Abstract
BackgroundAdult forearm fractures require surgical treatment in most cases. Open reduction and internal fixation with plate osteosynthesis is the therapy of choice. Intramedullary fixation offers several advantages compared to plate fixation but is not routinely used. The aim of our study was to compare a newly designed ulna nail with angular stable plating in a biomechanical testing setup of an ulna shaft fracture with a diaphyseal defect.MethodsTen pairs of sawbones with a defect osteotomy of the ulna shaft (OTA 2U2C3) were fixed with an interlocked nail or locked plate osteosynthesis. The constructs were tested under four-point bending, torsional loading and axial loading in a servo-pneumatic testing machine to compare the stiffness of both stabilization methods.ResultsThe nail constructs show lower yet sufficient bending stiffness (62.25 ± 6.64 N/mm) compared to the plate constructs (71.2 ± 5.98 N/mm, p = 0.005). The torsional loading test shows superior stiffness of the plate constructs (0.24 ± 0.03 Nm/deg vs. 0.1 ± 0.01 Nm/deg; p < 0.001), while the axial loading shows superior stiffness of the nail constructs (1028.9 ± 402.1 N/mm vs. 343.9 ± 112.6 N/mm; p < 0.001).ConclusionsIntramedullary nailing of ulna shaft fractures obtains sufficient but lower stability in bending and torsional loading when compared to rigid angular stable plating and could be an alternative technique to plate fixation. The lower stability and the closed stabilization technique allow for a rapid periosteal healing, which is not present in stiffer constructs.
Highlights
In adult diaphyseal forearm fractures, precise restoration of the anatomy is crucial to achieve bony union and good functional results
Several surgical methods have been described for their treatment including plate-screw osteosynthesis and intramedullary nailing [2]
Comminuted or segmental forearm fractures increase the risk for infection and non-union when treated with open reduction and plate osteosynthesis
Summary
In adult diaphyseal forearm fractures, precise restoration of the anatomy is crucial to achieve bony union and good functional results. Several surgical methods have been described for their treatment including plate-screw osteosynthesis and intramedullary nailing [2]. Intramedullary fixation is less often used in adult forearm fractures, they offer several advantages compared to plate fixation as less periosteal stripping, preservation of the fracture hematoma, and biomechanical advantages of a central load-bearing implant [1, 4,5,6]. This could be explained with a challenging implantation process with difficulties in restoration of forearm geometry. The aim of our study was to compare a newly designed ulna nail with angular stable plating in a biomechanical testing setup of an ulna shaft fracture with a diaphyseal defect
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