Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study

Samiezadeh, Saeid; Avval, Pouria Tavakkoli; Fawaz, Zouheir

doi:10.1016/j.clinbiomech.2014.05.010

Cited by 54 publications

(53 citation statements)

References 41 publications

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“…This, combined with attachment of interlocking screws to the bone fragments, guarantees that the majority of the load is supported by the nail, which shields the bone from the stress and reduces the stimulus required for proper healing to occur. Such effect was perceived as a potential problem and was assumed to cause delayed recovery and nonunion cases . In an attempt to reduce the stress‐shielding effect and promote healing, Grosse and Kempf emphasized nail dynamization , where a fixed end is responsible for ensuring fracture rotational stability, while the opposite extremity is free to slide slightly inside the bone .…”

Section: The Evolutionary Biomechanical Landmarksmentioning

confidence: 99%

“…In an attempt to reduce the stress‐shielding effect and promote healing, Grosse and Kempf emphasized nail dynamization , where a fixed end is responsible for ensuring fracture rotational stability, while the opposite extremity is free to slide slightly inside the bone . In the materials field, a strong novelty was also introduced in the 1990s with the adoption of titanium, a new material competing with the until then commonly used AISI 136 LVM ASTM F138 stainless steel (generally known as medical‐grade stainless steel) . Today, both materials are widely accepted; however, there is a preferential tendency for titanium alloy owing to its attractive mechanical properties (see Table ), such as Young's modulus closer to the intact diaphyseal cortical bone, higher fatigue strength and yield strength, and the fact that it is biocompatible and shows less magnetic resonance imaging interference than that observed for stainless steel implants .…”

Section: The Evolutionary Biomechanical Landmarksmentioning

confidence: 99%

“…There is insufficient knowledge on the physiological mechanical environment that promotes fracture healing and how to adapt the intramedullary nail rigidity to mimic such an environment. Hence, it remains unclear which is the “ideal” mechanical environment at the fracture site, demonstrating the urgent need for an exhaustive study on this matter, which will also greatly affect future improvement of intramedullary nailing systems …”

Section: Current Biomechanical Nail Improvements and Upgradesmentioning

confidence: 99%

“…According to this author, the strength properties demonstrated by intramedullary nails composed of this material should be sufficient to ensure long bone fracture stabilization. The use of reinforced composites allows for adaptation of their mechanical properties on the basis of the requirements by changing the fiber orientation and their arrangement or volume fraction …”

Section: Current Biomechanical Nail Improvements and Upgradesmentioning

confidence: 99%

“…The primary goal of fracture treatment is to provide an optimum mechanobiological environment for each stage of fracture healing . Hence, the best way to promote callus development is to allow movements that stimulate and favor healing and to hinder those that may disrupt it .…”

Section: Reduced Screw‐to‐nail Compliancementioning

confidence: 99%

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Recent developments on intramedullary nailing: a biomechanical perspective

Rosa

Marta

Vaz

et al. 2017

Annals of the New York Academy of Sciences

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Combining contributions from engineering and medicine, we highlight the biomechanical turning points in the historical evolution of the intramedullary nailing stabilization technique and discuss the recent innovations concerning increase in bone-implant system stability. Following the earliest attempts, where stabilization of long bone fractures was purely based on intuition, intramedullary nailing evolved from allowing alignment and translational control through press-fit fixation to current clinical widespread acceptance marked by the mechanical linkage between nail and bone with interlocking screws that allow alignment, translation, rotation, and length control. In an attempt to achieve an optimum interfragmentary mechanical environment, recent improvements considered the impact of different biomaterials on bone-implant stiffness. Another strategy considered the increase in the structural stability through the reduction of the number of movements between the different components that constitute the bone-implant system. Intramedullary nail improvements will most likely benefit from merging mechanics and fracture-healing biology by combining surface engineering with sensor tools associated with the innovative progress in wireless technology and with bone-healing biological active agents. Future research should aim at better understanding the ideal mechanobiological environment for each stage of fracture healing in order to allow for intramedullary nail design that satisfies such requirements.

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Section: The Evolutionary Biomechanical Landmarksmentioning

confidence: 99%

Section: The Evolutionary Biomechanical Landmarksmentioning

confidence: 99%

Section: Current Biomechanical Nail Improvements and Upgradesmentioning

confidence: 99%

Section: Current Biomechanical Nail Improvements and Upgradesmentioning

confidence: 99%

Section: Reduced Screw‐to‐nail Compliancementioning

confidence: 99%

See 3 more Smart Citations

Recent developments on intramedullary nailing: a biomechanical perspective

Rosa

Marta

Vaz

et al. 2017

Annals of the New York Academy of Sciences

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Multi‐Axis Fatigue Experimentation System of Intramedullary Implants for Femur and Tibia

Kanerva

Pärnänen

Jokinen

et al. 2019

Journal Orthopaedic Research

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Current designs of leg-lengthening implants have faced serious failures due to inadequacies in the mechanical design. The failure typically is the result of fatigue induced by a combined loading condition with axial and shear components acting in the tubular body of the implant. One of the reasons leading to the failure is improper verification testing for the design of the fatigue limit. The current test standards for pre-clinical design phases of nail implants are relatively straightforward and widely accepted yet cannot produce the three-dimensional stress state representative of the anticipated operation in a patient during the consolidation phase. This work introduces a major improvement toward a method for verifying fatigue life of tubular as well as solid implants under combined torque, axial load, and bending. The report describes a new loading fixture, a calibration method, and compares the qualification results of finite element simulation analyses and experimental measurements during cyclic loading tests. The findings state that the fixture produces controlled multi-axial loadings to study varied osteotomy locations, quasi-static strength and fatigue of intramedullary implants at an intermediate, 2 Hz, cycle rate.

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