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Mechanische grenzindikationen der unaufgebohrten marknagelung

Mechanische grenzindikationen der unaufgebohrten marknagelung
Mechanische grenzindikationen der unaufgebohrten marknagelung
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 goal was to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, and to identify borderline indications due to biomechanical factors. In finite element analyses of a human tibia, horizontal defects were modeled using unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. 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. 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 with unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.
biomechanics, bone, nails, comparative study, female, follow-up studies, fracture fixation, intramedullary, methods, human, middle aged, models, theoretical, tibia surgery, tibial fractures, tibial radiography, tibial surgery, time factors, tomography, x-ray, computed
0177-5537
683-689
Duda, G.N.
32d09622-34ad-49dd-8314-3f61c99a764e
Mandruzzato, F.
dd56b0a0-989f-4fd7-ada9-6c938560dc4d
Heller, M.
3da19d2a-f34d-4ff1-8a34-9b5a7e695829
Schütz, M.
0de20e54-ecd2-42d7-9c38-8dc6de33257c
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
Schütz, M.
0de20e54-ecd2-42d7-9c38-8dc6de33257c
Claes, L.
0d49608f-bb00-4db4-8ad1-458bf9f59550
Haas, N.P.
2eb6acab-3bde-4c16-8e57-6be990ad420f

Duda, G.N., Mandruzzato, F., Heller, M., Schütz, M., Claes, L. and Haas, N.P. (2003) Mechanische grenzindikationen der unaufgebohrten marknagelung. Unfallchirurg, 106 (8), 683-689. (doi:10.1007/s00113-003-0633-6).

Record type: Article

Abstract

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 goal was to gain a thorough understanding of the load-sharing mechanism between unreamed nail and bone in a fractured tibia, and to identify borderline indications due to biomechanical factors. In finite element analyses of a human tibia, horizontal defects were modeled using unreamed nailing for five different fracture locations, including proximal and distal borderline indications for this treatment method. 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. 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 with unreamed nailing without additional fragment contact or without stabilizing the fibula should be carefully reconsidered.

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More information

Published date: August 2003
Keywords: biomechanics, bone, nails, comparative study, female, follow-up studies, fracture fixation, intramedullary, methods, human, middle aged, models, theoretical, tibia surgery, tibial fractures, tibial radiography, tibial surgery, time factors, tomography, x-ray, computed
Organisations: Bioengineering Group, Faculty of Engineering and the Environment

Identifiers

Local EPrints ID: 348491
URI: https://eprints.soton.ac.uk/id/eprint/348491
ISSN: 0177-5537
PURE UUID: 89e570d9-819b-4a46-a944-e704a347782b
ORCID for M. Heller: ORCID iD orcid.org/0000-0002-7879-1135

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Date deposited: 26 Feb 2013 10:25
Last modified: 20 Jul 2019 00:41

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Contributors

Author: G.N. Duda
Author: F. Mandruzzato
Author: M. Heller ORCID iD
Author: M. Schütz
Author: L. Claes
Author: N.P. Haas

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