Quantitative fit assessment of tibial nail designs using 3D computer modelling

Schmutz, Beat; Rathnayaka, Kanchana; Wullschleger, Martin; Meek, J.; Schuetz, Michael

doi:10.1016/j.injury.2009.10.012

Cited by 21 publications

(14 citation statements)

References 12 publications

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“…Computer graphical methods can be used to provide a quantitative fit assessment of implants or fracture fixation [ 7 , 8 ]. Recently, a comprehensive anatomical modelling study was conducted to establish the anatomical bow of the femur [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Schmutz

Amarathunga

Kmiec³

et al. 2016

J Orthop Surg Res

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BackgroundThe radius of curvature (ROC) misfit of cephalomedullary nails during anterograde nailing can lead to complications such as distal anterior cortical encroachment. This study quantified the anatomical fit of a new nail with 1.0-m ROC (TFN-ADVANCED™ Proximal Femoral Nailing System [TFNA]) compared with a nail with 1.5-m ROC (Gamma3 Long Nail R1.5 [Gamma3]).MethodsWe generated 63 three-dimensional models (48 female, 45 right femur) representing the cortical surfaces of the femora (31 Caucasian, 28 Japanese, and 4 Thai). The mean age of the specimens was 77 years (±8.1), and the mean height was 158.5 cm (±9.6). Utilizing a customized software tool, nail fit was determined from the total surface area of nail protrusion from the inner cortex surface and maximum distance of nail protrusion in the axial plane; the position of the distal nail tip within the canal was also determined.ResultsOverall, TFNA had both a significantly smaller mean total surface area of nail protrusion (915.8 vs. 1181.6 mm2; P < 0.05) and a mean maximum distance of nail protrusion in the axial plane (1.9 vs. 2.1 mm; P = 0.007) when compared with Gamma3. The mean total surface area of nail protrusion was significantly smaller with TFNA versus Gamma3 in both the Caucasian (P = 0.0009) and Asian (Japanese and Thai) samples (P = 0.000002); the mean maximum distance of TFNA protrusion was significantly smaller in Asians (P = 0.04), but not in Caucasians (P = 0.08). Most tip positions for both nail types were anterior, but TFNA had a higher number of center positions than Gamma3 (13 vs. 7) and a shift from the far anterior cortex to the center of the medullary canal (overall and in Caucasians). In Asians, the most prominent position was far anterior for both nails.ConclusionsThe 1.0-m ROC TFNA nail resulted in better fit than the 1.5-m ROC Gamma3 nail. Clinical trials and case studies should be conducted in the future to verify if these findings would also result in clinical improvements.

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Section: Introductionmentioning

confidence: 99%

Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Schmutz

Amarathunga

Kmiec³

et al. 2016

J Orthop Surg Res

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“…9 Although the previous study covers one aspect of validation of nail designs, it does not provide any indication whether the nail design which fits better at the final position is also easier to insert. In addition, the previous method utilising commercial software is not capable of assessing the anatomical fit between nail and bone during insertion.…”

Section: Discussionmentioning

confidence: 98%

“…9 The morphological bone data were obtained by means of CT scans and reconstructed using a commercial software (Amira, FEI, Hillsboro, OR, USA) according to a standard protocol.…”

Section: D Models Of Bonesmentioning

confidence: 99%

“…9 The ETN Proximal bend is a modified version of the original ETN. In order to improve the anatomical fitting of the nail modified ETN (ETN Proximal bend), a new bend has been introduced to the original ETN at the distal tip.…”

Section: D Models Of Nailsmentioning

confidence: 99%

“…Therefore, the anatomical fitting of the nail model to a particular bone was quantified in terms of the total surface area, and the maximum distance (in the axial plane) by which the nail was protruding from the medullary cavity of the virtual model. 9 The sums of protrusions (surface area and maximum distance), calculated at each increment level, were used to assess/ quantify the overall fitting of each design for a particular tibia model. The nail fitting was quantified for the unreamed bones.…”

Section: Quantification Of Nail Fitmentioning

confidence: 99%

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Automated fit quantification of tibial nail designs during the insertion using computer three-dimensional modelling

Amarathunga

Schuetz

Yarlagadda

et al. 2014

Proc Inst Mech Eng H

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Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of the tibia. An optimal nail design should both facilitate insertion and anatomically fit the bone geometry at its final position in order to reduce the risk of stress fractures and malalignments. Due to the nonexistence of suitable commercial software, we developed a software tool for the automated fit assessment of nail designs. Furthermore, we demonstrated that an optimised nail, which fits better at the final position, is also easier to insert. Three-dimensional models of two nail designs and 20 tibiae were used. The fitting was quantified in terms of surface area, maximum distance, sum of surface areas and sum of maximum distances by which the nail was protruding into the cortex. The software was programmed to insert the nail into the bone model and to quantify the fit at defined increment levels. On average, the misfit during the insertion in terms of the four fitting parameters was smaller for the Expert Tibial Nail Proximal bend (476.3 mm(2), 1.5 mm, 2029.8 mm(2), 6.5 mm) than the Expert Tibial Nail (736.7 mm(2), 2.2 mm, 2491.4 mm(2), 8.0 mm). The differences were statistically significant (p ≤ 0.05). The software could be used by nail implant manufacturers for the purpose of implant design validation.

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Secular evolution of femoral morphology from a clinical perspective

et al. 2020

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IntroductionIntramedullary nailing is the surgical method of choice for the treatment of proximal femur or femoral shaft fractures. Implant manufacturers aim to design implants fitting for the broadest possible population segment. As complete morphological data sets of long bones are not widely available, anatomical collections of historical dry bone specimens may represent abundant additional sources of morphological three‐dimensional (3D) data for implant design, provided they are consistent with present populations. This study aims to investigate secular trends and age‐related changes of femoral morphology of the Caucasian population over the past 800 years.Materials and methodsComputer graphical measurements of 3D‐datasets of right and left femora derived from computed tomography (CT) scans, representative of the present Caucasian population, were compared to computer graphical measurements of 3D‐datasets of right and left femora derived from CT scans of specimens from a historical medieval European bone collection.ResultsClinically relevant parameters of historical medieval European femora were found mostly consistent with correlative data of the present Caucasian population. Additionally, for some of the evaluated parameters, particularly anteversion, morphological differences significantly correlated to individual age and sex could be identified, whereas other parameters such as caput‐collum‐diaphyseal angle or radius of anterior femoral bowing were not correlated to individual age or sex.ConclusionThe findings suggest that more recent historical specimen collections may be a convenient and easily accessible source of new 3D morphological data, as well as to complement existing data, to be used by researchers and manufacturers for the development of intramedullary femoral nails.

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Quantitative fit assessment of tibial nail designs using 3D computer modelling

Cited by 21 publications

References 12 publications

Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Automated fit quantification of tibial nail designs during the insertion using computer three-dimensional modelling

Secular evolution of femoral morphology from a clinical perspective

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