The study investigates the optimal interference screw dimensions required to secure a tendon graft in a bone tunnel. A standard 8 mm pig flexor-tendon graft was inserted into a standard open-ended 8 mm bone tunnel of a porcine distal femur and secured using either 7 mm, 8 mm or 9 mm diameter metal interference screws (Arthrex Inc, Naples, FL). The construct was tested to failure using a Shimadzu ASG 10KN Universal Material Testing Machine (Shimadzu, Tokyo, Japan). Load and mode of construct failure were recorded for 37 individual constructs. There was no significant difference in the load at failure between the 7 mm screw (192 N; range 151-232) and 8 mm screw (181 N; range 150-212) (p>0.05). There was a significant difference between the 7 mm screw and the 9 mm screw (109 N; range 67-151) (p=0.006) and between the 8 mm screw and the 9 mm screw (p=0.015). When using a 9 mm screw, 100% of the constructs failed by cut out of the graft at the tunnel opening. The 7 mm constructs failed by slippage of the tendon from the bone tunnel in 83% of cases, with only 17% failing by cut out at the tunnel opening. The 8 mm constructs demonstrated a mixture of failure modes, with slippage occurring in 58% of cases, cut out in 38% and failure of the graft substance in one case (4%). In this model, screw diameters equal to or 1 mm less than the tunnel/tendon diameter provides better fixation than using a screw 1 mm larger. The mode of failure differs for each of these screws.
SUMMARYPortal hypertension and the development of varices in areas of portosystemic venous anastomoses can lead to dramatic and life‐threatening haemorrhage. Varices most commonly occur in the gastro‐oesophageal region but ectopic varices can arise at other sites in the gastrointestinal tract. This report describes a patient with massive haemorrhage from duodenal varices. We believe the case highlights the importance of considering ectopic varices as a cause of gastro‐intestinal haemorrhage especially when oesophageal varices are absent.
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