title: Angle stable locking reduces interfragmentary movements and promotes healing after unreamed nailing. Study of a displaced osteotomy model in sheep tibiae.
abstract: BACKGROUND
  Large interfragmentary movements may delay bone-healing. The hypothesis of the present study was that a reduction of interfragmentary movements, especially of torsional rotation and bending angles, would support the healing process and lead to improved healing following unreamed tibial nailing. The objective of this study was to investigate healing of an unstable tibial osteotomy site following stabilization with unreamed nailing with a modified tibial device that had angle stable holes for the locking bolts. We compared those findings with healing after stabilization of such sites with standard unreamed tibial nailing. The duration of the study period was nine weeks.
  
  
  METHODS
  The site of a standardized displaced osteotomy (3-mm gap) in twelve ovine tibiae was stabilized with unreamed tibial nailing: six animals were treated with a modified nail that had angle stable holes for the locking bolts, and six were treated with standard unreamed tibial nailing. In vivo gait analysis with optical measurements of interfragmentary movements and simultaneous measurements of ground reaction parameters were performed three days after the operation and once weekly afterward. After the animals were killed at nine weeks, the treated and contralateral tibiae were explanted, the implants were removed, and radiographs were made and evaluated for bridged cortices. Each pair of tibiae was also mechanically tested until torsional failure, after which the whole callus region was subjected to histological and histomorphometric analysis.
  
  
  RESULTS
  Throughout the examination period, the interfragmentary movements in all directions were significantly smaller in the group treated with the angle stable tibial nail than they were in the group treated with standard unreamed tibial nailing. The limbs treated with the angle stable tibial nails returned to almost full weight-bearing during the period of the investigation, whereas those treated with standard nailing did not. Histomorphometric analysis, radiographic data, and mechanical testing showed superior bone-healing following treatment with the angle stable tibial nail.
  
  
  CONCLUSIONS
  Use of an angle stable tibial nail may help to reduce interfragmentary movements in vivo and thus lead to superior bone-healing compared with that following standard unreamed tibial nailing.
authors.affiliation: Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Free and Humboldt-University of Berlin, Augustenburger Platz 1, D-13 353 Berlin, Germany.
authors.forename: K
authors.initials: K
authors.lastname: Kaspar
authors.forename: H
authors.initials: H
authors.lastname: Schell
authors.forename: P
authors.initials: P
authors.lastname: Seebeck
authors.forename: M S
authors.initials: MS
authors.lastname: Thompson
authors.forename: M
authors.initials: M
authors.lastname: Schütz
authors.forename: N P
authors.initials: NP
authors.lastname: Haas
authors.forename: G N
authors.initials: GN
authors.lastname: Duda
mesh_terms: D000704:Analysis of Variance; D000818:Animals; D001696:Biomechanical Phenomena; D001858:Bone Nails; D002102:Cadaver; D004867:Equipment Design; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D016014:Linear Models; D010027:Osteotomy / Q000379:methods*; D012756:Sheep; D013978:Tibial Fractures / Q000473:pathology / Q000601:surgery*