Evaluating the Stability of the Fractured Bone Implanted with Titanium Elastic Nails in C and S Configurations

Abdolreza Rastitalab, Salar Khajepour, Javad Dehghani, Ahmad Afsari, Shahin Heidari

Abstract

In this paper, numerical and experimental studies have been performed on titanium intramedullary nails. S-shaped and C-shaped elastic nails have been implanted in sheep bone to compare and evaluate the mechanical axial compressive and flexural strength during loading. The purpose of this analysis is to prevent the deformity of the fracture site (closure of the gap) that may cause leg length discrepancy. A simulation process was performed to investigate the nail's mechanical response inside the bone, and the effects of pre-bending of the nails and using end caps on the bone strength were investigated. An experiment was also performed on a fractured implanted sheep bone for validation. The results showed that S-shaped symmetrical nails caused more stability under compressive and flexural loading in the fractured bone than C-shaped symmetrical nails. Increasing the pre-bending diameter of the nail caused more contact between the medullary canal and the nails, thus increasing stability. Fixing the ends of the nails at the points of entry into the medullary canal was crucial to ensure strength and prevent bone instability. In this simulation, we fixed the end of the tibia in the boundary condition, and then the loading condition was applied.

Keywords: sheep bone fracture, titanium elastic nail, finite element analysis, experimental method, S-configuration, C-configuration.


Full Text:

PDF


References


MAKRIDIS, K., ZOURNTOU, S., and GIANNOUDIS, P. Management of infection after intramedullary nailing of long bone fractures: treatment protocols and outcomes, in Management of Infection after Intramedullary Nailing of Long Bone Fractures: Treatment Protocols and Outcomes. Springer: London, 2018, 160-S161.

ZORINA, Z.A. Animal intelligence: Laboratory experiments and observations in nature. Zoology Journal, 2005, 84(1): 134-148.

BAYOGLU, R., and OKYAR, A.F. Implementation of boundary conditions in modeling the femur are critical for evaluating distal intramedullary nailing. Medical engineering & physics, 2015, 37(11): 1053-1060.

KUBIAK, E.N., EGOL, K.A., SCHER, D., WASSERMAN, B., FELDMAN, D., and KOVAL, K.J. Operative treatment of tibial fractures in children: are elastic stable intramedullary nails an improvement over external fixation? JBJS, 2005, 87(8): 1761-1768.

LIGIER, J., METAIZEAU, J., PRÉVOT, J., and LASCOMBES, P. Elastic stable intramedullary nailing of femoral shaft fractures in children. The Journal of bone and joint surgery. British volume, 1988, 70(1): 74-77.

CHEN, Y.N., LEE, P.Y., CHANG, C.H., CHANG, C.W., HO, Y.H., LI, C.T., and PENG, Y.T. Computational comparison of tibial diaphyseal fractures fixed with various degrees of prebending of titanium elastic nails and with and without end caps. Injury, 2016, 47: 2339–2346.

KAISER, M., ZACHERT, G., WENDLANDT, R., EGGERT, R., STRATMANN, C., GROS, N., SCHULZE-HESSING, M., and RAPP, M. Increasing stability by pre-bending the nails in elastic stable intramedullary nailing: a biomechanical analysis of a synthetic femoral spiral fracture model. The Journal of bone and joint surgery. British volume, 2012, 94(5): 713-718.

PARIKH, S.N., JAIN, V.V., DENNING, J., TAMAI, J., MEHLMAN, C.T., MCCARTHY, J.J., WALL, E.J., and CRAWFORD, A.H. Complications of elastic stable intramedullary nailing in pediatric fracture management: AAOS exhibit selection. JBJS, 2012, 94(24): e184.

FLYNN, J.M., HRESKO, T., REYNOLDS, R.A., BLASIER, R.D., DAVIDSON, R., and KASSER, J. Titanium elastic nails for pediatric femur fractures: a multicenter study of early results with analysis of complications. Journal of Pediatric Orthopaedics, 2001, 21(1): 4-8.

NARAYANAN, U.G., HYMAN, J.E., WAINWRIGHT, A.M., RANG, M., and ALMAN, B.A. Complications of elastic stable intramedullary nail fixation of pediatric femoral fractures and how to avoid them. Journal of pediatric orthopedics, 2004, 24(4): 363-369.

SINK, E.L., GRALLA, J., and REPINE, M. Complications of pediatric femur fractures treated with titanium elastic nails: a comparison of fracture types. Journal of Pediatric Orthopaedics, 2005, 25(5): 577-580.

CHANG, C.-W., CHEN, Y.-N., LI, C.-T., PENG, Y.-T., and CHANG, C.-H. Role of the compression screw in the dynamic hip–screw system: A finite-element study. Medical engineering & physics, 2015, 37(12): 1174-1179.

ANDERSON, R.T., PACACCIO, D.J., YAKACKI, C.M., and CARPENTER, R.D. Finite element analysis of a pseudoelastic compression-generating intramedullary ankle arthrodesis nail. Journal of the mechanical behavior of biomedical materials, 2016, 62: 83-92.

PEREZ, A., MAHAR, A., NEGUS, C., NEWTON, P., and IMPELLUSO, T. A computational evaluation of the effect of intramedullary nail material properties on the stabilization of simulated femoral shaft fractures. Medical engineering & physics, 2008, 30(6): 755-760.

ZANI, B.G., BAIRD, R., STANLEY, J.R., MARKHAM, P.M., WILKE, M., ZEITER, S., BECK, A., NEHRBASS, D., KOPIA, G.A., and EDELMAN, E.R. Evaluation of an intramedullary bone stabilization system using a light‐curable monomer in sheep. Journal of Biomedical Materials Research Part B: Applied Biomaterials, 2016, 104(2): 291-299.

HUTCHINSON, R. Are stainless steel elastic nails the solution to heavier children with femoral shaft fractures? Archives of Trauma Research, 2019, 8(2): 87-92.

CHOUHAN, D., MEENA, S., KAMBOJ, K., MEENA, M.K., NARANG, A. and SINHA, S. Distal locked versus unlocked intramedullary nailing in intertrochanteric fracture; a systematic review and meta-analysis of randomized and non-randomized trials. Bulletin of Emergency & Trauma, 2020, 8(2): 56-61.

WIDBOM-KOLHANEN, S., and HELENIUS, I. Intramedullary Nailing of Paediatric Tibial Fractures: Comparison between Flexible and Rigid Nails. Scandinavian Journal of Surgery, 2020, 1457496920958620.

CHEN, Y., LEE, P., CHANG, C., HO, Y., PENG, Y., CHANG, C., and LI, C. Biomechanical investigation of titanium elastic nail prebending for treating diaphyseal long bone fractures. Australasian Physical & Engineering Sciences in Medicine, 2016, 40: 115-126.

SYNTHES. Titanium Elastic Nail system technique guide. Synthes, 1998, 19(1): 2-20.

HOEGEL, F.W., ABDULAZIM, A.N., BUEHREN, V., and AUGAT, P. Quantification of reaming debris at the fracture gap of diaphyseal A3 femur fractures after reamed intramedullary nailing and using an intramedullary application system. Journal of Trauma and Acute Care Surgery, 2010, 69(6): E98-E101.

MOROZ, L., LAUNAY, F., KOCHER, M., NEWTON, P., FRICK, S., SPONSELLER, P.D., and FLYNN, J. Titanium elastic nailing of fractures of the femur in children: predictors of complications and poor outcome. The Journal of bone and joint surgery. British volume, 2006, 88(10): 1361-1366.

LIN, J., LIN, S.J., CHEN, P.Q., and YANG, S.H. Stress analysis of the distal locking screws for femoral interlocking nailing. Journal of Orthopaedic Research, 2001, 19(1): 57-63.

MAHAR, A., SINK, E., FARO, F., OKA, R., and NEWTON, P.O. Differences in biomechanical stability of femur fracture fixation when using titanium nails of increasing diameter. Journal of children's orthopedics, 2007, 1(3): 211-215.

ASSOBHI, J.E. Reconstruction plate versus minimal invasive retrograde titanium elastic nail fixation for displaced midclavicular fractures. Journal of Orthopaedics and Traumatology, 2011, 12(4): 185-192.

AZAOUZI, M., MAKRADI, A., and BELOUETTAR, S. Deployment of a self-expanding stent inside an artery: a finite element analysis. Materials & Design, 2012, 41: 410-420.


Refbacks

  • There are currently no refbacks.