Computational comparison of tibial diaphyseal fractures fixed with various degrees of prebending of titanium elastic nails and with and without end caps |
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| Affiliation: | 1. Department of BioMedical Engineering, National Cheng Kung University, Tainan City, Taiwan;2. Metal Industries Research & Development Centre, Kaohsiung City, Taiwan;3. Department of Orthopedics, Show-Chwan Memorial Hospital, Changhua City, Taiwan;4. Department of Orthopedics, National Cheng Kung University Hospital, Tainan City, Taiwan;5. Graduate Institute of Mechatronic System Engineering, National University of Tainan, Tainan City, Taiwan;1. Trauma and General Surgeon, Sestre Milosrdnice University Hospital Center, University Hospital for Traumatology, Zagreb, Croatia;2. Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia;3. University Hospital Center Split, Split, Croatia;1. Aachen Institute for Advanced Study in Computational Engineering Science (AICES), RWTH Aachen University, Germany;2. Department of Civil, Environmental, and Geo-Engineering, University of Minnesota, Twin Cities, USA;3. Carleton College, Northfield/Minnesota, USA;4. Chair for Computational Analysis of Technical Systems, RWTH Aachen University, Germany;1. Department of Orthopedic Surgery, Juntendo University Urayasu Hospital, Chiba, Japan;2. Department of Mechanical Engineering, Juntendo University Shizuoka Hospital, Shizuoka, Japan;3. Department of Orthopedic Surgery, Juntendo University, Tokyo, Japan |
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| Abstract: | IntroductionElastic stable intramedullary nailing (ESIN) is a treatment strategy for the management of diaphyseal long-bone fractures in adolescents and children, but few studies have investigated the mechanical stability of tibial diaphyseal fractures treated with various degrees of prebending of the elastic nails. Therefore, the aim of this study was to compare the mechanical stability, including the gap deformation and nail dropping, of a tibia fracture with various fracture sites and fixed with various degrees of prebending of the elastic nails by the finite element method. Furthermore, the contribution of end caps to stability was taken into consideration in the simulation.MethodsA tibia model was developed with a transverse fracture at the proximal, middle and distal parts of the diaphysis, and fixed with three degrees of prebending of elastic nails, including those equal to, two times and three times the diameter of the intramedullary canal. The outer diameter of the nail used in the computation was 3.5 mm, and the fractured tibia was fixed with two elastic double C-type nails. Furthermore, the proximal end of each nail was set to free or being tied to the surrounding bone by a constraint equation to simulate with or without using end caps.ResultsThe results indicated that using end caps can prevent the fracture gap from collapsing by stopping the ends of the nails from dropping back in all prebending conditions and fracture patterns, and increasing the prebending of the nails to a degree three times the diameter of the canal reduced the gap shortening and the dropping distance of the nail end in those without using end caps under axial compression and bending. Insufficient prebending of the nails and not using end caps caused the gap to collapse and the nail to drop back at the entry point under loading.ConclusionsUsing end caps or increasing the prebending of the nails to three times the diameter of the canal is suggested to stop the nail from dropping back and thus produce a more stable structure, with less gap deformation, in the management of a simulated tibial diapyhseal fracture by using titanium elastic nails with a double C-shape. |
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| Keywords: | Elastic stable intramedullary nail Finite element (FE) method Tibial diaphyseal fracture End cap Prebending of the nail |
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