Biomechanical Performance of Flexible Intramedullary Nails With End Caps Tested in Distal Segmental Defects of Pediatric Femur Models

Volpon, José Batista; Perina, Mauricio Martins; Okubo, Rodrigo; Maranho, Daniel A

doi:10.1097/bpo.0b013e318259fe31

Cited by 20 publications

(25 citation statements)

References 21 publications

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“…The definition of failure was more than 10.0 mm of shortening during the test, which is in line with the radiological findings after stabilization according to the Flynn score for evaluating shortening after treatment of femur shaft fractures [ 27 ]. Failure was also considered to be more than 20.0° of rotation or angulation during the tests [ 5 ].…”

Section: Methodsmentioning

confidence: 99%

“…However, the technique does not always provide optimal stability, and can result in shortening, angulation, and rotation [ 3 , 4 ]. From biomechanical studies and clinical experience, we have learned that end caps prevent the nails from sliding back through the insertion site, and therefore increase the axial stabilization in femur fractures [ 5 , 6 ]. Another treatment option, beside external fixation and submuscular plating [ 7 , 8 ], is the more recently introduced semi-rigid pediatric locking nail (PLN) [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

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Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model

Flinck

Heideken

Janarv

et al. 2015

Journal of Children's Orthopaedics

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BackgroundThe treatment for length-unstable diaphyseal femur fractures among school-age children is commonly intramedullary elastic nails, with or without end caps. Another possible treatment is the semi-rigid pediatric locking nail (PLN). The purpose of this biomechanical study was to assess the stability of a length-unstable oblique midshaft fracture in a synthetic femur model stabilized with different combinations of intramedullary elastic nails and with a PLN.MethodsTwenty-four femur models with an intramedullary canal diameter of 10.0 mm were used. Three groups with various combinations of titanium elastic nails (TEN) with end caps and one group with a PLN were tested. An oblique midshaft fracture was created, and the models underwent compression, rotation, flexion/extension, and a varus/valgus test, with 50 and 100 % of the forces generated during walking in corresponding planes.ResultsWe present the results [median (range)] from 100 % loading during walking. In axial compression, the PLN was less shortened than the combination with two 4.0-mm TEN [by 4.4 (3.4–5.4) mm vs. 5.2 (4.8–6.6) mm, respectively; p = 0.030]. No difference was found in shortening between the PLN and the four 3.0-mm TEN [by 7.0 (3.3–8.4) mm; p = 0.065]. The two 3.0-mm TEN did not withstand the maximum shortening of 10.0 mm. In external rotation, the PLN rotated 12.0° (7.0–16.4°) while the TEN models displaced more than the maximum of 20.0°. No model withstood a maximal rotation of 20.0° internal rotation. In the four-point bending test, in the coronal and the sagittal plane, all combinations except the two 3.0-mm TEN in extension withstood the maximum angulation of 20.0°.ConclusionsPLN provides the greatest stability in all planes compared to TEN models with end caps, even though the difference from the two 4.0-mm or four 3.0-mm TEN models was small.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model

Flinck

Heideken

Janarv

et al. 2015

Journal of Children's Orthopaedics

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“…Indications were 4 varus deformities and 4 shortenings of the fracture (“telescoping”). In 3 cases these were caused by technical errors during implantation and 5 fractures which could not sufficiently stabilized owing to technical limitations of the method itself [21]. In conclusion, shortening, recurvation and varus seem to be the most important clinical problems associated with ESIN in femoral fractures.…”

Section: Introductionmentioning

confidence: 99%

Modification of elastic stable intramedullary nailing with a 3rd nail in a femoral spiral fracture model – results of biomechanical testing and a prospective clinical study

Kaiser

Stratmann

Zachert

et al. 2014

BMC Musculoskelet Disord

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BackgroundElastic stable intramedullary nailing (ESIN) is the standard treatment for displaced diaphyseal femoral fractures in children. However, high complication rates (10-50%) are reported in complex fractures. This biomechanical study compares the stiffness with a 3rd nail implanted to that in the classical 2C-shaped configuration and presents the application into clinical practice.MethodsFor each of the 3 configurations of ESIN-osteosynthesis with titanium nails eight composite femoral grafts (Sawbones®) with an identical spiral fracture were used: 2C configuration (2C-shaped nails, 2 × 3.5 mm), 3CM configuration (3rd nail from medial) and 3CL configuration (3rd nail from lateral). Each group underwent biomechanical testing in 4-point bending, internal/external rotation and axial compression.Results2C and 3CM configurations showed no significant differences in this spiroid type fracture model. 3CL had a significantly higher stiffness during anterior-posterior bending, internal rotation and 9° compression than 2C, and was stiffer in the lateral-medial direction than 3CM. The 3CL was less stable during p-a bending and external rotation than both the others. As biomechanical testing showed a higher stability for the 3CL configuration in two (a-p corresponding to recurvation and 9° compression to shortening) of three directions associated with the most important clinical problems, we added a 3rd nail in ESIN-osteosynthesis for femoral fractures. 11 boys and 6 girls (2.5-15 years) were treated with modified ESIN of whom 12 were ‘3CL’; due to the individual character of the fractures 4 patients were treated with ‘3CM’ (third nail from medial) and as an exception 1 adolescent with 4 nails and one boy with plate osteosynthesis. No additional stabilizations or re-operations were necessary. All patients achieved full points in the Harris-Score at follow-up; no limb length discrepancy occurred.ConclusionThe 3CL configuration provided a significantly higher stiffness than 2C and 3CM configurations in this biomechanical model. These results were successfully transmitted into clinical practice. All children, treated by 3CL or 3CM according to the individual character of each fracture, needed no additional stabilization and had no Re-Do operations. As a consequence, at our hospital all children with femoral diaphyseal fractures with open physis are treated with this modified ESIN-technique.

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“…Griffet J et al 31 included 86 children in his study and after 2 years of follow-up, he found the superiority of the ESIN technique over other fixation techniques, such as locking compression plate and percutaneous plating, in terms of postoperative complications. Volpon JB et al 32 concluded that the end caps inserted into the nail extremity contributed to an increase in the construct stability for torsion and axial-bending forces but not for 4-point bending forces. In my study 20 cases were treated with titanium elastic nails.…”

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confidence: 99%

Titanium elastic percutaneous nails for pediatric long bone shaft fractures: current concept

Sahu

Ahmed

2017

Bangladesh J Med Sci

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Abstract:Introduction: The objective of this study was to determine the effectiveness and the complications associated with elastic stable intramedullary nailing in long bone fractures in children. Methods: This study was conducted in the Department of Orthopaedic surgery in M. M. Medical College from July 2006 to November 2009. Eighty two patients were recruited from Emergency and out patient department having closed fracture of long bones of upper and lower limbs. All patients were operated under general or spinal anaethesia. All patients were followed for twelve months. Results: All children achieved union in a mean time of 10 weeks (range from 6 -16 weeks) depending on the type of long bone. Full weight bearing was possible in a mean time of 8.8 weeks. Mean duration of hospital stay was 9.8 days. The mean follow-up period was 28 months (17-48 months). Complications were recorded in 5 (6.09%) patients and included: two entry site skin irritations, one protrusion of the wires through the skin and two delayed union. The results were excellent in 97.310% and good in 2.44% patients. Conclusion: We concluded that this technique is advantageous because of early mobilization (early weight bearing), less complication with good results and is economical.

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Biomechanical Performance of Flexible Intramedullary Nails With End Caps Tested in Distal Segmental Defects of Pediatric Femur Models

Abstract: Type II [therapeutic study: lesser-quality randomized controlled trial (eg, <80% follow-up, no blinding, or improper randomization)].

Cited by 20 publications

References 21 publications

Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model

Biomechanical comparison of semi-rigid pediatric locking nail versus titanium elastic nails in a femur fracture model

Modification of elastic stable intramedullary nailing with a 3rd nail in a femoral spiral fracture model – results of biomechanical testing and a prospective clinical study

Titanium elastic percutaneous nails for pediatric long bone shaft fractures: current concept

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