Effects of a novel hydrogel on equine bone healing: a pilot study.

OBJECTIVE: To examine the efficacy and biocompatibility of a thiolated gelatin-thiolated carboxymethyl hyaluronan (CMHA-SGX) sponge as an osteoconductive device in an equine second and fourth metacarpal bone defect model. METHODS: Seven millimetre segmental ostectomies were created bilaterally in the second and fourth metacarpal bones of four horses. The left and right metacarpal defects were randomly assigned to (1) be filled with a CMHA-SGX sponge (treated) or (2) were left unfilled (control). The duration of the study was nine weeks. Bone healing was evaluated using serial radiology, as well as histologically and histomorphometrically. Data were analyzed using an analysis of variance (ANOVA). The level of significance was p<0.05. RESULTS: Serial radiographic evaluation revealed improved healing in the treated compared to the control defects at weeks eight and nine (p = 0.02). This finding was not corroborated histologically. Histomorphometry did not reveal any significant differences in healing between experimental groups. The CMHA-SGX sponge did not inhibit bone formation, induce local inflammation or lead to surgical site infection. CLINICAL SIGNIFICANCE: While further optimization to improve osteoconductive properties should be considered, the CMHA-SGX sponge appears to be a biocompatible orthopaedic implant and its use as a carrier for osteogenic proteins warrants further investigation.

Ex vivo comparison of a novel tapered-sleeve and traditional full-limb transfixation pin cast for distal radial fracture stabilization in the horse.

Distal radial fractures in adult horses are examples of long-bone fractures that are not always amenable to internal fixation. These fractures are often open, contaminated, severely comminuted, and located adjacent to the antebrachiocarpal joint. There have been few studies to improve upon the methods of stabilization of this type of fracture. External coaptation incorporating transfixation pins is one method that has been used to stabilize distal radial fractures in horses (1-3). The purpose of this preliminary study was to compare the load to failure in simulated weight-bearing of a novel tapered-sleeve transfixation pin cast (TSTPC) (4) with the traditional transfixation pin cast (TPC) in an ex vivo distal radial fracture model. Ten adult equine cadaveric forelimbs were randomly placed into a TPC group (n = 5) or a TSTPC group (n = 5). An oblique distal radial osteotomy was created prior to application of fibreglass cast material. The limbs were loaded in a single cycle to failure in simulated weight-bearing using an axial load. The mean load to failure for the TSTPC group (35,814 N) was significantly greater than in the TPC group (22,344 N) (p = 0.003). Tapered sleeves in conjunction with TPC warrant further investigation because they may prolong the life of the fixation, prevent or diminish fractures through the pin sites, and increase the load capacity of external coaptation used to stabilize equine fractures.

The horse-racetrack interface: a preliminary study on the effect of shoeing on impact trauma using a novel wireless data acquisition system.

REASONS FOR PERFORMING STUDY: There is a need to determine accelerations acting on the equine hoof under field conditions in order to better assess the risks for orthopaedic health associated with shoeing practices and/or surface conditions. OBJECTIVES: To measure the acceleration profiles generated in Thoroughbred racehorses exercising at high speeds over dirt racetracks and specifically to evaluate the effect of a toe grab shoe compared to a flat racing plate, using a newly developed wireless data acquisition system (WDAS). METHODS: Four Thoroughbred racehorses in training and racing were used. Based on previous trials, each horse served as its own control for speed trials, with shoe type as variable. Horses were evaluated at speeds ranging from 12.0-17.3 m/sec. Impact accelerations, acceleration on break over and take-off, and temporal stride parameters were calculated. Impact injury scores were also determined, using peak accelerations and the time over which they occurred. RESULTS: Recorded accelerations for the resultant vector (all horses all speeds) calculated from triaxial accelerometers ranged 96.3-251.1 g, depending on the phase of the impact event. An association was observed between shoe type and change in acceleration in individual horses, with 2 horses having increased g on initial impact with toe grab shoes in place. In the final impact phase, one horse had an increase of 110 g while wearing toe grab shoes. Increased accelerations were also observed on break over in 2 horses while wearing toe grab shoes. CONCLUSIONS: Shoe type may change impact accelerations significantly in an individual horse and could represent increased risk for injury. Further work is needed to determine if trends exist across a population. POTENTIAL RELEVANCE: The WDAS could be used for performance evaluation in individual horses to evaluate any component of the horse-performance surface interface, with the goal of minimising risk and optimising performance.

A novel wireless data acquisition system for the measurement of hoof accelerations in the exercising horse.

REASONS FOR PERFORMING STUDY: A device is needed to safely and wirelessly evaluate accelerations experienced by the horse hoof under a variety of surface conditions with the horse exercising at training or racing speeds. OBJECTIVES: To develop a miniaturised wireless data acquisition system (WDAS) which reliably records hoof accelerations and the times over which they occur in a minimally invasive manner in the exercising Thoroughbred. METHODS: The following criteria were set for device development: production of a lightweight and minimally invasive system, which provides an adequate acceleration range, appropriate frequency response to capture high speed events, and compatibility with a low power wireless telemetry system. Following device development, the WDAS was calibrated, and tested in 6 Thoroughbred horses over a variety of surfaces. RESULTS: Collection of acceleration in seven trials using 6 horses over a variety of surfaces resulted in repeatable acceleration data with respect to the overall characteristic shape of the impact profile. Impact accelerations varied with surface, ranging 34.8-191.7 g. Accelerations on take off were in a similar range, although higher in some trials. Peak impact accelerations tended to larger over the grass paddock surface, than either the indoor arena or the dirt track. During dirt track trials, accelerations on take-off were often comparably larger than those observed on impact within the same footfall. CONCLUSIONS: This study reports the development of a wireless system that successfully measures hoof acceleration in a minimally invasive manner over a variety of surface and exercise conditions. POTENTIAL RELEVANCE: The WDAS will be used in further studies to evaluate various components of the horse-racetrack interface, in an attempt to identify risk factors for musculoskeletal injury in the Thoroughbred racehorse.

Mechanical effects of high density polyethylene dynamic compression plate hole inserts on bone-plate constructs.

This study was conducted in order to investigate the mechanical effects of high density polyethylene screw hole inserts in 4.5 mm Dynamic Compression Plate (DCP)--synthetic bone constructs. A mid-shaft 'osteotomy' was created in synthetic bone cylinders. The bisecting 'osteotomy' was reduced using six-hole broad DCPs and 4.5 mm cortical bone screws. The screws adjacent to the 'osteotomy' were placed using a load-guide. The remaining screws were placed in neutral position. High density polyethylene DCP screw hole inserts were incorporated with each screw in neutral position, in the experimental group. The bone plate constructs were tested in four point cyclical bending with the plates loaded at 2,000 Newtons, for a total of 6,000 cycles. Osteotomy gap was measured at 3,000 and 6,000 cycles. Screw head deflection adjacent to the osteotomy was measured. Kruskal-Wallis non-parametric testing was used for statistical comparisons. There was significantly less gapping at the osteotomy site in the treatment group after 3,000 cycles (0.49 +/- 0.18 mm [control] vs. 0.06 +/- 0.14 mm [treated], P=0.02) and 6,000 cycles (0.6 +/- 0.18 mm [control] vs. 0.1 +/- 0.22 mm [treated], P=0.02). The screws adjacent to the gap were significantly more deformed in the control group than those in the treated constructs (3.63 +/- 1.81 [control] vs. 1.06 +/- 1.55 [treated], P=0.0002). The polyethylene inserts improved the interface between bone plate and screw head, resulting in decreased relative movement of the implant and bone. The polyethylene inserts also resulted in less bending of the loaded screws.

Evaluation of a tapered-sleeve transcortical pin to reduce stress at the bone-pin interface in metacarpal bones obtained from horses.

OBJECTIVE: To evaluate stiffness and bone-pin interface stress for a transcortical tapered-sleeve pin (TSP) that incorporates bilateral tapered sleeves over a transcortical pin. SAMPLE POPULATION: 14 third metacarpal bones (MCIII) collected from adult horses of various breeds. PROCEDURE: Each MCIII was cut in half to provide 2 test specimens. Pins (conventional and TSP) of 3 diameters (6.35, 7.94, and 9.50 mm) were inserted in specimens (3 specimens for each diameter and each type of pin). The test fixture simulated a typical sidebar-span skeletal fixation device for horses. Single cycle load-deflection tests were performed. Cyclic fatigue tests of TSP were performed to evaluate fatigue characteristics and stress conditions at the bone-pin interface. Maximum stress and strain were calculated, and results were compared with existing data on fatigue characteristics of bone. RESULTS: Significant increases in stiffness (load-deflection) and higher loads at yield point were detected for the TSP (stiffness for conventional 9.50mm pins, 4,500 N/mm; stiffness for TSP, 19,988 N/mm). Results of cyclic tests revealed a close correlation with existing data on fatigue characteristics. CONCLUSIONS AND CLINICAL RELEVANCE: The TSP described here is stiffer than conventional transcortical pins, and stress across the bone-pin interface is more evenly distributed. Use of this TSP should minimize major problems encountered during external fixation associated with the transcortical pin and bone-pin interface (ie, bone necrosis, infection of the pin track, pin loosening, and bone failure).

Gait and speed as exercise components of risk factors associated with onset of fatigue injury of the third metacarpal bone in 2-year-old Thoroughbred racehorses.

OBJECTIVE: To determine the degree to which components of the training program of 2-year-old Thoroughbred racehorses influence their susceptibility to fatigue injury of the third metacarpal bone (bucked shins). ANIMALS: 226 two-year-old Thoroughbred racehorses. PROCEDURE: Daily training information and health reports on 2-year-old Thoroughbreds were compiled from records provided from 5 commercial stables. For each horse, data (exercise variables) were collected that comprised distance jogged (approx speed of 5 m/s), galloped (approx 11 m/s), and breezed (approx 15 to 16 m/s) until a single instance of bucked shins was reported. Data were coded for analysis using cross-tabulation, graphic, and survival techniques. RESULTS: Of 226 horses, 56 had bucked shins, 9 completed the observation period without bucked shins, and 161 were lost to follow-up. Distinct training strategies were used at stables resulting in significantly different survival profiles among stables. Mean (+/- SD) allocation of exercise to breezing was 0.15 +/- 0.13 miles/wk (maximum, 0.64 miles/wk), to galloping was 4.47 +/- 1.52 miles/wk (maximum, 9.56 miles/wk), and to jogging was 2.34 +/- 1.70 miles/wk (maximum, 8.53 miles/wk). Survival (ie, lack of bucked shins during 1 year of monitoring) was found to be significantly reduced by exercise allocation to breezing, significantly increased by exercise allocation to galloping, and uninfluenced by exercise allocation to jogging. The log of the hazard ratio was reduced by 4.2 +/- 1.5/mile breezed and increased by 0.3 +/- 0.1/mile galloped. CONCLUSIONS AND CLINICAL RELEVANCE: Relationships between different gaits and speeds in the training regimen influence the incidence of bucked shins. To reduce the incidence of bucked shins, trainers should consider allocating more training effort to regular short-distance breezing and less to long-distance galloping.

Experimental models of fracture repair.

Many mammalian and avian species have been used as models to study fracture healing. The individual animals, based on their size and other characteristics, are used to show the effects of different interventions on healing bone. The models may have fractures created by closed or open means or osteotomies. Fracture healing can be evaluated through histologic, mechanical, chemical, or biological studies. Internal fixation, external skeletal fixation, or no fixation may be used in the experiments. Results of fracture healing studies among animal species may conflict even when the same model is used in each species. These differences may be explained by anatomic, biochemical, and gene expression differences. Evaluation of the animal model is an important consideration when applying the results of any particular study to humans. Consensus regarding fracture healing develops from agreement between results of animal models and human clinical studies.

Effect of alendronate on fracture healing and bone remodeling in dogs.

To examine the effect of alendronate (4-amino-1-hydroxybutylidene bisphosphonate) on fracture repair, the drug was given to mature beagle dogs orogastrically at 2 mg/kg/day for 9 weeks preceding fracture. 16 weeks after fracture, or both before and after fracture (25 weeks). A transverse mid-diaphyseal fracture of the right radius was surgically induced and was stabilized by external coaptation splinting. Fracture healing and bone remodeling were evaluated by radiography, gross and histological examination, and bone histomorphometry. The mechanical properties of the fracture callus were determined by a four-point bending test. Radiographs and gross and microscopic examination demonstrated normal bone healing at the fracture site in all dogs. In dogs that received alendronate during the fracture healing period, at 16 weeks the calluses were approximately 2-3 times larger than those in dogs that received a placebo during the healing period. This is consistent with slower callus bone remodeling, an expected pharmacological effect of the compound. Bone histomorphometry demonstrated that treatment with alendronate did not inhibit bone formation or mineralization. Mechanical testing showed that the ultimate load at failure and the flexural rigidity of both the fractured and contralateral intact bone were unaffected by treatment with alendronate. Therefore, in this study, treatment with alendronate before or during fracture healing, or both, resulted in no adverse effects on the union, strength, or mineralization of bone in mature beagle dogs.

Use of tension band wires in horses with fractures of the ulna: 22 cases (1980-1992).

Twenty-two horses with ulnar fractures were treated, using tension band wires alone or tension band wires in combination with pins or cortical bone screws. Age of the horses ranged from 2 weeks to 12 years (median, 4 months), and body weight ranged from 68 to 477 kg (median, 181 kg). Fractures were classified according to the Donecker and Bramlage ulnar fracture classification and included type 1-a (4 horses), type 1-b (4), type-2 (6), type-3 (1), type-4 (3), and type-5 (4), fractures. Tension band wires alone were used in 7 horses. Tension band wires were used in conjunction with unthreaded pins in 10 horses. In 3 horses, 5.5-mm cortical bone screws were inserted longitudinally instead of pins. A combination of a 5.5-mm cortical bone screw and a pin was used in 2 horses. In addition to pins and tension band wires, 4.5-mm cortical bone screws were placed in lag fashion to aid reduction of comminuted or oblique fractures in 7 of the 22 horses. Fractures healed in 18 (82%) horses. Four horses were euthanatized because of complications that included catastrophic failure of fixation during recovery from general anesthesia in 1 foal, septic arthritis and hyperextension of the contralateral metacarpophalangeal joint in 1 foal, and wound infection with partial disruption of repair in 2 horses. Nonfatal complications developed in 6 horses and included incision infection, partial wound dehiscence, carpal contraction, carpus varus of the contralateral forelimb, slight distraction of proximal fragments of the fractures, bent implants, and distal migration of pins. Long-term monitoring was performed on 17 horses.(ABSTRACT TRUNCATED AT 250 WORDS)

Contact area and static pressure profile at the plate-bone interface in the nonluted and luted bone plate.

Contact area and pressure between 6-hole broad dynamic compression plates and 20 pairs of equine third metatarsal bones were measured using nonluted and luted plating techniques. Pressure-sensitive film (pressure ranges 10 to 50 MPa and 50 to 130 MPa) was used as the static pressure transducer. Nonluted and one of two luting techniques were tested on each pair of bones; each luting technique was tested on 20 bones. Quantitative determinations of contact area and pressure were made using computerized image processing techniques. Mean (+/- SD) total contact area for nonluted plates was 18.49% +/- 3.5% of the potential plate-bone contact area. Luting increased (P < .05) total contact area to 25.56% +/- 4.0% and 31.29% +/- 6.6% for the respective luting techniques. The effects of luting on contact area were dependent on the contact pressure. At contact pressure ranges 10 to 20 and 21 to 35 MPa, luting increased contact area. In contact pressure ranges 36 to 45 and 50 to 65 MPa, plate-bone contact was inherently greatest and plate luting had no significant effect on contact area. In contact pressure ranges 66 to 99 and 100 to 126 MPa, luting decreased contact area. Contact area was increased at lower contact pressures at the expense of higher pressure contact. Contact in the middle third of the plate was 20% to 40% of the contact at either end of the plate. Plate luting increased contact area best where plate-bone contour was most similar.

Stress protection afforded by a cast on plate fixation of the distal forelimb in the horse in vitro.

Six forelimb specimens from three adult horses had the fetlock joint fused by application of a dorsal plate and by a screw placed in lag fashion through the metacarpus to each proximal sesamoid bone. Five specimens were instrumented on the central dorsal surface of the plate with a single rosette strain gage, and the plate of the sixth specimen was instrumented with four longitudinally oriented single-axis strain gages. The specimens were loaded axially in compression to 4,000 N in a cast (test 1), in a cast with a heel block (test 2), and uncast (test 3). The principal angle of strain in all specimens, in all tests, closely approximated the vertical axis at loads < 1,000 N. The principal angle in uncast specimens was significantly different at loads > 1,000 N than the cast specimens (P < .05). At loads > 3,000 N, the principal angle in test 3 closely approximated the horizontal axis, indicating a change from tension to compression on the dorsal surface of the plate, whereas the principal angle of the cast specimens was unchanged. Specimens in a cast (tests 1 and 2) suffered less surface deformation than did uncast specimens (test 3). Therefore, the cast changed the direction and extent of bending at the point of fixation, and thereby decreased the deformation of the plate. This effect would lead to greater fatigue life of the implant in the cast specimens compared with the uncast specimens.

Evaluation of plate luting, using an in vivo ovine osteotomy model.

Bilateral, midshaft metacarpal osteotomies were performed in 11 sheep and bilateral, midshaft radial osteotomies were performed in 7 sheep. The lesions were repaired with bone plates. One of each pair of plates was luted with polymethylmethacrylate and all screws were tightened uniformly with a torque screwdriver. Sheep were allowed unrestricted exercise after surgery. At 8 weeks, 10 of 11 sheep with metacarpal osteotomies were sound and both osteotomies were healing. Seven were lame on the limb with the unluted plate during the first 3 weeks; 4 were never lame on either limb. The screws of the unluted plates were significantly (P less than 0.01) looser at 8 weeks than those in the luted plates. All of the sheep with radial osteotomies were lame in the limb with the unluted plate. Four of 7 sheep had overt loosening of the unluted plates. One sheep only had mild screw loosening with continued alignment of the osteotomy. Two of 7 sheep fractured the radius with the luted plate; these 2 sheep were lame in the limb with the unluted plate and were using the limb with the luted plate vigorously. Excluding the 2 sheep with fractures, all had substantially more screw loosening in the unluted plate. Histologically, there were no discernible differences in the vascularity or porosity of the bone under the luted vs the unluted plates. The only adverse consequence of the luting technique was introduction of a small amount of polymethylmethacrylate into the osteotomy gap in 5 bones.

Quantitative evaluation of the remodeling response of the proximal sesamoid bones to training-related stimuli in Thoroughbreds.

Eight untrained 2-year-old Thoroughbred horses were used in a study of the remodeling response of the proximal sesamoid bone (PSB) to training-related stimuli. Two horses each were assigned to 1 of 4 groups: group 1, untrained, pasture turnout (control); group 2, modified-classically trained, dirt track; group 3, classically trained, dirt track; and group 4, classically trained, wood chip track. Horses were given fluorochromic bone labels every 28 days during training. All horses were euthanatized after 5 months of training, and the proximal sesamoid bones (PSB) were removed. A midsagittal section of bone 85- to 95-microns thick was prepared for histomorphometric analysis by use of computerized image analysis and epifluorescent microscopy. Porosity (percent), trabecular width (micrometer), extent of anisotropy (percent), mineralizing surface (percent), fractional mineralizing surface (percent), and mineral apposition rate (micrometers per day) were determined at 5 circular regions of each specimen. Region 1 was located within the apex of the PSB, regions 2, 3, and 4 were subjacent to the subchondral plate, and region 5 was within the basilar articular margin. Data were pooled to allow comparison by training group and by region. The PSB from horses trained on dirt tracks (groups 2 and 3) had significantly (P less than 0.05) lower porosities and greater trabecular width, compared with the control group. The PSB from all training group specimens had significantly larger mineralizing surfaces than control group specimens. The fractional mineralizing surface revealed a rapid and vigorous response of the endosteal surface of the PSB in horses trained on dirt tracks.(ABSTRACT TRUNCATED AT 250 WORDS)

Excision of oral squamous cell carcinoma in a horse.

A large oral squamous cell carcinoma in a 27-year-old Arabian stallion was removed by partial excision of the incisive bone. There was no gross evidence of recurrence or metastasis 5 months later.

Mechanical and morphometric analysis of the third carpal bone of Thoroughbreds.

The third carpal bone (C3) was collected from both forelimbs of 27 Thoroughbreds. On the basis of age, training, and history, specimens were assigned to 1 of 5 groups: yearling, untrained horses (group 1, n = 4); 2- to 3-year-old, untrained horses (group 2, n = 7); trained 2-year-old horses (group 3, n = 6); trained 3-year-old horses (group 4, n = 6); and 3-year-old, trained horses with carpal pathologic features (group 5, n = 4). A transverse section of subchondral bone 5-mm thick was cut in a precise fashion 10 mm below the proximal articular surface of all specimens. After high-detail radiography was done, indentation testing was performed on the proximal surface of the section at points 5 mm apart. The stiffness of the subchondral cancellous bone was determined from the slope of the load vs displacement curve. Topographic plots of stiffness measurements were compared with radiographs of each specimen. Point determinations were averaged to derive measures for the radial and intermediate facets, and for regions 5, 10, 15, and 20 mm from the dorsal margin of C3. Area fraction (1-p; p = porosity) was measured for the radial and intermediate facets, using an automated image analysis system. Significant (P less than 0.05) increases in stiffness and area fraction were found in the C3 from trained horses (groups 3 to 5), compared with untrained horses (groups 1 to 2). Stiffness and area fraction of the radial facet of pathologic C3 were significantly higher than the same variables measured in C3 from any other group.(ABSTRACT TRUNCATED AT 250 WORDS)

In vitro comparison of Thoroughbred and Standardbred racehorses with regard to local fatigue failure of the third metacarpal bone.

In vitro local fatigue testing of the third metacarpal bone from Thoroughbred and Standardbred racehorses was performed, using fully reversed cyclic bending. Strain number of cycle data were accumulated and indicated that significant difference did not exist between the 2 breeds. It was concluded that the marked difference in the incidence of fatigue failure in the third metacarpal bone (bucked shins, dorsal metacarpal disease) seen in Thoroughbreds and Standardbreds was not related to any differences between the 2 breeds in mechanical properties of the bone.

Circumferential wiring of mid-body and large basilar fractures of the proximal sesamoid bone in 15 horses.

Circumferential wiring was used to repair 12 mid-body fractures and four large basilar fractures of proximal sesamoid bones in 15 horses. Eighteen-gauge stainless steel wire was placed around both fragments in five horses, and through the proximal fragment and around the distal fragment in 10 horses. The horses were returned to work when they were clinically sound and fracture healing was evident radiographically. Eleven horses resumed athletic performance, three horses were used as breeding animals, and one horse was retired. Five horses performed at an athletic level equal to or better than their previous levels, and six horses performed at a lower level.

Mechanical and biological effects of plate luting.

Plate luting, a technique that uses polymethylmethacrylate (PMMA) interposed between the plate and the bone, as well as between the screw heads and the plate, to improve the stability of internal fixation was tested in vitro using 20 paired equine third metacarpal bones with mid-diaphyseal osteotomies plated with six-hole broad ASIF compression plates. One of each pair was luted and all specimens were tested in static overload or cyclic loading at 75% of the ultimate breaking strength using four-point bending. Although no differences were measured in static overload tests between luted and nonluted plates, a three to 12-fold increase in the number of cycles to failure was noted with the luted specimens. In vivo studies of the biological reaction to plate luting were performed in seven horses using identical plates fixed to the intact radius. One side was luted while the opposite side was plated without luting. The horses were killed at 1, 2, 6, and 15 months after surgery. Quantitative histomorphometry showed no increase in porosity under the luted plate when compared with the nonluted side.

Fatigue fractures in thoroughbred racehorses: relationships with age, peak bone strain, and training.

The North American Thoroughbred racehorse was chosen as a model to study the pathogenesis of fatigue failure of bone. This species has a high incidence of spontaneous fatigue failure of bone (bucked shins) during its early training. In vivo strain gauge studies of the third metacarpal bone of four young racehorses running at racing speeds showed high principal compressive strains [-4,841 +/- 572 (SD) microstrain] while two older horses had lower principal compressive strains (-3,317 microstrain measured at racing speed, -3,250 microstrain extrapolated from a slower speed run). Previously reported inertial property measurements of the third metacarpal bone were related to the difference in bone strains seen in young and older horses. The high strains on the surface of the third metacarpal bone associated with young horses in training may lead to high strain, low cycle fatigue. The changing shape of the third metacarpal bone during maturation may be consistent with the lower strains recorded during high speed exercise in the older animals. This phenomenon may allow for the accumulation of additional strain cycles in older animals before failure occurs.