Segmented interlocking nail: An in vivo evaluation of a novel humeral osteotomy fixation device in a caprine model

Summary

Objectives: To describe a novel humeral fixation device, the insertion technique, healing of humeral osteotomies, and clinical outcomes in a caprine model over a six month period.

Methods: Fourteen mature female Boer/Nubian cross goats with a mean body weight of 50.7 kg were implanted with a proprietary segmented interlocking nail (SILN) in both humeri. Each goat had one humerus randomly selected for mid-diaphyseal osteotomy.

Results: Immediately after surgery all but one goat was able to stand, although none of the goats were weight bearing on the osteotomy limb. During the six month study, clinical lameness was always associated with the osteotomy limb. One month after surgery, lameness for twelve of the goats was grade 2/5 or better. At three months, 11 of the 14 did not exhibit any signs of lameness. On radio-graphic images, notable malalignment of the osteotomy was observed, although all osteotomies went to bone union.

Clinical significance: The results of this study suggest that despite misalignment, the SILN maintained adequate osteotomy fixation to achieve bone union in the research model studied, with reduced morbidity and early return to function with bilateral implantation. The SILN used in this study allowed intramedullary fixation of humeral diaphyseal osteotomies with a limited and safe surgical approach.

Keywords

Segmented - humerus - interlocking nail - osteotomy

• References

• 1 Kuntscher G. Die Marknalung von Knochenbrüchen [Intramedullary nailing of bone fractures]. Langenbecks. Arch Klin Chir 1940; 200: 443-455.
• 2 Modny MT, Bambara J. The perforated cruciate intramedullary nail: Preliminary report of its use in geriatric patients. J Am Geriatr Soc 1953; 1: 579-588.
• 3 Klemm K, Schellmann WD. Dynamische und statische Verriegelung des Marknagels [Dynamic and static locking of the intramedullary nail]. Monatsschr Unfallheilkd 1972; 75: 568-575.
• 4 Dueland RT, Berglund L, Vanderby Jr R. et al. Structural properties of interlocking nails, canine femora and femur-interlocking nail constructs. Vet Surg 1996; 25: 386-396.
• 5 Roush JK, McLaughlin RM. Using interlocking nail fixation to repair fractures in small animals. Vet Med 1999; 94: 46-52.
• 6 Wheeler JL, Cross AR, Lewis DL. et al. Intramedullary interlocking nail fixation in dogs and cats: clinical applications. Compend Cont Educ Pract Vet (Small Anim) 2004; 26: 531-544.
• 7 Dueland RT. History of interlocking nail fixation. Proceedings of the 28th Annual American College of Veterinary Surgeons Symposium 2000. October Chicago: Illinois, USA.; 435.
• 8 Johnson KA, Huckstep RL. Bone remodeling in canine femora after internal fixation with the “Huck-step nail.”. Vet Radiol 1986; 27: 20
• 9 Muir P, Parker RB, Goldsmid SE. et al. Interlocking intramedullary nail stabilization of a diaphyseal tibial fracture. J Small Anim Pract 1993; 34: 26-30.
• 10 Dueland RT, Johnson KA, Roe SC. et al. Interlocking nail treatment of diaphyseal long bone fractures in dogs. J Am Vet Med Assoc 1999; 214: 59-66.
• 11 Durall I, Diaz MC, Morales I. Interlocking nail stabilization of humeral fractures. Initial experience in seven cases. Vet Comp Orthop Traumatol 1994; 7: 3-8.
• 12 Durall I, Diaz MC. Early experience with the use of an interlocking nail for the repair of canine femoral shaft fractures. Vet Surg 1996; 25: 397-406.
• 13 Lorinson D, Grosslinger K, Vidoni B. Anwendung des Verriegelungsnagels bei Frakturen langer Röhrenknochen von Hund und Katze [Application of the locking nail for use in fractures of long bones in the dog and cat]. Wein Tierartz Monat 2000; 87: 278-283.
• 14 Moses P, Lewis D, Lanz O. et al. Intramedullary interlocking nail stabilisation of 21 humeral fractures in 19 dogs and one cat. Aust Vet J 2002; 80: 336-343.
• 15 Cox MA, Dolan M, Synnott K. et al. Closed interlocking nailing of humeral shaft fractures with the Russell-Taylor nail. J Orthop Trauma 2000; 14: 349-353.
• 16 Hems TE, Bhullar TP. Interlocking nailing of humeral shaft fractures: the Oxford experience 1991 to 1994. Injury 1996; 27: 485-489.
• 17 Flinkkila T, Hyvonen P, Lakovaara M. et al. Intramedullary nailing of humeral shaft fractures. A retrospective study of 126 cases. Acta Orthop Scand 1999; 70: 133-136.
• 18 McCormack RG, Brien D, Buckley RE. et al. Fixation of fractures of the shaft of the humerus by dynamic compression plate or intramedullary nail. A prospective, randomised trial. J Bone Joint Surg Br 2000; 82: 336-339.
• 19 Lin HC, Tyler JW, Welles EG. et al. Effects of anesthesia induced and maintained by continuous intravenous administration of guaifenesin, ketamine, and xylazine in spontaneously breathing sheep. Am J Vet Res 1993; 54: 1913-1916.
• 20 Hammer RRR, Hammerby S, Linholm B. Accuracy of radiologic assessment of tibial shaft fractures unions in humans. Clin Orthop 1985; 199: 233-238.
• 21 Muir P, Johnson KA, Markel MD. Area moment of inertia for comparison of implant cross-sectional geometry and bending stiffness. Vet Comp Orthop Traumatol 1995; 8: 146-152.
• 22 Bernardé A, Diop A, Maurel N. et al. An in vitro bio-mechanical study of bone plate and interlocking nail in a canine diaphyseal femoral fracture model. Vet Surg 2001; 30: 397-408.
• 23 Goett SD, Sinnott MT, Ting D. et al. Mechanical comparison of an interlocking nail locked with conventional bolts to extended bolts connected with a type-IA external skeletal fixator in a tibial fracture model. Vet Surg 2007; 36: 279-286.
• 24 von Pfeil DJ, Déjardin LM, DeCamp CE. et al. In vitro biomechanical comparison of a plate-rod combination-construct and an interlocking nail-construct for experimentally induced gap fractures in canine tibiae. Am J Vet Res 2005; 66: 1536-1543.
• 25 Lansdowne JL, Sinnott MT, Déjardin LM. et al. In vitro mechanical comparison of screwed, bolted, and novel interlocking nail systems to buttress plate fixation in torsion and mediolateral bending. Vet Surg 2007; 36: 368-377.
• 26 Déjardin LM, Guillou RP, Ting D. et al. Effect of bending direction on the mechanical behaviour of interlocking nail systems. Vet Comp Orthop Traumatol 2009; 22: 264-269.
• 27 Déjardin LM, Lansdowne JL, Sinnott MT. et al. In vitro mechanical evaluation of torsional loading in simulated canine tibiae for a novel hourglass-shaped interlocking nail with a self-tapping tapered locking design. Am J Vet Res 2006; 67: 678-685.
• 28 Ting D, Cabassu JB, Guillou RP. et al. In vitro evaluation of the effect of fracture configuration on the mechanical properties of standard and novel inter-locking nail systems in bending. Vet Surg 2009; 38: 881-887.
• 29 Déjardin LM. Interlocking Nailing of Complex Shaft Fractures [course material]. AO/ASIF Small Animal Advance Course 2011. Columbus; OH, USA.: April 22-25.
• 30 Eugster S, Schawalder P, Gaschen F. et al. A prospective study of postoperative surgical site infections in dogs and cats. Vet Surg 2004; 33: 542-550.
• 31 Stannard JP, Harris HW, McGwin Jr G. et al. Intramedullary nailing of humeral shaft fractures with a locking flexible nail. J Bone Joint Surg Am 2003; 85 A 2103-2110.
• 32 Rüedi T, Perren SM, Pohler O. et al. Titanium, steel and their combination in bone surgery. Langenbecks Arch Chir 1975; Suppl 395-398.
• 33 Serhan H, Slivka M, Albert T. et al. Is galvanic corrosion between titanium alloy and stainless steel spinal implants a clinical concern?. Spine J 2004; 4: 379-387.
• 34 Sinibaldi KR, Pugh J, Rosen H. et al. Osteomyolitis and neoplasia associated with use of Jonas intramedullary splint in small animals. J Am Vet Med Assoc 1982; 181: 885-890.
• 35 Kang R, Stern PJ. Humeral nonunion associated with metallosis secondary to use of a titanium flexible humeral intramedullary nail: a case report. J Bone Joint Surg Am 2002; 84–A 2266.