An assessment of the fixin tplo jig to generate effective compression using a transverse fracture model

Cassio Ricardo Auada Ferringo; George Diggs; Daniel D. Lewis; Scott A. Banks

doi:10.1371/journal.pone.0286937

Peer Review History

Original SubmissionMay 25, 2023
26 Jul 2023 Decision Letter - Mohamed El-Sayed Abdel-Wanis, Editor PONE-D-23-15995An assessment of the fixin tplo jig to generate effective compression using a transverse fracture modelPLOS ONE Dear Dr. ferrigno, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Sep 09 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. 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Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: No Reviewer #2: N/A ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: No Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: The authors demonstrate a biomechanical model comparing several surgical options for transverse fracture/osteotomy interfragmentary compression. Methods and materials: The 3D printed APS plastic was selected to simulate bone. Is it similar in its biomechanical properties to bone? If so provide evidence. There must be a rational why natural bones weren't used. As an LCDCP plate utility is clear, it is not clear if the TPLO jig practical in clinical scenarios? In which exactly? Please provide an explanation, as not all of the readership of this journal come from the Veterinarian community. The maintenance of compression over time is the end purpose of all fixation methods. Other than the read of compression force after 10 seconds there is no other reference to this issue. See this manuscript for further discussion: Keltz E, Mora AJ, Wulsten D, Rußow G, Märdian S, Duda GN, Heyland M. Is initial interfragmentary compression made to last? An ovine bone in vitro study. Injury. 2021 Jun;52(6):1263-1270. Statistical analysis: It is not detailed enough. A table of the individual values measured should be attached as supplementary material. It is unclear what are the results that were analyzed with the Tukey Honestly Significant Difference test Discussion The clinical relevance of this model is not discussed enough. Line 244: I would add that the main desirable effect by enhanced stability is not the protection of the plate but the reduction of shear forces which is the effect needed to ensure fracture union. Limitations Line 256-262: A fair point, but the correlation to practical real life clinical decision is missing. In which wire will the authors recommend to use in fracture surgery? If other than 18 gauge, why was this wire selected for their model? If not, what is their explanation? Reviewer #2: The objective of this study was to determine compressive loads that could be generated using a tibial plateau leveling osteotomy (TPLO) jig with a tensioned strandof 18-gauge stainless steel orthopedic wire in a simulated transverse fracture model. The wire was sequentially tensioned using heavy needle holders or an AO wire tightener. The results demonstrate that the TPLO jig allows surgeons to compress transverse fractures or osteotomies effectively. Tensioning the AO wire tightener allows for sequential tensioning and generates superior compressive loads than tensioning wires with heavy needle holders ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? 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Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0286937.r001
Revision 1
21 Aug 2023 Author Response ALL THE QUESTIONS ARE ANSWERED IN THE LETTER FROM THE EDITOR AND REVIEWER ONE, BUT I AM COPYING IT HERE. This is the answer to reviewer one question and analysis response. “The 3D printed APS plastic was selected to simulate bone. Is it similar in its biomechanical properties to the bone? If so provide evidence. There must be a rationale why natural bones weren't used.” The Delrin rod was selected in the experimental environment as it is a more consistent, homogeneus material than bone. Natural bone introduces variability, such as size differences, bone density, and conformation that can affect the overall data collection in a biomechanical study. On the other hand, several experiments have already been published that use Delrin rod as a reliable substitute for natural bone in biomechanical testing. I have included some references to papers that use a similar methodology with the Delrin rod..(1)(2)(3)(4)(5) “As an LCDCP plate utility is clear, it is not clear if the TPLO jig practical in clinical scenarios? In which exactly? Please provide an explanation, as not all of the readership of this journal come from the Veterinarian community.” The use of neutral locking plates in veterinary orthopedics is becoming increasingly popular. However, many new generation implants lack the compress hole in the plate. Thus, using the TPLO jig has the potential to compress the fracture gap using a neutral implant. In some fractures, if a stronger compression is desired, the jig could be used. Additionally, in a MIPO scenario where achieving good compression in the fracture gap is not always possible, this concept could also be utilized. “The maintenance of compression over time is the end purpose of all fixation methods. Other than the read of compression force after 10 seconds there is no other reference to this issue. See this manuscript for further discussion: Keltz E, Mora AJ, Wulsten D, Rußow G, Märdian S, Duda GN, Heyland M. Is initial interfragmentary compression made to last? An ovine bone in vitro study. Injury. 2021 Jun;52(6):1263-1270.” The manuscript cited by the first reviewer discusses the importance of maintaining compression over time in two different models of achieving compression in the fracture gap. The paper suggests that compression of more than 100 N might be necessary to overcome the loss of compression due to bone biomechanical characteristics and other physiological forces acting on the bone, such as axial displacement, in a real patient. Our paper's scope differs from the previous one. While they measured if an implant could overcome compression loss over time, we focus on the amount of compression various techniques cause in a transverse fracture gap, aside from the conventional dynamic compression plate. As mentioned in the paper cited by the reviser, it may be necessary to use different methods to achieve greater compression in the fracture gap in order to sustain it over time. Our paper provides some possible ways to achieve this. “Statistical analysis: It is not detailed enough. A table of the individual values measured should be attached as supplementary material. It is unclear what are the results that were analyzed with the Tukey Honestly Significant Difference test” A supplementary material containing graphics with all values has been added to the Plos One website as other files. The print of the statistical data has also been included to enhance the appreciation of the statistical treatment. “The clinical relevance of this model is not discussed enough” I believe that the clinical relevance of the project is already expressed in lines 302-305 in our conclusions paragraph. “Line 244: I would add that the main desirable effect by enhanced stability is not the protection of the plate but the reduction of shear forces which is the effect needed to ensure fracture union.” I respectfully disagree with this statement. If a transverse fracture model is managed with compression and a plate or other bone implant is used to protect the fracture gap, there will not be any shear forces present. In other words, the bending forces will be negated and counteracted. If there is shared loading between the implant and the bone column, the friction of the plate in the periosteum will be “protected”. This shared loading can only occur with a compressive fracture gap. However, if the compression is too weak, a high-strain environment with minimal movement will hinder primary callus formation. “Line 256-262: A fair point, but the correlation to practical real life clinical decision is missing. In which wire will the authors recommend to use in fracture surgery? If other than 18 gauge, why was this wire selected for their model? If not, what is their explanation?” The decision to use the 18 gauge wire in the study was empirical. Further studies need to be done to find if different gauges of wires will yield higher or lower compression before the wire fails. Attachments Attachment Submitted filename: Response to Reviewers 2 jig project.docx https://doi.org/10.1371/journal.pone.0286937.r002
8 Sep 2023 Decision Letter - Mohamed El-Sayed Abdel-Wanis, Editor PONE-D-23-15995R1An assessment of the fixin tplo jig to generate effective compression using a transverse fracture modelPLOS ONE Dear Dr. ferrigno, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.I agree that the authors addressed all the reviewer comments, however a lot of the points explained in their detailed reply should be included in summaryin the 'Discussion" of the revised manuscript Please submit your revised manuscript by Oct 23 2023 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Mohamed El-Sayed Abdel-Wanis, Ph.D. Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. 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Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0286937.r003
Revision 2
26 Sep 2023 Author Response The editors' letter contains the response, but all the information has been added to the manuscript. Attachments Attachment Submitted filename: second revision Response to editor 1 jig project.docx https://doi.org/10.1371/journal.pone.0286937.r004
28 Sep 2023 Decision Letter - Mohamed El-Sayed Abdel-Wanis, Editor An assessment of the fixin tplo jig to generate effective compression using a transverse fracture model PONE-D-23-15995R2 Dear Dr. Cassio Ferrigno, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Mohamed El-Sayed Abdel-Wanis, Ph.D. Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0286937.r005
Formally Accepted
4 Oct 2023 Acceptance Letter - Mohamed El-Sayed Abdel-Wanis, Editor PONE-D-23-15995R2 An assessment of the fixin tplo jig to generate effective compression using a transverse fracture model Dear Dr. Ferringo: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Dr Mohamed El-Sayed Abdel-Wanis Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0286937.r006

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