Bending and torsional stiffness in cadaver humeri fixed with a self-locking expandable or interlocking nail system: a mechanical study.
OBJECTIVE
This study was designed to gain data about a new expandable, noninterlocked intramedullary nail's capacity to stabilize unstable transverse humeral shaft fractures without the need for interlocking, thus making nail implantation simpler and to prove our goal hypothesis: that in a midshaft osteotomy of the humeral shaft the expandable humeral nail will show the same bending and torsional stiffness as an interlocked humeral nail, when implanted correctly according to the manufacturer's instructions.


METHODS
Pair randomization.


METHODS
Mechanical laboratory testing.


METHODS
Eight pairs of freshly harvested cadaveric humeri.


METHODS
Fracture model was a midshaft transverse osteotomy, gapped to 3 mm. Each humerus pair received an expandable humeral nail (Fixion) or an interlocked humerus nail (Synthes) through a retrograde approach. The humeri were fixed in polymethylmethacrylate cylinders and tested in a servo-pneumatic material-testing machine.


METHODS
Torsional stiffness and bending stiffness of the nail-bone-construction.


RESULTS
Expandable nails (interlocked nails) showed a lateral bending stiffness of 0.73 +/- 0.14 (0.63 +/- 0.1) KN/mm (P = 0.026) and a frontal bending stiffness of 0.67 +/- 0.18 (0.58 +/- 0.09) KN/mm (P = 0.084). Torsional stiffness values were 0.13 +/- 0.19 (0.43 +/- 0.09 Nm/degrees) (P = 0.012). Lower torsional stiffness in the expandable nail group was observed in humeri with a funnel shaped proximal intramedullary canal.


CONCLUSIONS
The nail systems showed similar characteristics for frontal bending (P = 0.084), but not for lateral bending (P = 0.026). For lateral bending, the Fixion nail showed significantly more stiffness than the UHN nail (P = 0.026). There was significantly lower torsional stiffness with expandable nails compared with interlocked nails. Clinical correlation would suggest that in rotationally unstable fractures (A2 and A3 diaphyseal fractures), interlocked nails would provide increased stability over expandable nails.
Blum
Jochen
J
Clinic and Trauma and Hand Surgery, City Hospitals Worms, Germany. blammainz@t-online.de
Karagül
Göksen
G
Sternstein
Werner
W
Rommens
Pol M
PM
D001696:Biomechanical Phenomena; D002102:Cadaver; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D006811:Humerus; D008297:Male; D014102:Torsion Abnormality