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Mechanical boundary conditions of fracture healing: borderline indications in the treatment of unreamed tibial nailing

Mechanical boundary conditions of fracture healing: borderline indications in the treatment of unreamed tibial nailing
Mechanical boundary conditions of fracture healing: borderline indications in the treatment of unreamed tibial nailing
Unreamed nailing favors biology at the expense of the achievable mechanical stability. It is therefore of interest to define the limits of the clinical indications for this method. The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. The goals of this work were to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, to identify the mechanical reasons for the unfavorable clinical results, and to identify borderline indications due to biomechanical factors. In a three-dimensional finite element model of a human tibia, horizontal defects were stabilized by means of unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. The loading of the bone, the loading of the implant and the inter-fragmentary strains were computed. The findings of this study show that with all muscle and joint contact forces included, nailing leads to considerable unloading of the interlocked bone segments. Unreamed nailing of the distal defect results in an extremely low axial and high shear strain between the fragments. The results suggest that mechanical conditions are advantageous to unreamed nailing of proximal and mid-diaphyseal defects. Apart from biological reasons, clinical problems reported for distal fractures may be due to the less favorable mechanical conditions in unreamed nailing. From a biomechanical perspective, the treatment of distal tibial shaft fractures by means of unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.
biomechanics, bone, nails, compressive strength, fracture fixation, intramedullary, fracture healing, fracture physiology, gait, physiology, human, models, anatomic models, biological, tibial fractures, tibial pathology, tibil physiopathology, tibial surgery
0021-9290
639-650
Duda, G.N.
32d09622-34ad-49dd-8314-3f61c99a764e
Mandruzzato, F.
dd56b0a0-989f-4fd7-ada9-6c938560dc4d
Heller, M.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Goldhahn, J.
5979a675-5356-4498-a53f-2338be1d6f62
Moser, R.
35915dec-338b-4a2c-ad9c-57b488b91a1c
Hehli, M.
f0db3cdf-bd5e-4619-9283-88be05c09418
Claes, L.
0d49608f-bb00-4db4-8ad1-458bf9f59550
Haas, N.P.
2eb6acab-3bde-4c16-8e57-6be990ad420f
Duda, G.N.
32d09622-34ad-49dd-8314-3f61c99a764e
Mandruzzato, F.
dd56b0a0-989f-4fd7-ada9-6c938560dc4d
Heller, M.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Goldhahn, J.
5979a675-5356-4498-a53f-2338be1d6f62
Moser, R.
35915dec-338b-4a2c-ad9c-57b488b91a1c
Hehli, M.
f0db3cdf-bd5e-4619-9283-88be05c09418
Claes, L.
0d49608f-bb00-4db4-8ad1-458bf9f59550
Haas, N.P.
2eb6acab-3bde-4c16-8e57-6be990ad420f

Duda, G.N., Mandruzzato, F., Heller, M., Goldhahn, J., Moser, R., Hehli, M., Claes, L. and Haas, N.P. (2001) Mechanical boundary conditions of fracture healing: borderline indications in the treatment of unreamed tibial nailing. Journal of Biomechanics, 34 (5), 639-650. (PMID:11311705)

Record type: Article

Abstract

Unreamed nailing favors biology at the expense of the achievable mechanical stability. It is therefore of interest to define the limits of the clinical indications for this method. The extended usage of unreamed tibial nailing resulted in reports of an increased rate of complications, especially for the distal portion of the tibia. The goals of this work were to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, to identify the mechanical reasons for the unfavorable clinical results, and to identify borderline indications due to biomechanical factors. In a three-dimensional finite element model of a human tibia, horizontal defects were stabilized by means of unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. The loading of the bone, the loading of the implant and the inter-fragmentary strains were computed. The findings of this study show that with all muscle and joint contact forces included, nailing leads to considerable unloading of the interlocked bone segments. Unreamed nailing of the distal defect results in an extremely low axial and high shear strain between the fragments. The results suggest that mechanical conditions are advantageous to unreamed nailing of proximal and mid-diaphyseal defects. Apart from biological reasons, clinical problems reported for distal fractures may be due to the less favorable mechanical conditions in unreamed nailing. From a biomechanical perspective, the treatment of distal tibial shaft fractures by means of unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.

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More information

Published date: May 2001
Keywords: biomechanics, bone, nails, compressive strength, fracture fixation, intramedullary, fracture healing, fracture physiology, gait, physiology, human, models, anatomic models, biological, tibial fractures, tibial pathology, tibil physiopathology, tibial surgery
Organisations: Bioengineering Group

Identifiers

Local EPrints ID: 348486
URI: http://eprints.soton.ac.uk/id/eprint/348486
ISSN: 0021-9290
PURE UUID: 9abed20c-92e7-4fe0-a905-070ebea88f05
ORCID for M. Heller: ORCID iD orcid.org/0000-0002-7879-1135

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Date deposited: 26 Feb 2013 10:20
Last modified: 23 Jul 2022 02:05

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Contributors

Author: G.N. Duda
Author: F. Mandruzzato
Author: M. Heller ORCID iD
Author: J. Goldhahn
Author: R. Moser
Author: M. Hehli
Author: L. Claes
Author: N.P. Haas

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