Abstract
Objective
To compare the maximum failure load and failure mode among 3 fixation methods for canine olecranon fractures and evaluate the feasibility of replacing the pin and tension band wiring method with screw plus tension band wiring (TBW) methods.
Methods
18 ulnas from 9 canine cadavers (10.3 to 16.4 kg) were collected and randomly assigned to 3 groups (n = 6) for surgical procedures. Surgical procedures and biomechanical testing were performed from June 14 through October 7, 2024. A transverse ulnar osteotomy was performed immediately proximal to the anconeal process and aligned perpendicularly to the caudal cortex. In group 1, the pin and tension band wiring technique was employed using 2 1.2-mm Kirschner wires and #2 FiberWire. Group 2 applied the screw TBW method using a partially threaded cannulated screw and #2 FiberWire. Group 3 used the screw TBW method but with a fully threaded headless cannulated screw and #2 FiberWire. Biomechanical testing was conducted to apply tensile forces using a universal testing machine.
Results
Maximum failure loads of groups 1 (n = 6), 2 (n = 6), and 3 (n = 6) were 351.3 ± 22.2 N, 345.78 ± 25.6 N, and 326.3 ± 18.2 N, respectively. No significant difference was observed in maximum failure loads among the groups.
Conclusions
This study suggests that the screw with TBW methods represent viable alternatives for internal fixation in extra-articular transverse olecranon fractures in dogs.
Clinical Relevance
This study's results imply that fully threaded headless cannulated screws can be effectively applied to areas under tensile forces.
Olecranon fractures can be classified as articular or extra-articular.1 In cases of extra-articular olecranon fractures, the trochlear notch is not involved, and the fracture typically presents as an avulsion fracture caused by the pull of the triceps muscle.2 In such fractures, the proximal bone fragment is often significantly displaced due to triceps muscle traction.3 Surgical intervention through open reduction and internal fixation helps counteract the tensile forces exerted by the triceps brachii muscle group, promotes primary bone healing, reduces the risk of post-traumatic osteoarthritis, and optimizes the likelihood of restoring prefracture limb function.4 For extra-articular olecranon fractures located proximal to the trochlear notch, the AO Vet group recommends pins with tension band wiring (PTBW) as an effective repair method.5 While PTBW fixation in dogs generally shows a favorable long-term prognosis, some complications are associated with this technique, such as Kirschner (K)-wire displacement, chronic osteomyelitis, K-wire protrusion beneath the skin, and pain.6–8 In a retrospective study4 evaluating complications and long-term outcomes of olecranon fractures stabilized with PTBW fixation in dogs and cats, an overall complication rate of 73.7% was reported. In human olecranon fractures, complications with the traditional PTBW method have led to hardware removal in 40% to 92% of cases.6
In some cases of olecranon fracture repair using the tension band wiring (TBW) technique, intramedullary screws are used instead of pins.6,9 This screw TBW approach employs a large intramedullary screw combined with tension band augmentation to prevent proximal migration of the wire and minimize hardware irritation, ideally reducing the need for future removal without compromising fracture fixation and healing.6,9 Studies6,10 indicate that the screw plus TBW method offers superior fixation compared to PTBW or plate fixation alone and is associated with a low rate of hardware removal (< 10%).
The fully threaded headless cannulated screw is a headless, cannulated, fully threaded cancellous screw with a variable-stepped thread pitch. From tip to tail, the screw's minor diameter gradually increases while the thread pitch decreases. The tapered tip engages the bone with each turn, generating compression, while the variable thread design allows for faster insertion. As the screw is driven into the bone, it produces interfragmentary compression at the fracture site, enhancing stability.11–14 With its interfragmentary compression capability and headless design, the fully threaded headless cannulated screw has been studied as a fixation method for areas subjected to compressive forces in human medicine, such as scaphoid, metacarpal, and femoral fractures.12–16 However, several studies17–19 have demonstrated that headless screws may also be effective in areas subjected to tensile forces. In human medicine, the use of headless screws in an antegrade or retrograde manner has been shown to effectively reduce return-to-sport time without significant complications in olecranon stress fractures among baseball or softball players.17,19 In veterinary medicine, headless cannulated screws have been employed for the treatment of canine sacroiliac luxation, radiocarpal fractures, humeral condylar fracture, and femoral neck fractures in dogs and cats.11,20–22 However, to the authors’ knowledge, clinical or biomechanical studies on the use of headless cannulated screws under tensile forces in dogs remain limited, and no studies have investigated the use of headless screws for canine olecranon fractures.
The objectives of this study were to compare the maximum failure load among 3 fixation methods for canine olecranon fractures and to evaluate the feasibility of replacing the PTBW method with screw TBW methods. Additionally, this study investigated the effectiveness and failure mode of the fully threaded headless cannulated screw under tensile forces to enhance the understanding of its characteristics in areas subjected to tensile forces. The authors hypothesized that the fixation strength of the screw tension band wiring methods would surpass those of the PTBW. Furthermore, among the screw tension band wiring methods, using the fully threaded headless cannulated screw was expected to offer greater load at displacement with fixation strength than the partially threaded cannulated screw.
Methods
Cadaver preparation
A total of 18 ulnas from the forelimbs of 9 euthanized dogs were obtained. The dogs weighed 10.3 to 16.4 kg (12.96 ± 2.07 kg). The dogs were euthanized for reasons unrelated to this study. All cadavers were frozen at −70 °C and subsequently thawed at room temperature for sample collection. All cadaveric forelimbs underwent an orthopedic examination and radiographic imaging to identify any bone deformation or other orthopedic disease. The elbow joint and antebrachiocarpal joint were disarticulated, and the interosseous ligament between the proximal radius and the ulna was dissected to detach ulna. All soft tissues except the triceps brachii tendon were removed. The samples were wrapped in gauze soaked with 0.9% saline solution and frozen at −70 °C.11,22 Before the mechanical testing, the frozen specimens were thawed to room temperature over 24 hours.11
Surgical procedure
Twenty-four samples were randomly divided into 3 groups. A transverse ulnar osteotomy was performed to create an extra-articular fracture of the olecranon. The osteotomy was performed immediately proximal to the anconeal process using a saw, creating a complete transverse cut perpendicular to the caudal cortex at that level.7,23 The osteotomy sites were reduced to their normal position using pointed reduction forceps until fixation was completed.
Group 1: pins with TBW
In group 1, 2 1.2-mm K-wires (Chengdu GreatLH Medical Instrument Manufacturer) were inserted in an antegrade manner from the olecranon tuberosity to the cranial cortex of the ulna under the coronoid process. A 1.5-mm transverse hole was drilled at the approximately symmetric site with the proximal ends of K-wires relative to the fracture line. A #2 FiberWire (Arthrex) was passed through the transverse hole to create figure-of-8 patterns and tied up by the static surgeon knot technique (Figure 1).24,25 To maximize the quality of the knots, all knots were hand tied without the use of instruments, minimizing unnecessary friction and potential damage to the suture material.
Illustrations of the 3 internal fixation methods for a simulated olecranon fracture. A and D—Pins with tension band wiring (PTBW) using 2 1.2-mm parallel Kirschner wires and #2 FiberWire was applied to group 1. B and E—Screw tension band wiring (TBW) method with a 2.3-mm partially threaded cannulated screw and #2 FiberWire was applied to group 2. C and F—Screw TBW method using a 2.5-mm fully threaded headless cannulated screw and #2 FiberWire was applied to group 3.
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.24.12.0375
Group 2: partially threaded cannulated screw with TBW
In group 2, the olecranon fracture was fixed to a partially threaded cannulated screw TBW method. After the olecranon fracture line was accurately reduced with small, pointed reduction clamps, a 0.8-mm guide pin was inserted in an antegrade manner from the olecranon tip into the medullary canal to guide the cannulated drill bit and screw. Then, the top of the cranial cortex to the medulla was drilled by a 1.8-mm cannulated drill bit along a guide pin. A length of 30-mm, 2.3-mm-diameter partially threaded cannulated screw (Jeil Medical Corp) was implanted over the guide pin. A 1.5-mm transverse hole was drilled at the approximately symmetric site with the insertion point of the screw in the olecranon tip, relative to the fracture line. A #2 FiberWire was looped over screw head, passed through the transverse hole in the distal bone fragment, and configured into a figure-of-eight pattern following the same technique as in group 1 (Figure 1).
Group 3: fully threaded headless cannulated screw with TBW
In group 3, the olecranon fracture was fixed to a fully threaded cannulate screw TBW method. The osteotomy line was accurately reduced with small, pointed reduction clamps. A 0.8-mm guide pin was inserted 30 mm into the medullary canal through the tip of the olecranon to guide the placement of the cannulated screw. After confirming the length of the inserted guide pin with a depth gauge, a 2.0-mm cannulated drill bit was used to drill from the cranial cortex to the medullary canal along the guide pin. A 2.5-mm fully threaded headless cannulated screw (Arthrex), 30 mm in length, was sent over the guide pin. The guide pin was removed after the screw was fully seated. A distal transverse hole was created in the same manner as groups 1 and 2. A #2 FiberWire was passed through the transverse hole to make figure-of-eight patterns and tied the same as groups 1 and 2 (Figure 1).
Biomechanical testing
Immediately following the surgical procedure, biomechanical testing was conducted in 6 separate sessions from June 14 through October 7, 2024. Each triceps brachii tendon was wrapped with dry gauze and secured using the transfixation suture technique with nonabsorbable suture materials. The samples were then mounted laterally on wooden boards. Following previous studies,23 the entire ulna was positioned with the long axis of the ulna at a 135° angle relative to the vertically aligned triceps tendon, simulating the normal standing posture. Two 2.0-mm pins were inserted through the ulnar shafts into the boards, and 3 screws were placed above the ulnar notch, above the ulnar body, and below the ulnar body to prevent rotation and ensure that the distal fragment of the ulna remained fixed to the boards.
Wooden board samples were secured in a universal testing machine (Instron 5585; Instron Corp) for evaluation. The bottoms of the boards were anchored to the machine's lower holder jig, and the triceps brachii tendons were clamped by the upper holder jig. Locking grips, attached to a 3-kN load cell connected to the crosshead, applied incremental tensile forces at a rate of 10 mm/min until the samples reached their maximum failure point. The loads at 0.5- and 1-mm displacement, as well as the maximum failure load (newtons) for each sample, were recorded. Failure was defined as implant breakage, complete fracture of the ulna, or sudden drop in the load-displacement curve (Figure 2).
A—A universal testing machine (Instron 5585; Instron Corp) was used for biomechanical evaluation. B—Two 2.0-mm pins were inserted through the ulnar shafts into the boards. Three screws were placed above the ulnar notch, at the ulnar body, and below the ulnar body to affix samples to a wooden board while simulating the normal standing joint angle by positioning the long axis of the ulna at a 135° angle relative to the vertically aligned triceps tendon.
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.24.12.0375
Statistical analysis
All statistical analyses were conducted using SPSS Statistics (version 29.0.2.0; IBM Corp). Since every group consisted of 6 samples, the mean body weight, the loads at 0.5- and 1.0-mm displacement (newtons), and the maximal failure load (newtons) for each group were analyzed using the Kruskal-Wallis test. Statistical difference among each group was confirmed by the Mann-Whitney U test. Additionally, effect size and 95% CIs for the maximum failure load were also calculated to further evaluate the differences between groups. All statistical analyses were carried out with SPSS Statistics (version 29.0.2.0; IBM Corp). A P value of less than .05 was considered statistically significant. Effect sizes were interpreted based on Cohen criteria, where 0.2 indicates a small effect, 0.5 a medium effect, and 0.8 or greater a large effect. Confidence intervals were reported at the 95% level to provide an estimate of the range within which the true population parameter is expected to fall.
Results
Distribution of body weight (kilograms)
Mean body weights of 6 samples included in each group were recorded as 12.28, 12.98, and 13.61 kg for groups 1, 2, and 3, respectively. There was no significant difference in body weight distribution among the groups (P = .77).
Loads at 0.5- and 1.0-mm displacement
The mean loads at 0.5- and 1.0-mm displacement (newtons) of each group were displayed (Table 1). The loads at 0.5- and 1.0-mm displacement of each group differed significantly. At 0.5-mm displacement, groups 2 (P = .004) and 3 (P = .002) exhibited significantly higher loads compared to group 1. At 1-mm displacement, group 3 showed a significantly higher load than group 2 (P = .01), whereas group 2 demonstrated a significantly higher load than group 1 (P = .002).
Mean and P values of biomechanical variables for groups 1 (pins with tension band wiring), 2 (partially threaded cannulated screw with tension band wiring), and 3 (fully threaded cannulated screw with tension band wiring).
| Group 1 (n = 6) | Group 2 (n = 6) | Group 3 (n = 6) | P value | |
|---|---|---|---|---|
| Load at 0.5-mm displacement (N) | 86.3a | 136.2b | 152.5b | .002* |
| Load at 1-mm displacement (N) | 113.2a | 166.5b | 238.4c | .001* |
| Maximum failure load (N) | 351.3a | 345.7a | 326.3a | .12 |
Values with different superscripts are significantly (P < .05) different.
Although no statistically significant difference was observed in the maximum failure load (newtons; P > .05), group 3 (a 2.5-mm fully threaded headless cannulated screw with tension band wiring) exhibited a significantly higher load than group 1 (pins with tension band wiring) at 0.5-mm displacement and a significantly higher load than both group 1 and group 2 (a 2.3-mm partially threaded cannulated screw with tension band wiring) at 1-mm displacement. Given that failure occurred before a 2-mm displacement in group 3, the fully threaded headless screw fixation demonstrated the greatest strength prior to failure.
Maximum failure loads (newtons) in the tensile test
During the tensile tests, the maximum failure loads for groups 1, 2, and 3 were 351.3 ± 20.2 N, 345.7 ± 23.3 N, and 326.3 ± 18.2 N, respectively (Table 1). No statistically significant difference in maximum failure loads was observed among the 3 groups (Figure 3, Kruskal-Wallis test; P = .12). The effect size analysis indicated a small difference between group 1 and group 2 (Cohen d = 0.23), whereas larger differences were observed between group 1 and group 3 (Cohen d = 1.18) and between group 2 and group 3 (Cohen d = 0.85). The 95% CIs for each group were as follows: group 1, 328.01 to 374.59 N; group 2, 318.90 to 372.66 N; and group 3, 305.45 to 347.32 N. Since the CIs overlapped, statistical significance was not reached.
Box and whisker plot of the maximum failure load in each group. The 3 groups are marked with the same letter (a) above their respective box plots as there was no statistically significant difference in maximum failure load among group 1 (PTBW), group 2 (a 2.3-mm partially threaded cannulated screw with TBW), and group 3 (a 2.5-mm fully threaded headless cannulated screw with TBW; P > .05).
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.24.12.0375
Modes of failure in the tensile test
Each group exhibited distinct failure types. In group 1, all samples failed due to K-wire displacement and bending without any breakage of the suture material (n = 6). In group 2, all samples experienced failure due to screw bending, with 2 samples also showing pullout of the screw from the distal bone fragment. In group 3, all specimens exhibited a characteristic sudden failure before reaching 2 mm of displacement, primarily due to the pullout of the proximal bone fragment from the screw, with 1 specimen also showing screw bending.
Discussion
This study compares the biomechanical characteristics of the traditional PTBW and screw with TBW methods for extra-articular transverse fractures of the canine olecranon to assess the effectiveness of screw fixation combined with TBW methods. This study applied high-strength polyester and polyethylene suture, known as FiberWire, in place of stainless steel cerclage wires in all groups to reduce the potential complications of the PTBW method. FiberWire has been reported in several biomechanical and clinical studies23,26–28 to provide sufficient strength while reducing skin irritation and pain in olecranon fracture patients.
The screw with TBW methods were selected to prevent complications associated with the PTBW approach, such as pin displacement and a high rate of hardware removal.3 Additionally, a fully threaded headless cannulated screw was chosen to prevent soft tissue irritation and achieve greater screw pullout strength. The findings of this study indicate that, despite the absence of a significant difference in maximum failure load, both the partially threaded cannulated screw with TBW group and the fully threaded headless cannulated screw with TBW group exhibited significantly higher loads at 0.5- and 1-mm displacement (Table 1). These results suggest that the screw with TBW methods may offer a more promising alternative to the PTBW group, with a low risk of complications or hardware removal rate.
The peak vertical force exerted by a dog's forelimb is reported to be 60%, 131%, and 223% of body weight during walking, trotting, and galloping, respectively.29,30 Based on this and the average body weight in this study (12.96 kg), the estimated peak vertical forces of the forelimbs during walking, trotting, and galloping were 77.76, 169.77, and 289 N, respectively. The maximum failure loads for each group were 351.3 ± 22.2 N, 345.78 ± 25.6 N, and 326.3 ± 18.2 N. These findings suggest that all specimens exhibited sufficient stability to withstand forces generated during walking, trotting, and galloping (Figure 4). Consequently, both screw with TBW techniques appear to be suitable for canine extra-articular transverse olecranon fractures.
Comparison of the maximum failure load (newtons) for each group with load values reported in previous studies. The lines on the graph indicate the loads applied to the forelimb during walking, trotting, and galloping, calculated based on the mean body weight of the cadavers used in this study. Group 1 (PTBW), group 2 (a 2.3-mm partially threaded cannulated screw with TBW), and group 3 (a 2.5-mm fully threaded headless cannulated screw with TBW) all exhibited sufficient stability to withstand forces generated during walking, trotting, and galloping.
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.24.12.0375
In this study, 2 types of intramedullary screws were selected in the screw TBW groups: a partially threaded cannulated screw and a fully threaded cannulated screw. Although both screws were of the same length and were inserted intramedullary, their fixation mechanisms differed due to variations in screw design. When the partially threaded cannulated screw is inserted, the threads at the screw tip engage with the cancellous bone in the metaphyseal area, creating compression of the fracture fragments as it is tightened.3 Additionally, compression is augmented in group 2 through tension band wiring with a #2 FiberWire looped over the screw head. Because the partially threaded cannulated screw has a smooth shaft without threads, the stress applied to the screw is concentrated at the threaded tip.18 Conversely, the fully threaded cannulated screw features threads distributed along its length, with a gradually decreasing screw pitch from tip to tail and an increasing screw minor diameter. This design enables interfragmentary compression regardless of the position along the threaded portion.11 In group 3, compression is further supported through tension band wiring with a #2 FiberWire passed through the proximal transverse hole. Unlike the partially threaded cannulated screw, the fully threaded cannulated screw distributes stress across the entire screw length due to the continuous screw thread.18
Fully threaded headless cannulated screws can largely be categorized into 2 structural types based on thread depth. The first type features a conical design, where both the major and minor diameters increase from the screw tip toward the tail. In this structure, the screw thread depth remains constant from the screw tip to the tail.18 In contrast, the second type maintains a constant screw major diameter while the thread depth decreases as the minor diameter increases from screw tip to tail. Since screw pullout strength is inversely proportional to screw pitch and directly proportional to thread diameter, conical fully threaded headless cannulated screws exhibit a gradual increase in pullout strength from screw tip to tail.31 However, the fully threaded headless cannulated screw used in this study—the Arthrex headless microcompression fully threaded screw—has a consistent screw major diameter throughout. Therefore, unlike the conical type, it does not exhibit a progressive increase in screw pullout strength from screw tip to tail.
Due to the structural differences among the implants, the type of failure varied significantly across all groups (Figure 5). In group 1, all specimens exhibited K-wire bending accompanied by displacement of the K-wire. This finding is consistent with those of previous studies4,6,7,10 and aligns with complications reported in patients treated with PTBW. In group 2, all specimens experienced bending of the screw, with 2 specimens additionally showing screw pullout from the distal bone fragment. In group 3, failure occurred in all specimens due to the sudden loosening of the proximal bone fragment before reaching 2-mm displacement, leading to pullout from the screw. In 1 specimen, this was accompanied by screw bending. The failure modes of group 2 and 3 observed in this study were consistent with a previous study18 using a human polyurethane-foam bone model. Specifically, in the previous study,18 the fully threaded headless screw exhibited failure at the proximal threads, whereas failure in shanked screws occurred at the distal threads. Additionally, the fully threaded design of the fully threaded headless screw demonstrated greater resistance to bending forces compared to the shanked screws. These variations in failure locations may be attributed to differences in screw design. In the partially threaded cannulated screw, the presence of a smooth shaft led to stress concentration at the threaded screw tip, resulting in load being focused on the distal bone fragment and subsequent pullout from distal bone fragment or bending occurring near the threadless shaft.18 Conversely, in the fully threaded cannulated screw, stress was more evenly distributed across the entire screw length.18 However, due to the lower thread depth near the screw tail characteristic of the Arthrex microcompression fully threaded headless screw, the proximal bone fragment was more susceptible to tensile forces pulling proximally, leading to pullout from the screw. Additionally, the presence or absence of a screw head likely influenced whether failure occurred at the proximal or distal bone fragment. Consequently, this experiment, conducted in a canine cadaveric model, indicates that the fully threaded headless cannulated screw exhibits relatively weaker fixation strength in the proximal bone fragment under tensile forces, whereas its resistance to bending forces is superior.
Radiographic images demonstrated significant difference in failure types among the groups after the tensile test. A—In group 1, 2 Kirschner wires were displaced and bent without suture material breakage. B—In group 2, the 2.3-mm partially threaded cannulated screw was bent. C—In group 3, the proximal bone fragment was pulled out from the 2.5-mm fully threaded headless cannulated screw.
Citation: American Journal of Veterinary Research 2025; 10.2460/ajvr.24.12.0375
This study has several limitations. First, the small sample size in each experimental group may have influenced the mechanical outcomes and reduced statistical power. Further studies with larger sample sizes are necessary to confirm these findings. Second, to simplify the distracting forces in olecranon fractures, all soft tissues except the triceps brachii muscle and tendon were removed, which may not accurately represent the full range of forces acting on the ulna. In vivo studies are needed to fully simulate the natural movement of the elbow joint and evaluate the effectiveness and potential side effects of each method in a biological context. Third, although the long axis of the ulna was positioned at 135° relative to the vertically aligned triceps tendon to replicate the normal standing joint angle, the study was limited to a single tensile test without assessing clinically relevant cyclic loading. Nonetheless, the findings of this study suggest that TBW methods using either a partially threaded cannulated screw or a fully threaded headless cannulated screw may serve as effective options for internal fixation of canine extra-articular transverse olecranon fractures. Further research is warranted to identify the biomechanical advantages of headless cannulated screws at fracture sites under tensile forces and to evaluate the long-term complication rates associated with their use in dogs.
This study demonstrates the effectiveness of an intramedullary screw combined with TBW, using a partially threaded cannulated screw or fully threaded headless cannulated screw, in a canine cadaver model of extra-articular olecranon fractures. Specifically, the fully threaded headless cannulated screw, which provides interfragmentary compression without causing soft tissue irritation, demonstrates effectiveness even under tensile forces. Accordingly, TBW with a fully threaded headless cannulated screw is expected to reduce complication rates associated with traditional PTBW in canine extra-articular olecranon fractures, thereby accelerating bone healing and functional recovery.
Acknowledgments
None reported.
Disclosures
The authors have nothing to disclose. No AI-assisted technologies were used in the composition of this manuscript.
Funding
The authors have nothing to disclose.
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