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

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Abstract

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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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany

    Sebastian Kuhn, Philipp Appelmann, Philip Pairon, Dorothea Mehler, Frank Hartmann & Pol M. Rommens

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  1. Sebastian Kuhn
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  2. Philipp Appelmann
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  3. Philip Pairon
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  4. Dorothea Mehler
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  5. Frank Hartmann
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  6. Pol M. Rommens
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Correspondence to Sebastian Kuhn.

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Kuhn, S., Appelmann, P., Pairon, P. et al. A new angle stable nailing concept for the treatment of distal tibia fractures. International Orthopaedics (SICOT) 38, 1255–1260 (2014). https://doi.org/10.1007/s00264-013-2267-9

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  • DOI: https://doi.org/10.1007/s00264-013-2267-9

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