The Retrograde Tibial Nail: Presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures

Kühn, Sebastian; Appelmann, Philipp; Pairon, Philip; Mehler, Dorothea; Rommens, Pol Maria

doi:10.1016/j.injury.2013.10.025

Cited by 25 publications

(17 citation statements)

References 43 publications

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“…Destructive extra-axial compression resulted in failure of all MDTP constructs, while all RTN samples withstood the load-to failure test up to the maximal force applicable by the testing machine. This supports already published results where favorable biomechanical properties of the RTN were shown for torsion and load-to-failure test in comparison to antegrade nails [16,17]. In distal defect fractures, plates have an even low rigidity against axial compression, which are results of their geometry and excentric position [30].…”

Section: Discussionsupporting

confidence: 87%

“…Given an adequate implant, a closed surgical approach by retrograde tibial nailing seems an attractive option since it could offer stable fracture fixation with minimal additional soft-tissue injury and sparing of the knee. The retrograde tibial nail (RTN) is an experimental intramedullary implant which has demonstrated favorable biomechanical properties in comparison to antegrade nailing [16,17]. …”

Section: Introductionmentioning

confidence: 99%

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Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

et al. 2014

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BackgroundCurrently, antegrade intramedullary nailing and minimally invasive plate osteosynthesis (MIPO) represent the main surgical alternatives in distal tibial fractures. However, neither choice is optimal for all bony and soft tissue injuries. The Retrograde Tibial Nail (RTN) is a small-caliber prototype implant, which is introduced through a 2-cm-long incision at the tip of the medial malleolus with stab incisions sufficient for interlocking. During this project, we investigated the feasibility of retrograde tibial nailing in a cadaver model and conducted biomechanical testing.MethodsAnatomical implantations of the RTN were carried out in AO/OTA 43 A1-3 fracture types in three cadaveric lower limbs. Biomechanical testing was conducted in an AO/OTA 43 A3 fracture model for extra-axial compression, torsion, and destructive extra-axial compression. Sixteen composite tibiae were used to compare the RTN against an angle-stable plate osteosynthesis (Medial Distal Tibial Plate, Synthes®). Statistical analysis was performed by Student's t test.ResultsRetrograde intramedullary nailing is feasible in simple fracture types by closed manual reduction and percutaneous reduction forceps, while in highly comminuted fractures, the use of a large distractor can aid the reduction. Biomechanical testing shows a statistically superior stability (p < 0.001) of the RTN during non-destructive axial loading and torsion. Destructive extra-axial compression testing resulted in failure of all plate constructs, while all RTN specimens survived the maximal load of 1,200 N.ConclusionsThe prototype retrograde tibial nail meets the requirements of maximum soft tissue protection by a minimally invasive surgical approach with the ability of secure fracture fixation by multiple locking options. Retrograde tibial nailing with the RTN is a promising concept in the treatment of distal tibia fractures.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

et al. 2014

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“…Additionally, anterior knee pain is a common complaint after antegrade tibial nailing. 8 , 9 , 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

Distal tibial fracture: An ideal indication for external fixation using locking plate

Zhang

Ebraheim

et al. 2016

Chinese Journal of Traumatology

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ObjectiveTo evaluate the feasibility and efficiency of one-stage external fixation by using locking plate in distal tibial fractures.MethodsIn this non-control prospective study, 28 patients with distal tibial fractures were included and underwent one-stage external fixation by using locking plate. There were 21 males and 7 females, with a mean age of 43 years (19–63). According to AO/OTA fracture classification, there were 9 cases of Type A1, 9 of Type A2, 10 of Type A3 fractures. There were 21 close and 7 open fractures. The locking plate was placed on the anteromedial aspect of the tibia with 4–5 bicortical screws inserted in both distal metaphysis and diaphysis. The radiographic and clinic results were evaluated.ResultsAll patients were followed up for the average of 16 months (ranging from 12 to 21 months). The average surgery duration was 38 (25–60) minutes. The mean time to fracture healing were 14.6 ± 2.67, 17.5 ± 3.66, and 18.4 ± 3.37 (p < 0.05) weeks in type A1, A2, and A3 fractures respectively. By the end of the follow-ups, the mean AOFAS score were 96.11 ± 2.32, 92.67 ± 1.80 and 92.00 ± 2.06 (p > 0.05) in type A1, A2, and A3 fractures respectively. None of nonunion, deep infection, or breakage of screw or plate were observed.ConclusionsDistal tibial fracture was the ideal indication for external fixation using locking plate. The external plating is characterized by ease of performance, less invasive, fewer soft tissue impingement, improved cosmesis, and convenient for removal.

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“…The experimental Retrograde Tibial Nail (RTN) is a small caliber intramedullary implant, which can be introduced through a 2-cm long incision at the tip of the medial malleolus [12]. The concept is that of a truly minimally invasive local intramedullary osteosynthesis.…”

Section: Introductionmentioning

confidence: 99%

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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The Retrograde Tibial Nail: Presentation and biomechanical evaluation of a new concept in the treatment of distal tibia fractures

Cited by 25 publications

References 43 publications

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

Retrograde Tibial Nailing: a minimally invasive and biomechanically superior alternative to angle-stable plate osteosynthesis in distal tibia fractures

Distal tibial fracture: An ideal indication for external fixation using locking plate

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

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