Does the Extent of Prebending Affect the Stability of Femoral Shaft Fractures Stabilized by Titanium Elastic Nails? A Biomechanical Investigation on an Adolescent Femur Model

Doser, Andreas; Helwig, Peter; Konstantinidis, Lukas; Kuminack, Kerstin; Südkamp, Norbert P.; Strohm, P. C.

doi:10.1097/bpo.0b013e318230aafa

Cited by 8 publications

(4 citation statements)

References 21 publications

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“…However, in other aspects the synthetic bone corresponds to the structural properties of human bone [37]. In addition, we used a small sample size, nevertheless comparable to previous biomechanical studies that have also used similar synthetic bones (Table 1) [5,[12][13][14][15][16][17][18][19][20][21][22][23][24][25]. Furthermore, our study does not report how much load is needed to create a plastic (permanent) deformity of PLN and TEN.…”

Section: Discussionmentioning

confidence: 94%

“…Twenty-four synthetic composite pediatric-sized femur models (fourth generation; Sawbones, Pacific Research Laboratories, Inc., Vashon, WA, USA) were used for mechanical testing. In previous biomechanical studies on femur shaft fractures in children, these pediatric synthetic models have been proven to appropriately represent biomechanical properties of human femurs [5,[12][13][14][15][16][17][18][19][20][21][22][23][24][25].…”

Section: Methodsmentioning

confidence: 99%

“…The biomechanical properties of femur shaft fractures in children have been studied by several investigators, beginning in 2001 with Lee et al (Table 1) [5,[12][13][14][15][16][17][18][19][20][21][22][23][24][25]. These studies cannot be directly compared with each other, however, because they differ regarding the type of implant, fracture, and mechanical test when considering the direction and force applied to the specimen.…”

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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: Discussionmentioning

confidence: 94%

Section: Methodsmentioning

confidence: 99%

mentioning

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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“…As a result, the flexible intramedullary nail was the safest option, with plate fixation if nailing failed. Accounting for the limitation in its mechanical strength when compared to intramedullary nails, we used pre-bending of the nails in our procedure, as this has been shown to increase fracture stability [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Novel Management of a Femoral Fracture in Klippel-Trenaunay Syndrome

Patel

Hussain

Fuad

et al. 2022

Cureus

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Klippel-Trenaunay syndrome (KTS) is a rare congenital disorder with a clinical triad of capillary malformations, vascular abnormalities, and bone/soft tissue hypertrophy. This is the first case of closed femoral shaft fracture in a patient with KTS managed by flexible intramedullary nails.A 34-year-old patient sustained a right femoral mid-shaft spiral fracture after slipping on the grass. Due to a very narrow femur and large venous malformations, nail or plate fixation was impossible. Surgery was conducted using flexible intramedullary (TENS) nails with good reduction but significant bleeding which was controlled with tranexamic acid and CELOX. The patient required 4 units of red blood cells, 3 units of fresh frozen plasma, and 900 mL of cell saver intraoperatively with a further 2 units of RBC post-op. Fracture union was achieved 14 months after the initial fracture with additional pulsed ultrasound therapy.Bleeding from vascular malformations during surgery makes operative management challenging in KTS patients. Previous studies have reported a variety of management strategies to achieve fracture fixation and union including IM nailing, plate fixation, and external fixators, but encountered significant bleeding of up to 10 units and 15 units, respectively. Ultrasound therapy has been utilized as a useful adjunct in lower limb fracture with delayed therapy. Management of fractures in patients affected by KTS is extremely challenging despite extensive workup and planning to evaluate the optimal fixation method and explore strategies to reduce the risk of intra-operative bleeding. Management strategies should be tailored to the patient with close follow-up to assess fracture union.

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