Is tibial expert nailing biomechanically more stable compared to intramedullary nailing for tibial fractures?

Abstract

Background: Fractures of the tibia and fibula are relatively common and have been recognized as serious and debilitating injuries, because its surface is subcutaneous throughout most of its length, open fractures are more common in the tibia than in any other major long bones. To avoid complications of operative treatment in association with these characteristics of the tibia, intramedullary nailing has been widely introduced for the tibial diaphyseal fractures, and even tibial expert nails have been manufactured and applied for the proximal and distal tibial fractures leading to good outcomes with fewer complications. We conducted a study to compare biomechanical characteristics of two intramedullary nailings by universal tibial nail and tibial expert nail for tibial fractures including proximal, diaphyseal and distal regions. Method: We performed a biomechanical analysis using 3-D geometrical and FEM(Finite Element Method) models of tibial fractures(proximal, diaphyseal and distal) and stabilized by universal tibial nail and tibial expert nail under three types of loads including axial compression, anterior-posterior bending and axial compression). Results: In the proximal and distal tibial fractures, all the loads produced significantly lower stiffness and displacement when fixed by tibial expert nail compared with universal tibial nail, while there was no significant difference in terms of biomechanical properties between the two implants for the diaphyseal fractures. Conclusion: Tibial expert nailing is biomechanically safe in the proximal and distal tibial fractures, however, either universal tibial nailing or tibial expert nailing is possible for tibial diaphyseal fractures.