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1.
OBJECTIVE: To determine a hand-tied ligature knot configuration, suture size, and suture type that would be an acceptable substitute to commercially available ligature knots for use in equine laparoscopic surgery. STUDY DESIGN: Three-factor ANOVA with the fixed effects being suture type, suture size, and knot type. The dependent variable was ligature security (load to failure). METHODS: Commercially available Endoloop and 4 hand-tied slipknot ligatures were compared with a 4-layer square knot. The hand tied ligature knots tested were the 4S modified Roeder knot, the Brooks knot, the modified Roeder knot, and the Weston knot. Two suture sizes (0, 2) of each of 2 suture types (polydioxanone, polyglactin 910) were tested with each hand tied knot. Two types (polydioxanone, polyglactin 910) of size 0 Endoloop were tested. Twenty repetitions of each knot suture type were tested for force to yield on a materials testing machine. Statistical analysis consisted of a 3-way ANOVA with individual comparisons made using the Bonferroni method. Significance was P< or = .05. RESULTS: Only the 4S modified Roeder knot in 2 polydioxanone (103 N) was comparable with the breaking strength of the square knots (157 N). All other knot suture combinations tested were significantly weaker than the square knot (range, 2-18 N). CONCLUSION: For equine laparoscopy, a 2 polydioxanone 4S modified Roeder knot would be an acceptable alternative to the commercially available Endoloop. CLINICAL RELEVANCE: Laparoscopic slip knots are commonly used in equine laparoscopic surgery. Various knot configuration and suture size and type combinations will affect the security of the slip knot.  相似文献   

2.
Objective— To evaluate the effect of 6 different knotting methods on the mechanical properties of 3 large absorbable suture materials used in large animal surgery. Study Design— In vitro mechanical study. Sample Population— Knotted suture loops (n=15 per group). Methods— Suture loops were created between two low‐friction pulleys with either 2 polydioxanone, 2 polyglactin 910 or 3 polyglactin 910. Strands were tied using 1 of 6 knotting technique: square knot, surgeon knot, clamped surgeon's knot, sliding half‐hitch knot (HH), Delimar knot and self‐locking knot (SLK). A single cycle to failure test was performed on each suture loop with a distraction rate of 100 mm/min. Failure modes were evaluated and breaking strength, elongation to failure and stiffness were compared. Results— All loops except two HH failed at the knot by acute breaking. The double‐stranded SLK was both stronger and stiffer than all other knots for each suture material. Clamping the first throw of the surgeon knot decreased load to failure significantly (143.11 ± 8.64 N) compared with not clamping (159.21 ± 6.14 N) for polydioxanone. Stiffness and elongation to failure were respectively lower and increased for 2 polydioxanone compared with both polyglactin 910 materials for all knotting techniques. Conclusions— Knotting techniques do influence structural properties of suture loops. The double strand loop conferred stiffer and stronger properties to the SLK Clinical Relevance— Clamping the first throw of polydioxanone should be avoided when tying a suture under tension even using large diameter suture materials. Using a SLK might be considered as a useful alternative when excessive tension is present.  相似文献   

3.
Objective: To determine (1) the minimum number of throws to form secure Aberdeen (AB) and square knots to start (SS) and end (SE) continuous patterns, in fat‐ and plasma‐coated polydioxanone; and (2) compare relative knot security (RKS) and knot volumes of these secure SS, SE, and AB knots. Study Design: In vitro experimental materials testing. Sample Population: Polydioxanone suture material (3 metric). Methods: Each knot was tested 20 times, and throws incrementally added until secure SS, SE, and AB knots were found. RKS and knot volumes were calculated for SS, SE, and AB knots. Results: Secure SE knots needed 5 throws in plasma or fat. Secure SS knots needed 4 throws in plasma, but 5 in fat. The minimum AB configuration that was secure in plasma or fat was 3+1, however, the 4+1 AB knot was also secure in fat. Mean (SD) RKS of secure knots were: SE 59.69% (5.91), SS 67.92% (12.50), AB 81.08% (8.99). AB knots had significantly higher mean RKS than any SS or SE knot in plasma or fat (P<.001). Mean knot volume of 3+1 AB knot was significantly smaller than any secure SS or SE knots by 22.6–69.4% (P<.0001). Mean knot volume of 4+1 AB knots was significantly smaller than all fat secure SS and SE knots by 19.9–57.5% (P=.0001). Conclusion: The knot security of the SS knot was decreased by fat coating polydioxanone suture, requiring an additional throw to keep it secure. Secure AB knots had a higher breaking strength and smaller knot volume than secure SS and SE knots. Clinical Relevance: The AB may be preferable to square knots in continuous closures. As many body fluids contain lipid, surgeons should tie knot configurations considered secure in fat. We advise tying a 4+1 AB and placing a minimum of 5 throws to tie SS and SE knots using 3 metric polydioxanone.  相似文献   

4.
OBJECTIVE: To evaluate the effect of knotting method on the mechanical properties of large diameter nonabsorbable monofilament suture materials. STUDY DESIGN: In vitro mechanical evaluation. METHODS: A conventional square knot was compared with the surgeon's knot, sliding half-hitch, and clamped square knot. Knotted suture loops were created in a uniform manner and acutely tensioned to failure (20 mm/min loading rate; n = 20 per knot type for each material). Stiffness, yield, and failure characteristics of USP #2 nylon, #2 polybutester, #2 polypropylene, 27 kg test monofilament nylon fishing line, and 27 kg nylon leader material were evaluated. RESULTS: Compared with a conventional square knot, a surgeon's knot decreased stiffness for #2 polypropylene, 27 kg fishing line, and 27 kg leader (P < .05). A sliding half-hitch weakened all materials except 27 kg leader (P < .05). Clamping the first throw of a square knot increased the stiffness of 27 kg leader loops (P < .05). CONCLUSIONS: Based on clinically relevant parameters (stiffness and yield), knotting method had no effect on #2 nylon and #2 polybutester. The surgeon's knot is not recommended for #2 polypropylene and 27 kg fishing line and leader material. A sliding half-hitch decreased the yield of leader material. Clamping the first throw of a square knot had no adverse effects on acute properties of tested materials; it increased the stiffness for leader material. CLINICAL RELEVANCE: Knotting method does influence the structural properties of suture materials and should be considered when tying knots under tension.  相似文献   

5.
Autogenous lamellar corneal grafting in dogs   总被引：1，自引：0，他引：1  
Lamellar, autogenous, corneal grafts were performed on 9 clinically normal dogs (1 eye in each of 2 dogs and both eyes in each of 7 dogs) and 7 dogs with corneal disease (1 eye in each dog). Nylon, polyglycolic acid, polyglactin 910, and polydioxanone suture materials were used in 8-0 to 10-0 sizes. The eyes of the normal dogs were examined weekly for up to 16 weeks; corneal endothelium was reestablished in all eyes by 6 weeks after surgery. The eyes of the dogs with corneal disease were reexamined periodically for up to 9 months. Twenty-two of 23 (95.7%) grafts were considered successful in that they were translucent, and the dogs were able to see after surgery. The suture materials that caused the least tissue reaction were nylon and polyglactin 910. This procedure is indicated for chronic descemetoceles and other perforating corneal disease. It has the advantage of rapidly resolving severe corneal disease, with a high degree of success.  相似文献   

6.
Polydioxanone (PDS™) synthetic absorbable suture material was evaluated in 169 dogs and cats. Sutures or ligatures were used on 446 tissues including 18 contaminated and 16 infected wounds. There was less tissue friction than with polyglycolic acid or polyglactin 910 sutures. The suture tended to kink during placement of continuous suture patterns. There was one wound dehiscence.
Polydioxanone may be used wherever surgical gut, polyglycolic acid, or polyglactin 910 sutures are normally used.  相似文献   

7.
O bjectives : To determine the minimum number of throws/turns to form a secure Aberdeen knot and the maximum ear slippage for these knots using three metric polydioxanone coated in fat or plasma. To compare plasma and novel canine liquefied fat as suture coating mediums for in vitro knot security testing.
M ethods : Throws/turns were incrementally added until a secure knot was found for plasma and fat. Knots were tensioned until failure and remaining ear length measured. A secure knot was defined as ear slippage 3 mm or less in 20 consecutively tested knots. Ear slippages were statistically analysed.
R esults : Minimum secure configuration was a 3+1 knot in plasma and fat, and its ear slipped a maximum of 2 mm in plasma and 2·5 mm in fat. A secure 4+1 knot had a maximum ear slippage of 0·5 mm, which was significantly less than that of the 3+1 knot (P<0·0001). Fat coating suture significantly decreases in vitro knot security compared with plasma (P=0·0035).
C linical S ignificance : The novel fat coating medium should be considered when testing in vitro knot security as it simulates a clinical knot tying environment. A 4+1 Aberdeen knot with a 3 mm ear is recommended to tie a secure Aberdeen knot in any body fluid environment.  相似文献   

8.
Objective: To compare the mechanical, knotting, and absorption properties of 3 synthetic absorbable suture materials (polyglactin 910, polydioxanone, poliglecaprone 25) from 2 different manufacturers (Huaiyin Medical Instruments Co. Ltd. and Ethicon Inc.). Sample Population: Suture material samples from the same manufacturing lot for each suture type and manufacturer. Methods: Part 1: 10 samples of each suture were incubated in bovine serum and tested for ultimate load and stiffness at days 0, 1, 7, 14, 21, and 28. Part 2: 10 knotted samples were similarly evaluated, without incubation. Results: Huaiyin polydioxanone had a greater (P<.001) ultimate load on days 0, 1, and 7; and a consistently greater stiffness for the duration of the study, compared with the Ethicon polydioxanone. Ethicon poliglecaprone 25 had a greater ultimate load on days 0, 1, 7 (P<.001); on day 21 Huaiyin had a greater ultimate load. Ethicon poliglecaprone had greater stiffness on days 0, 1, 7 (P<.001). Ethicon polyglactin 910 had a greater (P<.001) ultimate load at all times and a greater stiffness (P<.001) at days 0, 1, 7, and 14 compared with Huaiyin polyglactin 910. Huaiyin polydioxanone and polyglactin 910 had greater knot breaking strengths than Ethicon equivalents (P<.001). Conclusion: Differences in mechanical properties exist between nominally identical suture materials from different manufacturers.  相似文献   

9.
The loss of breaking strength and elasticity of five absorbable suture materials (polydioxanone [PDS-II], polyglycolic acid [PGA], polyglactin 910 [PG-910], polyglyconate [GTMC], and chromic gut) after in vitro incubation in sterile, Escherichia coli- and Proteus mirab/tfs-inoculated canine urine was studied. Biomechanical testing, in a controlled environment, was performed during the 28-day study period. Polydioxanone and chromic gut retained greater than 90% of their original strengths after 28 days of incubation in sterile urine and 87% of original strengths in E. co//-inoculated urine. Polyglyconate retained 24% and 18% of original strength, respectively, after incubation in sterile and E. co/i-inoculated urine for 28 days. Polyglycolic acid and PG-910 retained less than 30% of original strength in sterile urine and only 7% in E. co/i-inoculated urine after 21 days of incubation. In P. m/rabi/is-inoculated urine, loss of tensile strength and elongation was significant for all suture materials. Polyglycolic acid and PG-910 lost all strength after 24 hours of incubation. Polydioxanone lost all strength after 7 days of incubation, whereas GTMC retained 19% at day 7. Chromic gut retained 78% at day 7 and 16% after 21 days of incubation, however, the absence of normal phagocytic destruction of chromic gut in this in vitro study may have artificially elevated these values. In sterile urine with chemically modified pH, loss of strength and elongation was greater in alkaline urine than in neutral or acidic urine for all types of suture materials.  相似文献   

10.
Swelling and inflammation along the incision line were observed after elective ovariohysterectomy in 22 of 66 cats in a retrospective study. In a prospective study of 99 feline abdominal incisions closed with surgical gut, polyglactin 910, or polydioxanone, with and without subcutaneous closure, the least inflammation occurred when the linea alba was sutured with polyglactin 910 and the subcutaneous tissues were not sutured. Histologically, reactions in the linea alba of 12 other cats progressed from purulent to fibromononuclear to fibrous within 14 days after closure with gut, polyglactin 910, and polydioxanone. Microscopic evidence of seroma formation in 9 of 12 animals in which the subcutaneous tissue was not sutured suggested that surgical closure of subcutaneous dead space was indicated. The inflammatory reaction did not appear to be related to any one suture material as reactions were seen with all of them.  相似文献   

11.
OBJECTIVE: To evaluate closure strength (in vitro bursting pressure) of jejunal enterotomies in llamas. STUDY DESIGN: In vitro experimental study. SAMPLE POPULATION: Jejunal specimens (n=72) from 6 llamas. METHODS: Differences in bursting pressures and luminal diameters were compared between 2 layer enterotomy closures with an initial full thickness simple continuous pattern oversewn with either a continuous Lembert or Cushing suture pattern using 3 sizes (2-0, 3-0, 4-0) of polyglactin 910 and polydioxanone. RESULTS: Bursting pressures were significantly higher for enterotomies closed with polydioxanone than polyglactin 910, independent of suture size, but there was no difference between Lembert and Cushing oversew patterns. Use of a Lembert pattern reduced intestinal diameter more than a Cushing pattern regardless of suture material or size. CONCLUSIONS: Although polydioxanone resisted higher bursting pressures than polyglactin 910, both suture materials should be considered satisfactory for jejunal enterotomy closure in llamas based on typical intraluminal pressures expected in clinical patients. The optimal oversew pattern may be continuous Cushing to maximize the luminal diameter in small intestinal enterotomy closures. CLINICAL RELEVANCE: In vitro bursting pressures may help to predict which enterotomy sites would leak post-operatively, although further studies are necessary to determine the outcome in clinical patients.  相似文献   

12.
OBJECTIVE: To determine failure strength, stiffness, and failure mode of 4 suture materials in equine linea alba. STUDY DESIGN: Randomized complete block design. SAMPLE POPULATION: Linea albas collected from 12 adult horses (mean weight, 475 kg; mean age, 10 years). METHODS: The ventral abdominal fascia, including the linea alba, was collected and bisected along the linea alba into right and left halves. Each half was divided into four, 5-cm sections extending from the umbilicus cranially, and randomly assigned to 1 of 4 suture materials: 2 polydioxanone (2 PD), 3 polyglactin 910 (3 PG), 6 polyglactin 910 (6 PG), and 7 polydioxanone (7 PD). A single cycle to failure test was performed on each specimen at a distraction rate of 100 mm/min. Differences in failure strength and stiffness for the materials were evaluated using a mixed linear model with significance set at P<.05. RESULTS: In 94 of 96 test sections, constructs failed by suture failure. There were significant differences in failure strength (P<.0001) and stiffness (P<.001) among the suture/tissue constructs. 7 PD had the highest breaking strength (316.8 N) followed by 6 PG (281.3 N), 3 PG (229.9 N), and 2 PD (193.0 N). Six PG had the largest stiffness (14 N/mm) followed by 3 PG (12.7 N/mm), 7 PD (10.1 N/mm), and 2 PD (7.2 N/mm). Suture breaking strength and stiffness were not affected by linea or fascia thickness, individual horse, half of the linea alba, or abdominal wall position. Eighty-five (90.4%) suture loops failed adjacent the knot. CONCLUSIONS: When tested in single cycle to failure, suture material was more likely to fail than the linea alba. Larger suture materials had higher breaking strengths than smaller suture materials and stiffness was also affected by suture material and size. CLINICAL RELEVANCE: Given its high initial breaking strength and its relatively longer in vivo strength retention, 7 PD seems an appropriate choice of suture material for closure of the equine linea alba when maximal short-term failure strength is desired.  相似文献   

13.
OBJECTIVE: To determine in vitro effects of PBSS, milk, and bacteria-contaminated milk (BCM; contaminated by Streptococcus agalactiae) on properties of 3 synthetic absorbable suture materials. SAMPLE POPULATION: 3 types of synthetic absorbable suture materials (poliglecaprone 25, polyglycolic acid, and polydioxanone). PROCEDURES: Suture materials were tested to determine breaking strength and elasticity before (day 0) and after incubation in 3 media (PBSS, milk, and BCM) for 7, 14, and 21 days. A loop of suture material was elongated at a rate of 60 mm/min until it reached the breaking point. Tensile properties were statistically analyzed among media and incubation times. RESULTS: Incubation in milk and BCM significantly decreased breaking strength and elasticity of poliglecaprone 25, compared with results for incubation in PBSS. Incubation in BCM significantly decreased tensile properties of polyglycolic acid suture, compared with results for incubation in PBSS and milk. After incubation for 21 days, tensile properties of polydioxanone did not differ significantly among the media but were significantly decreased from values on day 0. CONCLUSIONS AND CLINICAL RELEVANCE: On the basis of this study, poliglecaprone 25 is an inappropriate suture material for use in teat surgery. Polyglycolic acid suture should be avoided in teats of cattle with mastitis. Of the suture materials tested, polydioxanone was best suited for use in teat surgery, as determined on the basis of material testing after incubation in milk, even when the milk was contaminated with bacteria.  相似文献   

14.
Five different suture materials (silk, monofilament nylon, polyglyconate, polyglactin 910, and chromic gut) were placed in the skin and body wall of 10 Doitsu (scaleless) koi (Cyprinus carpio). After seven days the sutures were retrieved from five of the fish in 5 mm and 6 mm punch biopsies, and after 14 days they were retrieved in the same way from the other five. The tissue reactions were evaluated by gross visual inspection and by histological examination. The total inflammatory reaction was graded on a scale from 0 (no inflammation) to 5 (severe inflammation). The synthetic suture materials generally induced a moderate inflammatory reaction that decreased after seven days. After 14 days the superficial reaction to monofilament nylon was substantial, and the tissue reactions to the organic suture materials were slightly greater than the reactions to the synthetics. The inflammatory response to silk was greater after 14 days than after seven, and chromic gut induced a moderately severe inflammatory response after seven days; the chromic gut sutures fell out before the biopsies were taken after 14 days. The organic materials induced intense inflammatory reactions which did not subside if the suture remained in the tissue.  相似文献   

15.
Tensile testing of reproducible loops of size 5 braided polyester, size 2 polyglycolic acid, size 2 monofilament nylon, and size 2 polydioxanone sutures was performed in vitro and after subcutaneous implantation in horses for 7, 14, and 28 days. Maximum breaking strength, energy absorption, and percentage elongation to breakage point were measured. Size 5 braided polyester had the highest maximum breaking strength and energy absorption over 28 days. Polydioxanone had better mechanical performance over 28 days than did polyglycolic acid. On day 28, none of these parameters was measurable in polyglycolic acid. Monofilament nylon had the lowest breaking strength of the three materials tested on day 28.  相似文献   

16.
This study compares the healing of oronasal defects created by partial maxillectomy when closed using two different suture materials and two different suture patterns. In experiment 1, 24 dogs were divided into four equal groups. Partial maxillectomy was performed on each dog and was closed using either a two-layer simple interrupted suture pattern (12 dogs) or a modified Mayo mattress pattern (12 dogs) with either polyglactin 910 (12 dogs) or polypropylene (12 dogs) sutures. On the seventh postoperative day, the dogs were euthanized, suture line bursting pressures were measured, and wound healing was evaluated grossly and histopathologically. Suture line dehiscence occurred in one dog from each of the four groups. These were the only dogs in which electrocoagulation had been used. The healing of suture lines closed with the two-layer simple interrupted pattern was superior to that of those closed with the modified Mayo mattress pattern based on the degree of gross oral ulceration, suppurative inflammation, fibrosis and oral epithelial covering at the suture line, and the number of necrotic sites in the adjacent tissue. The healing of suture lines closed with polypropylene was superior to that of those closed with polyglactin 910 based on suture line bursting pressures and the degree of suppurative inflammation and tissue necrosis at the suture sites. In Experiment 2, partial maxillectomies were performed on four dogs, and closure was achieved using a two-layer simple interrupted suture pattern with either polyglactin 910 (two dogs) or polypropylene (two dogs). On the 30th postoperative day, the dogs were euthanized, and wound healing was evaluated grossly and histopathologically. All suture lines were well healed. All polyglactin 910 oral sutures were absent, while all polypropylene oral sutures were still present.  相似文献   

17.
This study compared incisional complications after ventral midline laparotomy using 2 absorbable suture materials for apposition of the linea alba in sheep. The linea alba of 93 yearling sheep was sutured by 3 veterinarians in a simple continuous pattern using either polyglactin 910 (PG910; group PG) or polydioxanone (PDS; group PD). A blinded observer assessed surgical sites at the time of suture removal. Multivariate logistic regression was used to assess the association between incisional complications and variables (suture material used, veterinarian, skin suture removal time). The odds of incisional complications did not vary significantly with the type of suture material used (P = 0.11), veterinarian (P = 0.61) or skin suture removal time (P = 0.36). Most incisional complications were cutaneous suture sinus formation. Either PG910 or PDS may be used for linea alba closure in sheep.  相似文献   

18.
The purposes of this study were to mechanically determine the optimal tissue bite size and to evaluate seven suture materials at their largest commercially available size for breaking strength and stiffness using cadaveric adult equine linea alba. Soft tissues were removed from the abdominal fascia of 16 adult horses. Individual test sections were created from the entire linea alba and labeled (1 through 6) starting at the umbilicus and extending craniad. A single biomechanical test was performed on each test section. Tissue bite size (3, 6, 9, 12, 15, 18, and 21 mm) significantly altered breaking strength directly in a logarithmic fashion (P < .0001; R2= 0.94). Tissue bite size accounted for 44% and linea alba thickness for 24% of the variability in breaking strength of the equine linea alba. The optimal tissue bite size for adult horses was 15 mm from the edge of the linea alba based on lack of significant gain in breaking strength. There were no differences in breaking strength among horses, horses weight, or left and right test sections. Test sections taken from near or at the umbilicus had greater breaking strength (P < .005) and thicker linea alba (P < .001) when compared with more cranial test sections. Linea alba thickness alone accounted for 34% of the variability in breaking strength associated with test section position. There were no differences in linea alba stiffness among tissue bite sizes. All suture loops failed before complete fascial disruption, and 52 of 56 (93%) suture loops failed at the knot. Suture breaking strength and stiffness were significantly affected by the type of suture material examined (P < .0001). Size 5 polyester had a greater breaking strength and stiffness compared with the other suture materials tested. The next strongest suture materials were size 3 polyglactin 910 and size 2 polyglycolic acid, which were similar in breaking strengths and stiffness. Size 2 nylon was significantly weaker in breaking strength when compared with the other suture materials.  相似文献   

19.
OBJECTIVE: To compare the peak force required for failure of hand-tied laparoscopic slipknot ligatures. STUDY DESIGN: In vitro mechanical evaluation of suture material/knot combinations. Sample POPULATION: Four hand-tied laparoscopic slipknots were studied. Three suture materials and 2 suture sizes were evaluated. Twenty samples of each group were tested, for a total of 400 samples. METHODS: The 4S modified Roeder, modified Roeder, and Weston and Brooks laparoscopic slipknots using 0 polyglyconate, 0 polyglycolic acid, 1 polyglyconate, and 1 polydioxanone (PDS) were tested. A vertical distracting force (5 mm/s) was applied until failure. Mean peak force to failure was obtained for each suture material, size, and knot combination. RESULTS: Mean (+/-SEM) peak force to failure of hand-tied ligatures ranged from 156.8+/-9.1 N to 4.8+/-.4 N. The 4S-modified Roeder had the highest mean peak force to failure. Ligatures tied with polyglyconate and size 1 suture had the highest mean peak force to failure. CONCLUSIONS: The 4S-modified Roeder was significantly and consistently stronger than the other slipknots. Polyglyconate was superior to other suture materials. The 1 polyglyconate had the highest mean peak force to failure followed by 0 polyglyconate that exceeded the 1PDS. CLINICAL RELEVANCE: The 4S-modified Roeder slipknot using 1 polyglyconate has the greatest breaking strength of sutures tested and should be considered when performing laparoscopic ligatures.  相似文献   

20.
OBJECTIVE: To compare tension of 3 cerclage wire knots tied by surgeons of various abilities and experience. DESIGN: Cross-sectional study. SAMPLE POPULATION: Participants and faculty at a postgraduate course in veterinary orthopedics. PROCEDURE: Subjects tied a cerclage of their choice on an instrumented tying stand that displayed the tension on a computer. Mean tensions in cerclage wires tied with twist, single loop, or double loop knots were compared. The relationship between level of surgeon experience and tension achieved was examined. RESULTS: 29 twist, 30 single loop, and 16 double loop wires were analyzed. Mean +/- SD tension for twist knots was significantly less than for single loop knots (82.3+/-46.1 vs 166.6+/-42.2 N, respectively). Double loop knots achieved significantly greater tension (392.0+/-116.6 N) than twist and single loop knots did, even though few participants had ever tied this knot previously. There was no correlation with experience of the participant. For twist knots, wiggling the wire during cutting and pushing the twist over to flatten it to the bone further reduced tension. CONCLUSIONS AND CLINICAL RELEVANCE: Cerclage applied with a twist knot does not compress fracture fragments as effectively as cerclage applied with single loop or double loop techniques. Because greater compression of fragments will improve the stability of a fracture, a surgeon should strive to maximize the tension in the cerclage that they use. Experience and abilities of the surgeon are not associated with ability to tie cerclage wires tightly.  相似文献   

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