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Open Access Research article

Long-term stability of angle-stable versus conventional locked intramedullary nails in distal tibia fractures

Dirk Wähnert12*, Yves Stolarczyk1, Konrad L Hoffmeier1, Michael J Raschke2, Gunther O Hofmann13 and Thomas Mückley1

Author affiliations

1 Department of Trauma-, Hand- and Reconstructive Surgery, Friedrich Schiller University Jena, Erlanger Allee 101, Jena, 07747, Germany

2 Department of Trauma-, Hand- and Reconstructive Surgery, University Hospital Münster, Waldeyerstr. 1, Münster, 48149, Germany

3 BG-Kliniken Bergmannstrost Halle, Department of Trauma- and Reconstructive Surgery, Merseburger Str. 165, Halle, 06112, Germany

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Citation and License

BMC Musculoskeletal Disorders 2013, 14:66  doi:10.1186/1471-2474-14-66

Published: 20 February 2013

Abstract

Background

In the last years intramedullary nailing has become the treatment of choice for most displaced diaphyseal tibia fractures. In contrast intramedullary nailing of distal tibia fractures is accompanied by problems like decreased biomechanical stability. Nevertheless the indications for intramedullary nailing have been extended to include even more distal fractures. The purpose of this study was to compare long-term mechanical characteristics of angle-stable versus conventional locked intramedullary nails in the treatment of unstable distal tibia fractures. Therefore, the effect of time on the mechanical properties of biodegradable sleeves was assessed.

Methods

8 pairs of fresh, frozen porcine tibiae were used. The expert tibial nail (Synthes) was equipped with either three conventional locking screws (CL) or the angle-stable locking system (AS), consisting of a special ASLS screw and a biodegradable sleeve. Biomechanical testing included torsional and axial loading at different time-points over 12 weeks.

Results

The AS group showed a significantly higher torsional stiffness at all time-points (at least 60%) compared to the CL group (p < 0.001). The neutral zone was at least 5 times higher in the CL group (p < 0.001). The mean axial stiffness was maximum 10% higher (week 6) in the angle-stable locked group compared to the conventional group. There was no significant change of the torsional mechanical characteristics over the 12 weeks in both groups (p > 0.05). For axial stiffness and range of motion significant differences were found in the AS group.

Conclusions

The angle-stable locking system (ASLS) with the biodegradable sleeve provides significantly higher long-term stability. Especially the differences determined under torsional loading in this study may have clinical relevance. The ASLS permits the potential to decrease complications like secondary loss of reduction and mal-/non-union.

Keywords:
Distal tibia fractures; Angular stability; Intramedullary nailing; ASLS; Biomechanics; Long-term