Abstract
Background: Newer generation intramedullary (IM) tibial nails provide several distal interlocking screw options. The objectives were to determine: 1) if the new oblique interlocking option provides superior stability, 2) which screw orientation/ configuration is the most biomechanically stable, and 3) if three distal interlocking screws provide better stability. Methods: A preliminary experiment was performed in torsion, compression, and bending tests with four different screw configurations: (I) one medial-to-lateral and one oblique, (II) two me-dial-to-lateral, (III) one medial-to-lateral and one anterior-to-posterior, and (IV) one medial-to-lateral, one anterior-to-posterior and one oblique in simu-lated distal metaphyseal fracture tibiae. Twenty- four Synthes EXPERT tibial IM nails were used for six specimens of each screw configuration. Parts I and II, tibial IM nails were locked with 5.0 mm in-terlocking screws into simulated distal tibiae (PVC and composite analogue tibia). Part III, the two most stable configurations were tested using five pairs of simulated cadaveric distal tibiae metaphy-seal fractures. Results: Significant differences were attributable to distal screw orientation for intrame- dullary nailing of distal tibia fractures. Configura-tions II and IV were found to be more stable than the other two configurations. No significant differ-ence was detected in construct stability in all modes of testing between Configurations II and IV. Dis-cussion: Configuration I did not provide superior stability for the distal tibia fracture fixation. Con-figurations II and IV provided equivalent stability. When choosing IM fixation for treatment of distal tibia metaphyseal fractures two medial-to-lateral screws provide the necessary stability for satisfac-tory fixation. Clinical Relevance: This study indi-cated an option for operative treatment of distal metaphyseal tibia fracture fixation where preserva-tion of soft tissue and rigid stabilization are needed.
Highlights
The treatment of diaphyseal tibia fractures using intramedullary nailing is widely accepted and has been expanded to distal metaphyseal fractures [1,2,3]
For Part I, when compared in the compressive loading, anterior-posterior bending with low (±10 N) and high (±100 N) applied load, medial-lateral bending with low (±10 N) and high (±100 N) applied load, and rotation torque with low (±0.1 Nm) and high (±7.7 Nm) applied load, significant differences were detected in stability between all four screw configurations
For Part II, significant differences were detected in stability between all four screw configurations, and Figure 7 shows the construct stability properties for the four different screw configurations using composite analogue tibia
Summary
The treatment of diaphyseal tibia fractures using intramedullary nailing is widely accepted and has been expanded to distal metaphyseal fractures [1,2,3]. Newer generation intramedullary (IM) tibial nails provide several distal interlocking screw options. Methods: A preliminary experiment was performed in torsion, compression, and bending tests with four different screw configurations: (I) one medial-tolateral and one oblique, (II) two medial-to-lateral, (III) one medial-to-lateral and one anterior-to-posterior, and (IV) one medial-to-lateral, one anterior-to-posterior and one oblique in simulated distal metaphyseal fracture tibiae. Part III, the two most stable configurations were tested using five pairs of simulated cadaveric distal tibiae metaphyseal fractures. Discussion: Configuration I did not provide superior stability for the distal tibia fracture fixation. When choosing IM fixation for treatment of distal tibia metaphyseal fractures two medial-to-lateral screws provide the necessary stability for satisfactory fixation. Clinical Relevance: This study indicated an option for operative treatment of distal metaphyseal tibia fracture fixation where preservation of soft tissue and rigid stabilization are needed
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