Académique Documents
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27:301-306, 1998
Diplomate
ACVS,
Objective-To measure pullout strength of four pin types in avian humeri and tibiotarsi bones
and to compare slow-speed power and hand insertion methods.
Study Design-Axial pin extraction was measured in vitro in avian bones.
Animal Population-Four cadaver red-tailed hawks and 12 live red-tailed hawks.
Methods-The pullout strength of four fixator pin designs was measured: smooth, negative
profile threaded pins engaging one or two cortices and positive profile threaded pins. Part 1:
Pins were placed in humeri and tibiotarsi after soft tissue removal. Part 2: Pins were placed in
tibiotarsi in anesthetized hawks using slow-speed power or hand insertion.
Results-All threaded pins, regardless of pin design, had greater pullout strength than smooth
pins in all parts of the study (P < .OOOl). The cortices of tibiotarsi were thicker than the cortices
of humeri ( P < .OOOl). There were few differences in pin pullout strengths between threaded
pin types within or between bone groups. There were no differences between the pullout strength
of pins placed by slow-speed power or by hand.
Conclusions-There is little advantage of one threaded pin type over another in avian humeri
and tibiotarsi using currently available pin designs. There were few differences in pin pullout
strengths between humeri and tibiotarsi bones. It is possible that the ease of hand insertion in
thin cortices minimizes the potential for wobbling and therefore minimizes the difference between
slow-speed drill and hand insertion methods.
Clinical Relevance-Threaded pins have superior bone holding strength in avian cortices and
may be beneficial for use with external fixation devices in birds.
OCopyright 1998 by The American College of Veterinary Surgeons
From the Department of Companion Animals and Special Species Medicine, College of Veterinary Medicine, and the Department
of Biological and Agricultural Engineering, College of Agriculture and Life Sciences, North Carolina State University, Raleigh,
NC .
This study was supported by a Department of Companion Animals and Special Species Medicine Grant, College of Veterinary
Medicine, North Carolina State University.
Address reprint requests to Laurel Degernes, DVM, Department of Companion Animals and Special Species Medicine, College
of Veterinary Medicine, NCSU, Raleigh, NC 27606.
OCopyright 1998 by The American College of Veterinary Surgeons
016 1-3499/98/2704-0002$3.00/0
301
302
pullout of each of the four pin types after pin insertion into the tibiotarsal bone using slow-speed power
(150 rpm) or hand insertion.
303
STATISTICAL ANALYSIS
RESULTS
Part 1: Pin Pullout Tests on the Humerus and
Tibiotarsus Bones
Bone side (left or right) did not account for any
effects (P 2 .15), so the data were combined within
groups. The mean cortical thickness was significantly greater in the tibiotarsus than the humerus
(Fig 1; P 5 .0001). Mean cortical thickness at the
six pin locations ranged from 0.55 to 0.81 mm in
the humerus (overall mean, 0.70 mm) and from 0.88
to 1.O mm in the tibiotarsus (overall mean, 0.95 mm).
There was no correlation in any of the groups between cortical thickness and pin pullout (humerus,
R2 = .28; tibiotarsus, R2 = .06).
There was a significant difference in pin pullout
in the humeri and tibiotarsi based on pin type (Fig
2). The smooth pins had a lower pin pullout than
any of the threaded pins for both long bones (P I
.0001 for all comparisons). Within the humerus
group, the NEG-2 pins had a higher pin pullout than
304
4.2
'0
350
Smoom
Fig 1. Cortical thickness by pin location. Mean 2 SD cortical thickness (mm) of the avian humerus and tibiotarsus at
six pin locations, spaced at 1.5-cm intervals from proximal
(1) to distal (6). The tibiotarsus cortex was significantly
thicker than the humerus cortex at each pin location (P 5
.0001 for all comparisons).
the other threaded pins ( P I.009 for all comparisons). There was no difference between NEG-1 pins
and the POS pins (P = .27). Threaded pins were
two to three times more resistant to pullout from the
humerus than smooth pins.
Within the tibiotarsus group, there were no differ-
NEG-1
NEG-2
~-
pln T~~
&ow
~
POS
7
Speed Drill
.Hand I n s e r I i t i
~
Fig 2. Pin pullout resistance in the humerus and tibiotarsus. Pullout resistance (Newtons, mean 2 SD) of four pin
types (n = 12): smooth, negative profile with single cortical
contact (NEG-l), negative profile with double cortical contact (NEG-2), and positive profile pins (POS). The smooth
pins had significantly lower pin pullout resistance than the
three threaded pins in both sets of bones (P 5 .0001 for
all comparisons). The NEG-2 pin had greater pin pullout
resistance than the NEG-1 or POS pins in the humerus (P
5 .009). The NEG-1 pin had greater pin pullout resistance
in the tibiotarsus compared with the humerus (P 5 .02).
305
DISCUSSION
Threaded external fixator pins provided more resistance to pullout than smooth pins in avian bones.
This finding was in agreement with studies conducted in marnmal~.~-~*
An unexpected finding of
the study is that there was little difference between
pins with different thread designs. Because pins with
larger diameter should have greater bone-holding
strength, we anticipated that the positive profile pins
would resist pullout better than negative profile
threaded pins.16 The positive profile pin could have
caused damage to the bone at the pin entry site.
Microscopic studies of the bone at the pin entry site
have shown that the bone surface is damaged by the
threads until the threads engage and begin to cut
a tract. Because avian cortices are thin, a larger
proportion of the bone may be damaged by the pin
entry before the threads are formed. Microfissures at
the bone-pin interface could have developed, despite
predrilling. Although no visible cracks were noted
in the bone adjacent to the pins, we did not evaluate
the pin-bone interface microscopically or radiographically in this study.
End-threaded, negative profile pins with double
cortical contact provide better holding power than
similar pins with single cortical contact (eg, Ellis
pins) in canine bone.14 Ellis pins were designed to
minimize the potential for breakage at the weak
threaded-nonthreaded portion of the pin because this
weak section of the pin is protected within the medullary ~ a v i t y . In
~ ,our
~ ~ study, we observed greater
bone-holding strength in the NEG-2 pins in the humerus compared with the NEG-1 pins.
Bone-holding strength of threaded pins increases
linearly with increasing cortical bone thi~kness.~
We expected to find differences in pin pullout
strength between tibiotarsi and humeri because tibiotarsi cortices were an average of 26% thicker than
humeri cortices. The only difference we observed
was in the NEG-1 pin group, which had greater pin
pullout strength in the tibiotarsus when compared
with the humerus. Because only half of the threads
were engaged in cortical bone in the NEG-1 pin
group, compared with the NEG-2 and POS pin
groups, the contribution of each thread engaged in
bone could be important. When the number of engaged threads was decreased even more in the thin
humerus cortex, the difference between threaded pin
types became statistically significant. The differences between the humerus and tibiotarsus in pin
pullout strengths of the other pin types could have
been masked by wide sample variation.
The method of pin insertion has been identified
as a major influence on premature pin loosening in
Our study did not show any differences
within each pin type between the two pin insertion
methods. Little effort is required to drive pins manually through thin avian cortices when compared with
manual pin insertion in thicker cortices. Because of
this, wobbling during pin insertion is less likely to
occur. Proper technique must be used during pin
insertion to avoid wobbling. We did not measure pin
tip temperatures during pin insertion and did not
evaluate bone-holding strength in a long-term study.
It is possible that if thermal necrosis occurred during
pin insertion, more differences would have been evident at a later time.
Threaded pins, regardless of their design, have
better resistance to pullout than smooth pins in avian
long bones. There is reduced pin pullout strength
when single cortical contact negative profile pins
are placed in the avian humerus compared with the
tibiotarsus. For all other pin types studied, however,
the pin pullout resistance from the humerus is comparable to that from the tibiotarsus despite the thicker
cortex in the tibiotarsus. It is likely that the thin
cortices of avian bone diminish the influence of different threaded pin designs. The influence of pitch
and thread depth on the pullout strength of implants
in thin cortical bone deserves further study. There is
no difference in the pullout strength of pins inserted
in avian long bones by either slow-speed power or
hand methods.
ACKNOWLEDGMENT
The authors thank Debbie Whitt Smith and Timothy
Seaboch for their technical expertise and Judith Jayawickrama for statistical support.
REFERENCES
1. King AS, McLelland J: Birds: Their Structure and Function.
Philadelphia, PA, Baillibre Tindall, 1984, pp 43-78
2. Bennett RA, Kuzma AB: Fracture management of birds. J
Zoo Wild1 Med 23538, 1992
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