Interlocking Nail Research Articles

Retrograde Intramedullary Interlocking Nailing in Fractures of the Distal Femur: A Review of 20 Cases with an Average Follow-Up of One Year

Objectives: In patients with distal femur fractures, we studied the role of retrograde locked intramedullary nails. Methods: Retrograde locked intramedullary nailing was used to treat the distal femur fractures of 20 patients (15 males, 5 females; mean age 47 years; range 25 to 69 years). Two patients had fracture of the distal femur and shaft. The fractures were classified as A1 (n=12), A2 (n=6), A3 (n=2), by the AO classification. There were two Grade I open fractures and 18 closed fractures. Three fractures were managed with percutaneous technique. At the mean first follow-up time of 18 months (range 15-48 months and mean second follow up at 27 months (range 12 to 68 months), the concluding functional results were assessed by using the modified Hospital for Special Surgery (HSS) knee assessment scale. Results: The average time to achieve union was 24.2 weeks (range 14 to 42 weeks). One patient had a delayed union (44 weeks). Five knees (25%) had normal joint range of motion, ten knees (50%) were having range of motion from 100° to 110°, three knees (15%) were having range of motion of 80°, and two knees (10%) were having range of motion below the 80°. According to the modified HSS knee scale, the results were excellent in eleven cases (55%), good in six (30%), moderate in two (10%), and poor in one case (5%). In two patients (10%), the postoperative radiographic examination revealed varus angulation (10°), healing took place with severe distortion in one subject. None of the patient had any deep infection or wound issues. Conclusion: Retrograde femoral nailing is an effective method for treating distal femoral shaft fractures. The healing rate of femoral shaft fractures fixed with a retrograde nail is the same regardless of fracture location, patient age, gender, or degree of comminution. For good results surgical treatment, post-surgery immediate knee mobilisation and avoiding nail tip prominence in the knee are essential.

Biomechanical evaluation of interlocking nail and locking compression plating for stabilization of ovine critical-sized segmental tibia defects.

Segmental large volume bone loss resulting from fracture or osseous neoplasia is a major challenge to orthopedic surgeons and there is an ongoing quest to identify treatments that optimize healing. To advance treatment, large animal translational models-such as the ovine critical-sized tibia defect model-are instrumental for testing of novel scaffolds for bone regeneration. However, little standardization in the implants utilized for defect stabilization has been determined and current commercially available implants may be inadequate to replicate the strength of the native tibia. We hypothesize that a 10-mm interlocking nail (ILN) would be stiffer in axial, bending, and torsional loading than its 8-mm counterpart and would be stiffer in axial and torsional loading compared to a 4.5-mm broad locking compression plate (LCP). Tibias were harvested from 24 ovine hind limbs from skeletally mature ewes euthanized for reasons unrelated to this study and were randomized to treatment group. An ex vivo comparison of a novel 10-mm angle-stable non-tapered ILN was compared to a commercially available 8-mm angle-stable tapered ILN and a broad LCP in an ovine critical-sized (5-cm) tibia defect model. Axial stiffness, torsional stiffness, and bending stiffness were determined in control intact tibia and tibial constructs in the three treatment groups. Following implantation, radiography was performed in all limbs and tibia length and cortical and medullary cavity diameter were measured. Comparisons between groups were assessed with a one-way analysis of variance. Significance was set at P<0.05. The 10-mm ILN in tibia containing a 5-cm ostectomy gap most closely replicated the structural properties of intact tibia compared with other constructs. The 10-mm ILN had significantly stronger torsional (P<0.001) and bending (P=0.002) stiffness than the 8-mm ILN, and was significantly stronger than the LCP in axial (P=0.04) and torsional (P=0.01) stiffness. A 10-mm ILN used to stabilize an ovine critically-sized tibia defect most closely mimicked the structural properties of the intact tibia when compared to a 8-mm ILN or broad LCP. Further in vivo testing will aid in determining which stabilization method is best suited for testing of novel tissue engineering and bone healing studies.

Evaluation of Radiological and Functional Outcome of Intra-articular Proximal Tibia Plateau Fracture Treated with Plating.

Proximal tibial plateau fractures are one of the major problems in orthopaedic surgery and are associated with high complication rates. Intra-articular proximal tibia plateau fractures represent approximately 1% of fractures in adults. Various modalities of proximal tibial plateau fracture management have been considered, ranging from simple external fixators in impending compartment syndrome to periarticular proximal tibia plates and inter-locking nails with poller screws. Purpose of this study is to determine clinical outcomes of proximal tibial plateau fractures treated with plate. We did this study of proximal tibial plateau fracture according to Schatzker's classification treated with proximal tibial periarticular plates in 53 patients prospectively admitted at the author's institute from June 2018 to May 2020 with follow-up period of 6 months. In our study, the average knee score was 89.30 (ranging from 79 to 93) and functional knee score was 97.92 (ranging from 75 to 100). Fifty-one (51) patients (96.23%) showed excellent results and 2 patients (3.77%) showed good results according to Knee Society Score, which suggest that internal fixation of proximal tibia plateau fracture with plating provides better results. Out of 53 patients, 9 patients had post-operative complications. Average radiological union was seen at 14 weeks. Locking compression plate in proximal tibia plateau fractures act as a good biological fixation provide stable fixation, articular reduction and limb alignment even in difficult fracture situations. Fixation of proximal tibia plateau fractures with plate gives excellent to good knee society score, with satisfactory functional and radiological outcome.

A Comparative Study of Management of Closed & Comminuted Distal TibialFractures with Intramedullary Inter Locking Nail V/S MIPO

A Comparative Study of Management of Closed & Comminuted Distal TibialFractures with Intramedullary Inter Locking Nail V/S MIPO

Prospective Study to Assess the Osteogenic Potential of Cissus Quadrangularis in Tibia Fractures Treated with Intramedullary Interlocking Nailing

Prospective Study to Assess the Osteogenic Potential of Cissus Quadrangularis in Tibia Fractures Treated with Intramedullary Interlocking Nailing

Evaluate the Results of Closed Interlocking Nail Shaft of Femur Vs. Open Interlocking Nail

Objective: The purpose of this research is to evaluate the efficacy of closed versus open interlocking nails in treating femur shaft fractures. Study Design: Retrospective cohort study Place and Duration: This Retrospective cohort study was conducted at MTI Lady Reading Hospital Peshawar and Khyber Teaching Hospital Peshawar in the duration from 1st March, 2022 to 31 August, 2022. Methods: This research involved 108 cases with age 20-72-year had femoral shaft fracture were included. After informed written consent, age, sex, body mass index, and fracture reason were computed. Patients were equally divided in two groups. Group I utilized open interlocking nails, whereas group II used closed. Post-operative radiological and surgical results were evaluated for union, non-union, and delayed union. Calculated infection prevalence for both groups. Flynn's criterion assessed functional results. SPSS 24.0 analyzed all data. Results: In group I operation time was higher as compared to group II with p value &lt;0.004. Closed group union time was 17.3±6.51 weeks compared to open group 27.8±6.20 weeks. Group II had 51 (94.4%) unions, whereas group I had 45 (83.3%). Group I had 12 (22.2%) delayed unions while group II had 5 (9.3%). Closed interlocking nail performed better than open approach with p value &lt;0.03. The closed interlocking group had fewer complications as compared to open approach (p &lt;0.02). Conclusion: This study found that closed interlocking nails for the femur shaft were superior to open interlocking nails in terms of radiographic and functional success. In addition, patients who were given a closed interlocking nail experienced less complications after surgery. Keywords: Surgery, Femur Shaft, Complications, Closed/Open interlocking nail, Functional Outcomes

Extraction of Broken Interlocking Tibial Nails: A Review of Surgical Techniques and Practical Management

Breakage of tibial interlocking nails is a rare complication and is associated with tibial nonunion. The distal part of a broken tibial nail is difficult to extract and can be a real challenge. Preoperative planning is important, as the retrieval techniques of broken implants are not routine operations. There are various techniques and instruments described by different authors with none being uniformly successful. Therefore, surgeons should know as many methods as possible to choose the most suitable one. Minimally invasive retrieval techniques should be favored because of their reduced morbidity, while fenestration extraction methods should be used as the second intention. Cannulated intramedullary nails are more prone to benefitting from minimally invasive retrieval techniques than solid ones. This paper reviews and describes the present techniques used to extract the distal part of broken tibial nails, to serve as a quick guide for surgeons who need it.

A COMPARATIVE STUDY ON FUNCTIONAL OUTCOMES OF NAILING VS. PLATING IN PATIENTS HAVING FRACTURE SHAFT HUMERUS

Introduction: Fractures of shaft humerus are those fractures which lie distal to the surgical neck of the humerus and proximal to the supra-condylar ridge distally. Conservative management of fracture shaft humerus yield in satisfactory results in most of the cases. Dilemma between dynamic compression plating and ante grade intra-medullary nailing occurs when a surgery is indicated. In this study, we aim to p Objectives: resent a comparative analysis of two series of patients operated with dynamic compression plating and ante-grade intra-medullary interlock nailing respectively with focus over their functional outcomes, complications and other important parameters. A total of 32 Methods: patients with fracture shaft humerus were treated surgically. 17 were subjected to plating and 15 were subjected to intramedullary nailing. Functional outcome of patients was recorded using Constant and Murley score along with other parameters such as duration of surgery, intra-operative blood loss, complications, and union time. Treat Results: ment with plates in this comparative study led to a better ROM in the shoulder and fewer complications. Loss of shoulder motion may be expected after humeral shaft osteosynthesis. However, the functional scores and the healing index can be good and excellent with both techniques. In this comparative study, treatment with plates led to a better ROM in the s Conclusion: houlder and fewer complications. However, functional scores and healing rates can be good and excellent with both techniques. A loss of shoulder motion may be expected after humeral shaft osteosynthesis. Prospective studies are necessary with a long-term follow-up to strengthen these ndings.

Comparative prospective study of knee pain in medial pararpatellar and transpatellar entry for interlocking nail fixation of tibia fracture

Objective: To compare two insertion techniques of intramedullary interlocking nails (medial parapatellar versus intrapatellar insertion) in patients with tibial fractures. Methodology: This study was performed at Al-Kindy Teaching Hospital from August 2020 until March 2022. All 32 patients with tibial fractures (29 males and 3 females) were included for tibial closed nail fixation and then followed up for 6 months. We categorized these patients into two groups; Group A (16 patients), those treated by medial parapatellar insertion of an interlocking nail, and Group B (16 patients) with transpatellar tibial nail insertion. All patients were treated by the same surgical team. Results: The range of movement in two weeks (from extension to flexion) was up to 30°. At the end of the follow-up period, all patients in Group A had functional flexion greater than 90°, whereas three patients in Group B had limited flexion that necessitated scheduled physical therapy. Regarding the functional outcome, in group A patients and in group B patients, the mean International Knee Documentation Committee score demonstrated a better outcome in patients with medial parapatellar insertion than those in group B. According to the visual analysis score, the transpatellar insertion demonstrated more discomfort than that in the paramedial insertion group, both clinically and statistically. Conclusion: Medial entry point in intra medullary tibial nailing had less anterior knee pain in post-operative follow up.

Functional outcome of limited contact dynamic compression plating and interlocking nailing for fracture shaft of humerus in adults

ABSTRACT Background: Fractures of shaft of humerus are common, accounting 3% of all fractures. They have historically been managed conservatively with hanging casts or a functional brace. However, a lack of fracture reduction with these conservative measures resulted in malunion. Two surgical techniques under study include intramedullary nailing and limited contact dynamic compression plating. This study aims to analyze the functional outcome between the two surgical techniques. Materials and Methods: In this prospective randomized study, 38 patients were treated surgically for shaft of humerus fracture from August 2016 to August 2018 at a tertiary care center. Twenty patients underwent limited contact dynamic compression plate (LCDCP) plating and 18 underwent intramedullary nailing. All were assessed for radiological union, complications, and functional outcome at 6 weeks, 12 weeks, and 1 year using disabilities of arm, shoulder, and hand (DASH) questionnaire. Results: Thirty-eight patients completed the study of which 18 cases (47.5%) with fractures that were treated with interlocking nail and 20 cases that were treated with LCDCP plating. The mean duration to complete radiological healing was 15.06 weeks. The healing rate was relatively faster in the interlocking group as compared to the LCDCP group (P = 0.144). Complications such as shoulder impingement 8 (44.4%), shoulder pain 3 (16.7%), nonunion 1 (5.6%), and shoulder stiffness 1 (5.6%) were found to be more common in interlocking group as compared to LCDCP group, respectively. Whereas, complications such as superficial infection - 1(5%) and radial nerve deficits - 2(10%) were less common in the interlocking group compared to LCDCP group, respectively. The mean follow-up was 11.556 weeks, and the overall DASH score analysis showed better results in LCDCP group. Conclusion: In our study, LCDCP plating showed lower incidence of complications, particularly periarticular complications around the shoulder joint such as shoulder pain, stiffness, and impingement but carried a higher risk of radial nerve injury. Fracture union rates were found to be almost similar between both groups. DASH score analysis showed better functional outcome among the LCDCP plating group. The overall outcome of LCDCP plating over interlocking nailing was found to be better.

Functional outcome of diaphyseal fractures of humerus in adults treated with closed interlocking nails: A prospective study

Background: Diaphyseal fractures of humerus are common, representing 3% of all fractures and 20% of all humerus fractures. Though compression plate osteosynthesis is the gold standard, interlocking intramedullary nailing is also a reliable option. In this present study we evaluated the functional outcome of diaphyseal fractures of humerus treated with interlocking nails.Materials and Methods: A total of 36 patients with diaphyseal fractures of humerus, selected between October 2020 to May 2021 were managed by closed interlocking nail of humerus. This was a prospective study and all patients were followed up to a minimum of 6 months. The primary outcome measures were functional outcome assessed using DASH Score (The Disabilities of the Arm, Shoulder & Hand Score) & Constant-Murley scoring system respectively. Secondary outcomes were intra-operative conditions such as operative time and blood loss and post-operative complications.Results: The mean time of radiological union was 15.7 weeks ranging from14-26 weeks. All 36 fractures were united including one delayed union which united at 26 weeks. In our series, 4 patients had post-operative shoulder stiffness including one prominent nail, 1 patient developed radial nerve neuropraxia which recovered in 8 weeks. All patients were evaluated on the basis of Constant Murley score for shoulder function and DASH score. In our study of 36 patients 69.4% got excellent results, 19.4% got good results, 8.3% got moderate/fair results and 2.8% got poor results.Conclusion: Interlocking nailing is a relatively quick, minimally invasive, and biomechanically sound, cosmetically better method of internal stabilization of shaft humerus fractures with less union time, less infection and lesser threat to radial nerve and other complications. Besides it allows early mobilization. With correct anatomical knowledge, preoperative planning, good surgical techniques and postoperative rehabilitation interlocking humeral nailing is a viable option in the management of fracture shaft humerus promising excellent outcome.

Functional result of diaphyseal fractures of femur managed by closed Intramedullary interlocking nailing in adults

Introduction: Fractures of shaft of femur are among the most common fracture encountered in orthopedie practice in the road traffic accident.The femur is the largest and strongest bone in the body articulating with hip joint proximally forming knee joint with tibia at its distal end. As industrialization and urbanization are progressing year to year with rapid increase in traffic. Incidence of high energy trauma increasing with same speed. Hence, the aim of the present study was to assess the treatment of unstable diaphyseal fracture femur with femur intramedullary interlocking nailing. Material and methods: The present study was done among 15 patients where boot and bar traction in emergency was given. All routine investigation and surgical fitness were asked for intramedullary nailing was chosen for fracture shaft femur. Results: About 73.3% fractures of the mid shaft femur was present. The patten of fracture was found to be comminuted which was around 33.3%. The oblique pattern was around 26.6% and transverse pattern of fracture was observed to be 40%.The complications included were implant bending and breaking, infection, delayed and nonunion, rotational deformity. Conclusion: Unstable diaphyseal fractures with femur intramedullary interlocking nailing gives excellent result with this system there are minimal complications which help early return of patients to activity and work.

Functional outcome of management of open fractures both bones of leg with primary intramedullary interlocking nailing

Functional outcome of management of open fractures both bones of leg with primary intramedullary interlocking nailing

A study of functional outcome of extra-articular displaced upper 3rd tibia fracture fixation with tibia interlocking nail with use of poller screw

Background: The tibia is the second longest bone of the body, located at medial side of the leg. Among all the fractures in the body, tibia is the single largest bone that is commonly involved in injuries. Owing to the increase in vehicular accidents and industrial mishaps, high velocity trauma produces tibial fractures in increasing numbers. By its location and by being subcutaneous in most of its length tibia fractures tend to be open very commonly. Due to its precarious blood supply and scanty soft tissue coverage orthopedic surgeons around the world have been fighting infections and union problems. Extra-articular upper 3rd tibial fractures account for 5–11% of all tibial shaft fractures. This study was performed to analyze nailing with aid of poller screw for upper 3rd tibia extra-articular fractures.ObjectivesTo analyze the possible benefits of use of poller screw in upper 3rd tibia to prevent malalignment.To study the duration of union in proximal tibia fractures with the use nailing and poller screwTo establish the role of poller screw.To compare the results with published studies in term of hospital stay, mobilization, regaining normal range of movement and complications.Methods: This study was carried out at Department of orthopedics, tertiary care hospital from June 2021- October 2022, inclusive of both. During this period 30 patients were identified with upper 3rd tibia fractures. Functional outcome was assessed using Modified Karlstrom- Olerud score (clinical assessment) & RUST (radiographic union scale for tibial fractures) score.Results: 30 patient of upper 3rd tibia fracture were treated surgically with the use of Tibia Interlocking nail with use of Poller screw and the results were analysed functionally and radiologically. Conclusion: Acquiring and conserving acceptable alignment needs adopting the right entry point, establishing adequate reduction of the fracture whilst reaming and nail insertion, securing appropriate route of reamers, utilizing a poller screw, and picking of suitable supplemental fixation like a plate or external fixation.

Use of poller screw in proximal and distal metaphyseal fractures of tibia treated with intra-medullary inter-locking nail: A prospective study of 25 patients

Introduction: Treatment of tibia metaphyseal fractures is still difficult. Interlocking tibial fractures is preferred because it allows for some load sharing, preserves extraosseous blood flow, avoids major soft tissue dissection, and is well-known by most surgeons. Nailing of metaphyseal fractures with a short proximal or distal fragment is linked to increased malalignment, especially in the coronal plane, non-union, and the necessity for subsequent treatments to accomplish union. Blocking screws (poller screws), temporary unicortical plating, alternative nail designs with variable proximal bends (proximal third fractures), and fibular plating have all been proposed to better nailing metaphyseal fractures (distal third fractures).''The study's goal was to see if poller screws might be used as a supplement to stability in tibia metaphyseal fractures treated with a statically locked intramedullary nail. Materials and Methods: It was a prospective trial in which 25 patients with extraarticular Tibia metaphyseal fractures presented between July 2020 and December 2021 were treated with an Intra-Medullary Inter-Locking nail augmented with Poller screws and observed for six months. Results: The average age was 45.92 years, with a male majority.

Functional outcome of intramedullary interlocking nailing versus minimally invasive percutaneous plate osteosynthesis in distal tibia fracture

Aims: The aim of the study was to compare the functional outcome of patients with extra-articular distal one-third tibia fracture, treated with intramedullary interlocking nailing (IMILN) with those treated by minimally invasive percutaneous plate osteosynthesis (MIPPO). Settings and Design: This is a prospective study and nonprobability sampling technique. Subjects and Methods: In this study, 60 patients with distal third tibia fractures of AO classification Type 43 A1, A2, and A3 were selected, in which 30 of them were treated with IMILN and the remaining 30 were managed with MIPPO. The patients were regularly followed up, and functional outcome was measured at 4, 8, 12, and 24 weeks using a modified Klemm and Borner scoring system. Statistical Analysis Used: The data collected were subjected to data entry in MS Excel. The data were analyzed using SPSS version 20.0 using Chi-square test. Results: In our prospective study, the functional outcome of MIPPO has shown excellent outcome in 13 patients (43.3%) and good outcome in 13 patients (43.3%), fair outcome in three patients (10%), and only one patient had poor outcome (3.3%). However, in the IMILN group, excellent outcome was seen in 7 patients (23.3%) and good outcome in 15 patients (50%), fair in five patients (16.7%), and poor outcome in 3 patients (10%). Alignment of fracture was anatomical in 13 patients of MIPPO and 7 patients of IMILN. Complications such as nonunion and malunion were more in the IMILN group than MIPPO, whereas superficial wound infection and delayed union were comparable in both. Conclusions: Distal tibial fractures can be effectively treated by both intramedullary nailing and MIPPO with minimal soft tissue injury providing good-to-excellent results, whereas in our present study, we observed that MIPPO had excellent functional outcome when compared to IMILN. Although interlocking intramedullary nailing allows early weight-bearing in patients, malunion and nonunion were more frequently seen, which affects the functional outcome. Therefore, we recommend that MIPPO is considered a very effective modality of treatment in distal third tibia fractures.

A study of supra patellar versus infra patellar intramedullary interlocking nailing in tibial diaphyseal fractures

Introduction: Tibial shaft fractures are a common traumatic injury. Traditional infra patellar intra medullary nailing is a popular surgical procedure used in the treatment of tibia shaft fractures. Recently, the supra patellar approach has attracted the attention of orthopedic surgeons, as it seems to offer fewer complications and re-operations. Material and methods: The total of 30 patients with tibial diaphyseal fractures and underwent Intra medullary interlocking nailing, in which 15 with supra patellar approach and 15 patients with infra patellar approach. Results: There was a statistically significant difference in the final outcome in patients undergoing Intra medullary interlocking nailing through Supra Patellar and infrapatellar approach with better functional outcome in the former. Conclusion: we conclude that supra patellar approach had a better clinical outcome compared to Infra patellar approach for tibial diaphyseal fractures with relation to duration of surgery, Intra operative bleeding, Fluoroscopy time, Post-operative anterior knee pain and Knee functional outcome.

Effects of Dynamization on Delayed Union of Tibial Shaft Fractures After Reamed Intramedullary Interlocked Nailing

Objective: To determine the efficacy of dynamization in delayed union of tibia diaphyseal fractures Methodology: A descriptive cross sectional study was done at the Department of Orthopaedic Surgery, Jinnah Postgraduate Medical Center, Karachi, Pakistan, from July 2020 to April 2021. A total of 97 consenting patients who suffered from delayed union following intramedullary interlocking nailing were included in the study. Dynamization involved removal of proximal or distal locking screws in statically locked intramedullary nail. Patients were followed up for six months to check for delayed bone union. All the collected data were entered into a pro forma and used electronically for research purpose. Results: Over all union was achieved in 72 (74.2%) cases after dynamization. The mean age of our study population was 39.42+13.79 years. Advanced age, smoking, fresh or old fracture, the time of initial intramedullary nailing, and diabetes were associated with decreased efficacy of dynamization, with p-value &lt;0.001, 0.033, 0.007, and &lt;0.001 respectively. While no significant association was found between gender, BMI, hypertension, and union (p-value &gt;0.05). Conclusion: The findings of this study support the idea that dynamization can be an effective method to promote healing in tibia diaphyseal fractures for delayed union. More randomized comparative clinical trials are necessary to evaluate the effectiveness of dynamization.

Comparative study of range of motion and anterior knee pain in parapatellar versus trans patellar approach in tibia nailing

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Tibial shaft fractures are common traumatic fractures especially in road traffic accidents. Intramedullary interlocking nailing is considered treatment of choice tibial diaphyseal fractures, minimizing soft tissue injury and permitting early weight bearing and fracture healing. Anterior knee pain and reduced range of motion are some common complications that patients have to face in post-operative period.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;The&lt;strong&gt; &lt;/strong&gt;60 patients of both sex with traumatic diaphyseal tibial shaft fractures were included in this study out of which 30 were operated with interlocking tibia nailing with trans patellar (tendon splitting) approach while 30 were operated with medial parapatellar approach for tibia nail insertion. Range of motion at knee joint (in degrees) and anterior knee pain (on visual analogue scale) was evaluated on post-operative day 1, 2 weeks, 1 month, 3-month post operatively and compared for both groups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Mean anterior knee pain was significantly lower in parapatellar approach group at 2 weeks, 1 month and 3 months while there was no significant difference on post-operative day 1. Mean range of motion at knee joint was more in parapatellar approach group on post-operative day 1 and 2 weeks while there was no significant difference in range of motion after 2 weeks.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;In our study medial parapatellar approach is superior than tendon splitting approach with comparatively greater range of motion and lesser anterior knee pain. Thus, medial parapatellar approach should be encouraged for interlocking tibia nailing.&lt;/p&gt;

Effective Treatment of Femur Diaphyseal Fracture with Compression Plate - A Finite Element and In Vivo Study Comparing the Healing Outcomes of Nailing and Plating.

The rigidity in osteosynthesis causes primary healing, and it takes longer to heal. The flexibility provided to the fixation allows micromotion between fragments which accelerates secondary healing. In this study, the healing outcomes of nailing and plating in different fixation stabilities were investigated and compared by using a finite element tool. The clinical observational study was also performed to verify the results of the finite element analysis. The nonlinear contact analysis was performed on 5 different fixation configurations capturing nail and plate in immediate post-surgery. The finite element analysis results showed that flexibility instead of rigidity in interlock nail implantation increases the axial and shear micromotion near the fracture site by 47.4% (P < 0.05) and 12.4% (P < 0.05), respectively. For LCDCP implantation, the flexible fixation increases the axial and shear micromotion near fracture site by 75.7% (P < 0.05) and 25.3% (P < 0.05), respectively. Our findings suggest that flexible fixations of interlock nail and LCDCP provide a preferred mechanical environment for healing, and hence, the LCDCP in flexible mode can be an effective alternative to interlock nail for the femur diaphyseal fracture. The online version contains supplementary material available at 10.1007/s43465-022-00795-1.