A new angle stable nailing concept for the treatment of distal tibia fractures
- 542 Downloads
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.
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 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.
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.
KeywordsDistal tibia Metaphyseal fractures Intramedullary nailing Retrograde nailing Angle Stable Locking System
Conflict of interest
The authors declare that they have no conflict of interest.
- 6.Gueorguiev B, Wahnert D, Albrecht D, Ockert B, Windolf M, Schwieger K (2010) Effect on dynamic mechanical stability and interfragmentary movement of angle-stable locking of intramedullary nails in unstable distal tibia fractures: a biomechanical study. J Trauma 70(2):358–365. doi: 10.1097/TA.0b013e3181dbaaaf CrossRefGoogle Scholar
- 10.Gueorguiev B, Ockert B, Schwieger K, Wahnert D, Lawson-Smith M, Windolf M, Stoffel K (2011) Angular stability potentially permits fewer locking screws compared with conventional locking in intramedullary nailed distal tibia fractures: a biomechanical study. J Orthop Trauma 25(6):340–346. doi: 10.1097/BOT.0b013e3182163345 PubMedCrossRefGoogle Scholar
- 11.Kaspar K, Schell H, Seebeck P, Thompson MS, Schutz M, Haas NP, Duda GN (2005) Angle stable locking reduces interfragmentary movements and promotes healing after unreamed nailing. Study of a displaced osteotomy model in sheep tibiae. J Bone Joint Surg Am 87(9):2028–2037. doi: 10.2106/JBJS.D.02268 PubMedCrossRefGoogle Scholar
- 13.Hansen M, Mehler D, Hessmann MH, Blum J, Rommens PM (2007) Intramedullary stabilization of extraarticular proximal tibial fractures: a biomechanical comparison of intramedullary and extramedullary implants including a new proximal tibia nail (PTN). J Orthop Trauma 21(10):701–709PubMedCrossRefGoogle Scholar