• Simon Thelen, Marcel Betsch, Jan-Peter Grassmann, Vera Spoor, Christian Eichler, Jürgen Koebke, Joachim Windolf, Mohssen Hakimi, and Michael Wild.
• Department of Trauma and Hand Surgery, Heinrich Heine University Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany.
• Arch Orthop Trauma Surg. 2012 Jan 1;132(1):57-63.

IntroductionA tibial nail with fixed-angle locking screws intends to combine the advantages of angular stability and intramedullary stabilization in extraarticular proximal tibial fractures. The goal of this study is to analyze if the angle stable tibial nail (ASN) is biomechanically more stable than an established conventional standard nail (CN).MethodsTwo types of nails were compared on a series of ten matched pairs of human tibiae. After setting a proximal tibial defect fracture, the intramedullary stabilized tibiae were axially loaded starting from 100 N increasing in steps of 100 N after every 200 cycles until failure was reached. Failure was defined as deformation of the fracture gap, fracturing of the bone or the implant.ResultsThe two types of nails showed no significant difference in terms of maximum tolerated load, maximum cycles repeated or axial deformation of the bone-implant construct. The mean load at failure was 1,365 N for the CN and 1,195 N for the ASN. The mean axial deformation for conventional (19 mm) and angle stable nail (21 mm) did not differ significantly. Slightly less nail or screw loosening was noticed with the fixed-angle nail.ConclusionNo significant difference in stability between the two compared implants could be demonstrated. A trend could be shown indicating that the rate of nail loosening in the proximal osteotomized part of the bone was lower for the angle stable nail. This trend, however, could not be substantiated statistically.

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