Comparison of hydroxyapatite-coated and uncoated pins for transfixation casting in horses

Timothy B. Lescun Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.

Search for other papers by Timothy B. Lescun in
Current site
Google Scholar
PubMed
Close
 BVSc, MS
,
Debra K. Baird Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.

Search for other papers by Debra K. Baird in
Current site
Google Scholar
PubMed
Close
 DVM, PhD
,
Laurinda J. Oliver Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.

Search for other papers by Laurinda J. Oliver in
Current site
Google Scholar
PubMed
Close
 BVSc, MS
,
Stephen B. Adams Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.

Search for other papers by Stephen B. Adams in
Current site
Google Scholar
PubMed
Close
 DVM, MS
,
Jan F. Hawkins Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.

Search for other papers by Jan F. Hawkins in
Current site
Google Scholar
PubMed
Close
 DVM
, and
George E. Moore Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907.

Search for other papers by George E. Moore in
Current site
Google Scholar
PubMed
Close
 DVM, PhD

Abstract

Objective—To determine the extent to which a hydroxyapatite coating promotes pin stability in the third metacarpal bone during transfixation casting in horses.

Animals—14 adult horses.

Procedures—7 horses each were assigned to either an uncoated or hydroxyapatite-coated pin group. Three transcortical pins were placed in the third metacarpal bone of each horse and incorporated into a cast for 8 weeks. Insertion and extraction torque were measured, and torque reduction was calculated. Radiography was performed at 0, 4, and 8 weeks. Lameness evaluation was performed at 2, 4, 6, and 8 weeks. Bacteriologic culture of pins and pin holes was performed at pin removal.

Results—All horses used casts without major complication throughout the study. Insertion torque was higher in uncoated pins. There was no effect of group on extraction torque. Hydroxyapatite-coated pins had lower torque reduction. Five of 15 hydroxyapatite-coated pins maintained or increased stability, whereas all uncoated pins loosened. Pin hole radiolucency, lameness grades, and positive bacteriologic culture rates were not different between groups.

Conclusions and Clinical Relevance—Hydroxyapatite coating increased pin stability within the third metacarpal bone of horses during 8 weeks of transfixation casting but did not improve pin performance on clinical assessments. Clinical use of hydroxyapatite-coated transfixation pins may result in greater pin stability; however, further research is necessary to improve the consistency of pin osteointegration and elucidate whether clinical benefits will ultimately result from this approach in horses.

Abstract

Objective—To determine the extent to which a hydroxyapatite coating promotes pin stability in the third metacarpal bone during transfixation casting in horses.

Animals—14 adult horses.

Procedures—7 horses each were assigned to either an uncoated or hydroxyapatite-coated pin group. Three transcortical pins were placed in the third metacarpal bone of each horse and incorporated into a cast for 8 weeks. Insertion and extraction torque were measured, and torque reduction was calculated. Radiography was performed at 0, 4, and 8 weeks. Lameness evaluation was performed at 2, 4, 6, and 8 weeks. Bacteriologic culture of pins and pin holes was performed at pin removal.

Results—All horses used casts without major complication throughout the study. Insertion torque was higher in uncoated pins. There was no effect of group on extraction torque. Hydroxyapatite-coated pins had lower torque reduction. Five of 15 hydroxyapatite-coated pins maintained or increased stability, whereas all uncoated pins loosened. Pin hole radiolucency, lameness grades, and positive bacteriologic culture rates were not different between groups.

Conclusions and Clinical Relevance—Hydroxyapatite coating increased pin stability within the third metacarpal bone of horses during 8 weeks of transfixation casting but did not improve pin performance on clinical assessments. Clinical use of hydroxyapatite-coated transfixation pins may result in greater pin stability; however, further research is necessary to improve the consistency of pin osteointegration and elucidate whether clinical benefits will ultimately result from this approach in horses.

Contributor Notes

Supported by a grant from the Grayson Jockey Club Research Foundation.

Presented in part at the World Veterinary Orthopaedic Congress, Bologna, Italy, September 2010.

The authors thank Dr. David Van Sickle for assistance with histologic examinations and Dr. Carol Bain for histologic processing.

Address correspondence to Dr. Lescun (tlescun@purdue.edu).
  • 1.

    Lescun TB, McClure SR, Ward MP, et al. Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994–2004). J Am Vet Med Assoc 2007; 230:13401349.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 2.

    Kraus BM, Richardson DW, Nunamaker DM, et al. Management of comminuted fractures of the proximal phalanx in horses: 64 cases (1983–2001). J Am Vet Med Assoc 2004; 224:254263.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    McClure SR, Honnas CM, Watkins JP. Managing equine fractures with external skeletal fixation. Compend Contin Educ Pract Vet 1995; 17:10541063.

    • Search Google Scholar
    • Export Citation
  • 4.

    Aro HT, Markel MD, Chao EY. Cortical bone reactions at the interface of external fixation half-pins under different loading conditions. J Trauma 1993; 35:776785.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Clary E, Roe S. Enhancing external skeletal fixation pin performance—consideration of the pin-bone interface. Vet Comp Orthop Traumatol 1995; 8:613.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6.

    Nunamaker DM. A new external skeletal fixation device that allows immediate full weightbearing application in the horse. Vet Surg 1986; 15:345355.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7.

    Auer JA. Principles of fracture treatment. In: Auer JA, Stick JA, eds. Equine surgery. 3rd ed. St Louis: Saunders Elsevier, 2006;10001029.

    • Search Google Scholar
    • Export Citation
  • 8.

    McClure SR, Watkins JP, Hogan HA. In vitro evaluation of four methods of attaching transfixation pins into a fiberglass cast for use in horses. Am J Vet Res 1996; 57:10981101.

    • Search Google Scholar
    • Export Citation
  • 9.

    Moroni A, Aspenberg P, Toksvig-Larsen S, et al. Enhanced fixation with hydroxyapatite coated pins. Clin Orthop Relat Res 1998; 346:171177.

    • Search Google Scholar
    • Export Citation
  • 10.

    Németh F, Back W. The use of the walking cast to repair fractures in horses and ponies. Equine Vet J 1991; 23:3236.

  • 11.

    DeJong ES, DeBerardino TM, Brooks DE, et al. Antimicrobial efficacy of external fixator pins coated with a lipid stabilized hydroxyapatite/chlorhexidine complex to prevent pin tract infection in a goat model. J Trauma 2001; 50:10081014.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Huiskes R, Chao EY, Crippen TE. Parametric analyses of pin-bone stresses in external fracture fixation devices. J Orthop Res 1985; 3:341349.

  • 13.

    Dohan Ehrenfest DM, Coelho PG, Kang B, et al. Classification of osseointegrated implant surfaces: materials, chemistry and topography. Trends Biotechnol 2010; 28:198206.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14.

    Wennerberg A, Albrektsson T. Effects of titanium surface topography on bone integration: a systematic review. Clin Oral Implants Res 2009; 20:172184.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15.

    Kienapfel H, Sprey C, Wilke A, et al. Implant fixation by bone ingrowth. J Arthroplasty 1999; 14:355368.

  • 16.

    Pommer A, Muhr G, David A. Hydroxyapatite-coated Schanz pins in external fixators used for distraction osteogenesis: a randomized, controlled trial. J Bone Joint Surg Am 2002; 84:11621166.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17.

    Moroni A, Faldini C, Marchetti S, et al. Improvement of the bone-pin interface strength in osteoporotic bone with use of hydroxyapatite-coated tapered external-fixation pins. A prospective, randomized clinical study of wrist fractures. J Bone Joint Surg Am 2001; 83:717721.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18.

    Moroni A, Heikkila J, Magyar G, et al. Fixation strength and pin tract infection of hydroxyapatite-coated tapered pins. Clin Orthop Relat Res 2001; 388:209217.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19.

    Zacharias JR, Lescun TB, Moore GE, et al. Comparison of insertion characteristics of two types of hydroxyapatite-coated and uncoated positive profile transfixation pins in the third metacarpal bone of horses. Am J Vet Res 2007; 68:11601166.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20.

    Li P. Biomimetic nano-apatite coating capable of promoting bone ingrowth. J Biomed Mater Res A 2003; 66:7985.

  • 21.

    McClure SR, Watkins JP, Ashman RB. In vitro comparison of the effect of parallel and divergent transfixation pins on breaking strength of equine third metacarpal bones. Am J Vet Res 1994; 55:13271330.

    • Search Google Scholar
    • Export Citation
  • 22.

    Morisset S, McClure SR, Hillberry B, et al. In vitro comparison of the use of two large-animal, centrally threaded, positive-profile transfixation pin designs in the equine third metacarpal bone. Am J Vet Res 2000; 61:12981303.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Augat P, Claes L, Hanselmann K, et al. Increase of stability in external fracture fixation by hydroxyapatite-coated bone screws. J Appl Biomater 1995; 6:99104.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Pettine KA, Chao EY, Kelly PJ. Analysis of the external fixator pin-bone interface. Clin Orthop Relat Res 1993; 293:1827.

  • 25.

    Christensen FB, Dalstra M, Sejling F, et al. Titanium-alloy enhances bone-pedicle screw fixation: mechanical and histomor-phometrical results of titanium-alloy versus stainless steel. Eur Spine J 2000; 9:97103.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 26.

    Chang C, Lee T, Chang C, et al. The effect of microrough surface treatment on miniscrews used as orthodontic anchors. Clin Oral Implants Res 2009; 20:11781184.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27.

    Caja VL, Moroni A. Hydroxyapatite coated external fixation pins: an experimental study. Clin Orthop Relat Res 1996; 325:269275.

  • 28.

    Moroni A, Faldini C, Pegreffi F, et al. Fixation strength of tapered versus bicylindrical hydroxyapatite-coated external fixation pins: an animal study. J Biomed Mater Res 2002; 63:6164.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29.

    Moroni A, Toksvig-Larsen S, Maltarello MC, et al. A comparison of hydroxyapatite-coated, titanium-coated, and uncoated tapered external-fixation pins. An in vivo study in sheep. J Bone Joint Surg Am 1998; 80:547554.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 30.

    Moroni A, Cadossi M, Romagnoli M, et al. A biomechanical and histological analysis of standard versus hydroxyapatite-coated pins for external fixation. J Biomed Mater Res Part B Appl Biomater 2008; 86:417421.

    • Search Google Scholar
    • Export Citation
  • 31.

    Saithna A. The influence of hydroxyapatite coating of external fixator pins on pin loosening and pin track infection: a systematic review. Injury 2010; 41:128132.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 32.

    Smith TJ, Galm A, Chatterjee S, et al. Modulation of the soft tissue reactions to percutaneous orthopaedic implants. J Orthop Res 2006; 24:13771383.

  • 33.

    Pendegrass CJ, Goodship AE, Blunn GW. Development of a soft tissue seal around bone-anchored transcutaneous amputation prostheses. Biomaterials 2006; 27:41834191.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 34.

    Jansen JA, de Groot K. Guinea pig and rabbit model for the histological evaluation of permanent percutaneous implants. Biomaterials 1988; 9:268272.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 35.

    Vassiliou K, Scholes SC, Unsworth A. Laboratory studies on the tribology of hard bearing hip prostheses: ceramic on ceramic and metal on metal. Proc Inst Mech Eng H 2007; 221:1120.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 36.

    Gebeshuber IC, Stachelberger H, Drack M. Diatom bionanotribology-biological surfaces in relative motion: their design, friction, adhesion, lubrication and wear. J Nanosci Nanotechnol 2005; 5:7987.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 37.

    Check J, Karuppiah KSK, Sundararajan S. Comparison of the effect of surface roughness on the micro/nanotribological behavior of ultra-high-molecular-weight polyethylene (UHM-WPE) in air and bovine serum solution. J Biomed Mater Res A 2005; 74:687695.

    • Search Google Scholar
    • Export Citation
  • 38.

    Müller LP, Degreif J, Rudig L, et al. Friction of ceramic and metal hip hemi-endoprostheses against cadaveric acetabula. Arch Orthop Trauma Surg 2004; 124:681687.

    • Crossref
    • Search Google Scholar
    • Export Citation

Advertisement