Abstract
The Distal Tibia Nail (DTN; Mizuho, Japan) has demonstrated higher biomechanical stiffness to locking plates in previous research for A3 distal tibia fractures. It is here investigated as a fixation option for supramalleolar corrective osteotomies (SMOT). Sixteen Sawbones tibiae were implanted with either a DTN (n = 8) or Medial Distal Tibia Plate (MDTP; n = 8) and a SMOT simulated. Two surgical outcome scenarios were envisaged: “best-case” representing an intact lateral cortex, and “worst-case” representing a fractured lateral cortex. All samples were subjected to compressive (350 N, 700 N) and torsional (± 4 Nm, ± 8 Nm) testing. Samples were evaluated using calculated construct stiffness from force–displacement data, interfragmentary movement and Von Mises’ strain distribution. The DTN demonstrated a greater compressive stiffness for the best-case surgical scenario, whereas the MDTP showed higher stiffness (p < 0.05) for the worst-case surgical scenario. In torsional testing, the DTN proved more resistant to torsion in the worst-case surgical setup (p < 0.05) for both ± 4 Nm and ± 8 Nm. The equivalent stiffness of the DTN against the MDTP supports the use of this implant for SMOT fixation and should be considered as a treatment option particularly in patients presenting vascularisation problems where the MDTP is an inappropriate choice.
Highlights
Lower limb malalignment is a frequent post-operative condition due to the operative procedure or malunion; this problem can be related to genetic disposition, as is the case in people with bowed legs as a birth deformity[1]
At 700 N, there was a greater difference between the groups
The present study compared the Distal Tibia Nail (DTN) to the Medial Distal Tibia Plate (MDTP) in compressive and torsional testing for supramalleolar osteotomy fixation. Construct stiffness of both methods is similar for the best-case surgical scenario, indicating that both methods are adequate for supramalleolar corrective osteotomies (SMOT) fixation where an intact osteotomy can be assured
Summary
Lower limb malalignment is a frequent post-operative condition due to the operative procedure or malunion; this problem can be related to genetic disposition, as is the case in people with bowed legs as a birth deformity[1]. In the case of the distal tibia, a SupraMalleolar OsteoTomy (SMOT) is carried out to realign the ankle joint where the tibial pilon meets the superior surface of the talus b one[7,8]. Following this procedure, an implant is used to stabilise the osteotomy; to date the only available implants for this procedure are locking or dynamic compression plates[9]. Plating has been a solid option until now but patients with already compromised soft tissue in the distal tibia are put at risk when using this method[14,15,16]. Based on results from previous s tudies[10,13,14], we hypothesise that the DTN will demonstrate a greater biomechanical stiffness compared to the plate
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