Interlocking screw configuration influences distal tibial fracture stability in torsional loading after intramedullary n
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ORIGINAL ARTICLE
Interlocking screw configuration influences distal tibial fracture stability in torsional loading after intramedullary nailing David W. Lowenberg1 · Malcolm R. DeBaun1 · Anthony Behn1 · Alex Sox‑Harris1 Received: 16 January 2020 / Accepted: 24 April 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose This study evaluated the influence of fracture obliquity and locking screw configuration on interfragmentary motion during torsional loading of distal metaphyseal tibial fractures fixed by intramedullary (IM) nailing. Methods The stability of six IM nail locking screw configurations used to fix distal metaphyseal tibial fractures of various obliquities was evaluated. A coronal osteotomy from proximal lateral to distal medial was made in sawbone tibiae at different obliquities from 0° to 60°. After fixation, motion at the fracture was assessed during internal and external rotation tests to 7 Nm under two compressive loading conditions: 20 N and 500 N. Results With results organized by interlocking configuration, significant differences in interfragmentary rotation between fracture obliquities are observed when the number of interlocking screws is decreased to one distal static and one proximal dynamic during internal rotation. During external rotation testing, significant rotational differences between fracture obliquities are encountered with two distal static screws and one proximal dynamic. No significant differences were seen between different distal interlocking screw orientations (two parallel versus perpendicular distal screws) for all fracture obliquity patterns tested. Conclusion Fracture obliquity influences rotational stability which can be mitigated by interlocking screw configurations when nailing distal tibia fractures. At least two distal and one proximal interlocking screw in a static mode is recommended to resist torsional loading of distal tibia fractures undergoing intramedullary nailing. The addition of more interlocking screws than this did not significantly alter control of torsional displacement with load. Keywords Distal metaphyseal tibial fracture · Intramedullary nail · Distal interlocking screw · Fracture obliquity · Screw configuration · Torsional loading
Introduction Displaced diaphyseal tibial fractures are often best fixed with intramedullary nailing (IMN) [1–7]. Metaphyseal fractures of the distal tibia are also amendable to IMN if sufficient distal bone stock is available for interlocking screw fixation [8–11]. However, fractures in the distal metaphyseal tibia managed with IM nail fixation can provide less Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00590-020-02686-3) contains supplementary material, which is available to authorized users. * David W. Lowenberg [email protected] 1
Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street, Pavilion A, Redwood City, CA 94063, USA
stability as a result of the distal tibia morphology give
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