Biomechanical comparison of pin and nitinol bone staple fixation to pin and tension band wire fixation for the stabilization of canine olecranon osteotomies

Summary

Objective: To compare the initial biomechanical properties of olecranon osteotomies stabilized with intramedullary pins and a Nitinol bone staple to osteotomies stabilized with pin and tension band wire fixation.

Study design: Ex vivo mechanical evaluation on cadaveric bones.

Material and methods: Ten pairs of cadaveric forelimbs from skeletally mature Greyhounds with an olecranon osteotomy stabilized with either a pin and Nitinol bone staple or a pin and tension band wire. A single load to failure was applied to each specimen through the triceps tendon. Biomechanical properties were compared based on stiffness, yield load, and maximum load to failure and load at 2 mm of axial displacement.

Results: Specimens stabilized with the bone staple were biomechanically superior in all the variables tested. There was significantly greater stiffness (118.0 ± 25.9 N/mm versus 70.1 ± 40.4 N/mm; p = 0.005), yield load (319.0 ± 99.8 N versus 238.0 ± 42.5 N; p = 0.03), maximum load sustained (385.0 ± 99.2 N versus 287.0 ± 37.4 N; p = 0.009), and load at 2 mm of axial displacement (218.0 ± 51.5 N versus 138.0 ± 48.7 N; p = 0.002) in specimens stabilized with pins and a Nitinol bone staple than specimens stabilized with pin and tension band wire fixation.

Clinical significance: The pin and Nitinol bone staple construct provides a biomechanically superior alternative to pin and tension band wire fixation for stabilization of olecranon osteotomies, and its use warrants further clinical investigation.

Supplementary material for this article is available at https://doi.org/10.3415/VCOT-17-02-0025

Keywords

Olecranon osteotomy - pin and tension band wire - nitinol - bone staple - biomechanical

• References

• 1 Birchard SJ, Bright RM. The tension band wire for fracture repair in the dog. Compend Contin Educ Pract Vet 1981; 3: 37-41.
• 2 Palmer RH, Aron DN, Chambers JN. A combined tension band and lag screw technique for fixation of olecranon osteotomies. Vet Surg 1988; 17: 328-332.
• 3 De Haan JJ, Roe SC, Lewis DD. et al. Elbow arthrodesis in twelve dogs. Vet Comp Orthop Traumatol 1996; 9: 115-118.
• 4 Schatzker J, Meutstege F, Prieur WD. Implants and their application. In Brinker WO, Olmstead ML, Sumner-Smith G. et al. Editors Manual of Internal Fixation in Small Animals. 2nd ed. Berlin: Springer-Verlag; 1998: 88-91.
• 5 Johnson KA. Osteotomy. In Brinker WO, Olmstead ML, Sumner-Smith G. et al. Editors Manual of Internal Fixation in Small Animals. 2nd ed. Berlin: Springer-Verlag; 1998: 241-246.
• 6 Guerin SR, Lewis DD, Lanz OI. et al. Comminuted supracondylar humeral fractures repaired with a modified type I external skeletal skeletal fixator construct. J Small Anim Pract 1998; 39: 525-532.
• 7 Halling KB, Lewis DD, Cross AR. et al. Complication rate and factors affecting outcome of olecranon osteotomy repair in dogs. Can Vet J 2002; 43: 528-534.
• 8 Fyfe IS, Mossad MM, Holdsworth BJ. Methods of fixation of olecranon fractures. An experimental mechanical study. J Bone Joint Surg Br 1985; 67: 367-372.
• 9 Horner SR, Sadasivan KK, Lipka JM. et al. Analysis of mechanical factors affecting fixation of olecranon fractures. Orthopedics 1989; 12: 1469-1472.
• 10 Hutchinson DT, Horwitz DS, Ha G. et al. Cyclic loading of olecranon fracture fixation constructs. J Bone Joint Surg Am 2003; 85: 831-837.
• 11 Kozin SH, Berglund LJ, Cooney WP. et al. Biomechanical analysis of tension band fixation for olecranon fracture treatment. J Shoulder Elbow Surg 1996; 5: 442-448.
• 12 Molloy S, Jasper LE, Elliott DS. et al. Biomechanical evaluation of intramedullary nail versus tension band fixation for transverse olecranon fractures. J Orthop Trauma 2004; 18: 170-174.
• 13 Mullett JH, Shannon F, Noel J. et al. K-wire position in tension band wiring of the olecranon—a comparison of two techniques. Injury 2000; 31: 427-431.
• 14 Murphy DF, Greene WB, Gilbert JA. et al. Displaced olecranon fractures in adults. Biomechanical analysis of fixation methods. Clin Orthop Rel Res 1987; 224: 210-214.
• 15 Paremain GP, Novak VP, Jinnah RH. et al. Biomechanical evaluation of tension band placement for the repair of olecranon fractures. Clin Orthop Rel Res 1997; 335: 325-330.
• 16 Petraco DM, Koval KJ, Kummer FJ. et al. Fixation stability of olecranon osteotomies. Clin Orthop Rel Res 1996; 333: 181-185.
• 17 Prayson MJ, Williams JL, Marshall MP. et al. Biomechanical comparison of fixation methods in transverse olecranon fractures: a cadaveric study. J Orthop Trauma 1997; 11: 565-572.
• 18 Tejwani NC, Garnham IR, Wolinsky PR. et al. Posterior olecranon plating: biomechanical and clinical evaluation of a new operative technique. Bull Hosp Jt Dis 2002; 61: 27-31.
• 19 Wu CC, Tai CL, Shih CH. Biomechanical comparison for different configurations of tension band wiring techniques in treating an olecranon fracture. J Trauma 2000; 48: 1063-1067.
• 20 Halling KB, Lewis DD, Cross AR. et al. Biomechanical comparison of a circular external skeletal fixator construct to pin and tension band wire fixation for the stabilization of olecranon osteotomies in dogs: a cadaveric study. Vet Surg 2003; 32: 324-335.
• 21 Grafinger MS, Roe SC, Spodnick G. et al. Biomechanical comparison of dual interlocking single loop and double loop tension band techniques to the classic AO tension band technique for repair of olecranon osteotomies in dogs. Vet Surg 2007; 36: 141-148.
• 22 Murphy DF, Greene WB, Dameron TB. Displaced olecranon fractures in adults: Clinical evaluation. Clin Orthop Res Rel 1987; 224: 215-223.
• 23 Gullahorn LJ, Carlson D, Schneid K. Effectiveness of screw versus figure-of-eight tension band wire fixation of olecranon fractures. Proceedings of the American Academy of Orthopedic Surgery. Orlando, FL, USA: 2000. July
• 24 Hume MC, Wiss DA. Olecranon fractures. A clinical and radiographic comparison of tension band wiring and plate fixation. Clin Orthop Rel Res 1992; 285: 229-235.
• 25 Russell SM. Design considerations for nitinol bone staples. J Materi Eng and Perfom 2009; 18: 831-835.
• 26 Schnabel B, Scharf M, Schweiger K. et al. Biomechanical comparison of a new staple technique with tension band wiring for transverse patella fractures. Clin Biomech (Bristol, Avon) 2009; 24: 855-859.
• 27 Hoon QJ, Pelletier MH, Christou C. et al. Biomechanical evaluation of shape-memory alloy staples for internal fixation - an in vitro study. J Exp Orthop 2016; 3: 19.
• 28 Mereau TM, Ford TC. Nitinol compression staples for bone fixation in foot surgery. J Am Podiatr Med Assoc 2006; 96: 102-106.
• 29 Choudhary RK, Theruvil B, Taylor GR. First metatarsophalangeal joint arthrodesis: a new technique of internal fixation by using memory compression staples. J Foot Ankle Surg 2004; 43: 312-317.
• 30 Malal JJ, Hegde G, Ferdinand RD. Tarsal joint fusion using memory compression staples - a study of 10 cases. J Foot Ankle Surg 2006; 45: 113-117.
• 31 Tang RG, Dai KR, Chen YQ. Application of a NiTi staple in the metatarsal osteotomy. Biomed Mater Eng 1996; 6: 307-312.
• 32 Agarwala S, Shah SB. Staple versus locking compression plate fixation after lateral closing wedge high tibial osteotomy. J Orthop Surg (Hong Kong) 2008; 16: 303-307.
• 33 Aiyer A, Russell NA, Pelletier MH. et al. The impact of nitinol staples on the compressive forces, contact area, and mechanical properties in comparison to a claw plate and crossed screws for the first tarsometatarsal arthrodesis. Foot Ankle Spec 2016; 9: 232-240.
• 34 Le Corre A, Ardouin L, Loubersac T. et al. Retrospective study of two fixation methods for 4-corner fusion: Shape-memory staple vs. dorsal circular plate. Chir Main 2015; 34: 300-306.
• 35 Perren SM. Evolution of the internal fixation of long bone fractures. The scientific basis of biological internal fixation: choosing a new balance between stability and biology. J Bone Joint Surg 2002; 84: 1093-1110.
• 36 Neat BC, Kowaleski MP, Litsky AS. et al. Mechanical evaluation of pin and tension-band wire factors in an olecranon osteotomy model. Vet Surg 2006; 35: 398-405.
• 37 Neat B, Kowaleski MP, Litsky AS. et al. The effects of wire diameter and an additional lateral wire on pin and tension-band fixation subjected to cyclic loads. Vet Comp Orthop Traumatol 2006; 19: 213-218.
• 38 Smith GK. Biomechanics pertinent to fracture etiology, reduction, and fixation. In Newton CD, Nunamaker DM. Editors Textbook of Small Animal Orthopedics. Philadelphia, PA: Lippincott: 1985: 195-230.
• 39 Chao EY, Aro HT, Lewallen DG. et al. The effect of rigidity on fracture healing in external fixation. Clin Orthop Rel Res 1989; 241: 24-35.
• 40 Radasch RM. Biomechanics of bone and fractures. Vet Clin North Am Small Anim Pract 1999; 29: 1045-1082.
• 41 Henley MB. Intra-articular distal humerus fracture in adults. Orthop Clin N Am 1987; 18: 11-23.
• 42 Roe SC. Mechanical characteristics and comparisons of cerclage wires: Introduction of the double-wrap and loop/twist tying methods. Vet Surg 1997; 26: 310-316.
• 43 Rooks RL, Tarvin GB, Pijanowski GJ. et al. In vitro cerclage wiring analysis. Vet Surg 1982; 11: 34-43.
• 44 Roe SC. Evaluation of tension obtained by use of three knots for tying cerclage wires by surgeons of various abilities and experience. J Am Vet Med Assoc 2002; 220: 334-336.