Interfragmentary Movement in Diaphyseal Tibia Fractures Fixed With Locked Intramedullary Nails

Abstract

Clearance of the implant within the medullary canal, the flexibility of the implant itself, and the compliance of the implant (nail and locking screws) within the bone determine the extent of movement. The implant flexibility and the clearance are strongly dependent on the thickness of the intramedullary nail.

A newly designed intramedullary nail with distal interlocking system for tibia fractures in adults - the clinical results

“…The interfragmentary movements at the fracture site are found to be increased when unreamed nailing is performed. [20] When interfragmentary movement is increased, complications like nonunions, delayed unions or malunions are significantly increased. [9] Attempts have been made for reducing movements and increasing stability at the fracture site following IM nailing.…”

Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing

“…2C and D. No plateaus appear in the bending and shear data because load application was unilateral to preserve four-point bending conditions, protect the fibula, and avoid skewing the stiffness calculations by measuring deflection due to nail-canal clearance (Augat et al, 2008).…”

“…Fibular fractures accompanying distal-third tibial fractures may also be more likely to be addressed by surgical intervention when surgeons exercise discretionary choice (Egol et al, 2006, Whorton andHenley, 1998). However, we selected the midshaft osteotomy model for this study because this model has been used by previous investigators in cadaveric tests (Augat et al, 2008, Penzkofer et al, 2009) and biomechanical stability of these fractures has not been as well-documented. We did not find compelling evidence to support the clinical choice to fix fibular fractures in order to support speedy diaphyseal tibial fracture healing.…”

“…For the bending test, the crosshead load was ramped at 0.25 mm/s to produce a maximum bending moment of 20 N-m with tension on the anterior side of the tibia. Some previous investigators have clamped specimens at all four support points, which allows for bidirectional bending (Augat et al, 2008, Penzkofer et al, 2009). We followed the procedure used for testing composite bones, in which only one clamp and three rollers are used to minimise the geometric constraints and more-closely mimic physiological conditions.…”

“…Following protocols developed by other investigators (Augat et al, 2008, Epari et al, 2007, Kaspar et al, 2005, Penzkofer et al, 2009 and applied by ourselves previously for characterisation of tibial IM nailing stability , Dailey et al, 2013, we carried out testing in axial tension/compression, anteroposterior ( …”