUSIONS: There were no biomechanical or failure differences between bDCP and nDCP fixation of the PIPJ in horses when evaluated in single-cycle 3-point bending to failure. CLINICAL RELEVANCE: There is no biomechanical advantage to the use of two 7-hole, 3.5-mm bDCP in equine proximal interphalangeal arthrodesis compared with two 5-hole, 4.5-mm nDCP. Two 5-hole, 4.5-mm nDCP may be easier to place, whereas two 7-hole, 3.5-mm bDCP may provide more versatility in fracture repair.

Thermal chondroplasty of chondromalacic human cartilage. An ex vivo comparison of bipolar and monopolar radiofrequency devices.

We compared the effects of treatment with bipolar and monopolar radiofrequency energy on 30 osteochondral sections harvested from 22 patients with spontaneously occurring chondromalacia who were undergoing knee arthroplasty. Specimens with chondromalacia grades 2 or 3 were randomly assigned to one of two bipolar or one monopolar treatment groups. All samples were marked and mounted on a jig to allow simulation of an arthroscopic surgical procedure with a flow rate of 100 ml/min of a balanced electrolyte solution at 22 degrees C. Under arthroscopic visualization, the designated area was treated until smooth, and the total treatment time was recorded. There was no difference in patients' ages, chondromalacia grade, or cartilage thickness among groups. Significant chondrocyte death, as determined by cell viability staining with confocal laser microscopy, was observed with each group. The bipolar devices produced significantly greater depths of chondrocyte death (2228 +/- 1003 microm and 2810 +/- 517 microm) than did the monopolar device (737 +/- 391 microm). The bipolar devices caused cell death to subchondral bone significantly more often (13 of 20 specimens) than did the monopolar device (0 of 10 specimens). Caution should be used in treating fibrillated cartilage with radiofrequency energy, particularly with the bipolar devices tested.