Biomechanical comparison of one pin versus two pin fixation in a canine tibial tuberosity avulsion fracture model

Abstract

Objective: To determine whether one larger or two smaller diameter pins used for tibial tuberosity avulsion fracture (TTAF) stabilization provides greater axial tensile strength and stiffness when subjected to monotonic mechanical load to failure in normal skeletally mature canine cadavers.Study design: Paired ex vivo biomechanical study.Sample population: Eleven pairs of adult cadaveric dog tibias. Methods: Twenty-two tibias from 11 dogs were collected to model a TTAF.Each limb of a pair was randomly assigned a one or two-pin fixation. Tibias were subjected to monotonic, axial load to failure. Fixation stiffness, strength, and pin insertion angles were analyzed with parametric testing. Significance was set at p < .05. Results: The mean strength of the single-pin fixation was 426.2 ± 50.5 N compared to two-pin fixation at 639.2 ± 173.5 N (p = .003). The mean stiffness of the single-pin fixation was 57.3 ± 18.7 N/mm and the two-pin fixation was 71.7 ± 20.5 N/mm (p = .029). The normalized ratio between one and two-pin fixation had a mean stiffness of 68% ± 25.8% and strength of 82.8% ± 24.6%. Conclusions:In an ex vivo cadaveric TTAF model, vertically aligned two-pin fixation offers greater strength and stiffness when compared to a single-pin fixation.Clinical significance: When repairing TTAF, surgeons should aim to apply two vertically aligned pins rather than a single pin for greater strength and stiffness. | INTRODUCTIONTibial tuberosity avulsion fractures (TTAF) are common injuries in skeletally immature dogs. They are often associated with minimal trauma, such as a fall or jumping injury. [1][2][3] Traditionally, these fractures have been treated with open reduction and internal fixation using a pin and tension band technique. However, recent studies have advocated for fluoroscopic-guided percutaneous pinning rather than traditional open approaches. 1,2,4,5 There are limited studies directly comparing open reduction and internal fixation to fluoroscopic-guided percutaneous pinning in animals. The current literature suggests that fluoroscopic-guided percutaneous pinning results in decreased morbidity, expedited return to function, and decreased infection rates. 1,2,4,5 Furthermore,