Extending the Indication of Intramedullary Nailing of Tibial Fractures

Kühn, Sebastian; Hansen, Matthias; Rommens, Pol Maria

doi:10.1007/s00068-007-7039-z

Cited by 47 publications

(49 citation statements)

References 78 publications

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“…Angular malunions have been widely reported after intramedullary nailing with older generation nails [17]. Modern nail designs and angular locking options are implant modifications which reduce this risk [18]. The "load to failure" test in our setup resulted in nail breakage in one ETN and in plastic deformation of five other ETN specimens, while all RTNs withstood the maximum force.…”

Section: Discussionmentioning

confidence: 89%

A new angle stable nailing concept for the treatment of distal tibia fractures

Kühn

Appelmann

Pairon

et al. 2014

International Orthopaedics (SICOT)

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Purpose Surgical treatment of distal tibial fractures demands a stable fracture fixation while minimizing the irritation to the soft tissues by approach and implant. Biomechanical studies have demonstrated superior performance for angular-stable locked nails over standard locked nails in distal tibial fractures. The experimental Retrograde Tibial Nail (RTN) is a minimally invasive local intramedullary osteosynthesis, which has been under design by our group. We conducted a biomechanical comparison in composite tibiae of the Retrograde Tibial Nail against the Expert Tibial Nail (Synthes®). Our hypothesis was that the RTN would provide equivalent biomechanical stability with respect to extra-axial compression, torsion and load to failure testing, in an extra-articular distal tibia fracture model. Methods Biomechanical composite bone testing was conducted in 14 biomechanical composite tibiae in an AO 43 A3 fracture model. In both groups, triple angle stable interlocking was performed in the distal fragment. Results Results show a statistically non-significant higher stability of the ETN during the axial loading tests. Torsional stability testing resulted in a statistically superior performance for the RTN (p=0.018).Destructive extra-axial compression resulted in failure of six ETN constructs, while all RTN specimens survived the maximal load. Conclusions The experimental Retrograde Tibial Nail provides the key features for the treatment of distal tibial fractures. It combines a minimally invasive local intramedullary osteosynthesis with the ability to securely fix the fracture by multiple angle stable locking options.

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Section: Discussionmentioning

confidence: 89%

A new angle stable nailing concept for the treatment of distal tibia fractures

Kühn

Appelmann

Pairon

et al. 2014

International Orthopaedics (SICOT)

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“…Following this change in the spectrum of indications, the numbers of complications such as secondary loss of reduction, mal/non-union and delayed union increased [2,4,6,7,13,14]. Various modifications and implant developments have been investigated to exploit the benefits of intramedullary nailing [6,15].…”

Section: Discussionmentioning

confidence: 99%

“…One major disadvantage of this procedure is the considerable soft tissue damage with the increased risk of wound healing problems and infection [2,5,6]. Intramedullary nailing of distal tibia fractures can decrease these risks but is attended by other problems such as decreased biomechanical stability due to the anatomical conditions of the distal tibia [1,7]. Nevertheless the indications of intramedullary nailing have been extended to include even more distal fractures [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Intramedullary nailing of distal tibia fractures can decrease these risks but is attended by other problems such as decreased biomechanical stability due to the anatomical conditions of the distal tibia [1,7]. Nevertheless the indications of intramedullary nailing have been extended to include even more distal fractures [7,8]. To increase mechanical stability a new implant system, the angle-stable locking system (ASLS,Whereby a sleeve is applied over the locking screw.…”

Section: Introductionmentioning

confidence: 99%

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The primary stability of angle-stable versus conventional locked intramedullary nails

Wähnert

Stolarczyk

Hoffmeier

et al. 2011

International Orthopaedics (SICOT)

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Purpose The aim of this study was to compare the initial biomechanical characteristics of the angle-stable locking system for intramedullary nails using the new biodegradable sleeve with conventional locking in the treatment of unstable distal tibial fractures. Methods Eight pairs of fresh, frozen porcine tibiae were used for this study. The expert tibial nail (Synthes) was equipped with either conventional locking screws (CL) or the angle-stable locking system (AS). This system consists of a special ASLS screw with a biodegradable sleeve. For this investigation distal tibias (5.5 cm) were used and the nails were locked with three screws in both groups. Biomechanical testing included non-destructive torsional and axial loading. Results The AS group showed a significantly higher torsional stiffness (70%) compared to the CL group. The range of motion was 0.5 times smaller for the AS constructs. The neutral zone was eight times higher in the CL group (p<0.001). In axial loading the AS group also showed a 10% higher axial stiffness and a 12% lower range of motion (p<0.001). Conclusion The angle-stable locking system (ASLS) using a special screw and sleeve locking for intramedullary nails provides a significantly higher primary stability. The differences determined in this study may have clinical relevance particularly for torsional loads. For the new biodegradable angle-stable sleeve we found a comparable stability to the PEEK-based sleeve system. This system has the potential to decrease complications such as secondary loss of reduction and mal-/non-union.

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“…In these new implants the interlocking bolts can be introduced just below the tibia plateau, enabling the surgeon to treat very proximal tibial fractures with intramedullary nailing. 8 The Expert Tbial Nail System (ETNS) an intramedullary nailing system is indicated for fractures in the tibial shaft as well as for metaphyseal and certain intraarticular fractures of the tibial head and the pilon tibiale. In addition to the standard static and dynamic locking options, the ETNS features multi directional locking options in the distal and proximal part of the nail.…”

Section: Introductionmentioning

confidence: 99%