Biomechanical performance of flexible intramedullary nails with end caps tested in distal segmental defects of pediatric femur models.
BACKGROUND
Unstable distal femoral fractures in children are challenging lesions with restricted surgical options for adequate stabilization. Elastic nails have become popular for treating femoral shaft fractures, yet they are still challenging for using in distal fractures. The aim of this study was to test whether end caps (CAP) inserted into the nail extremity improved the mechanical stabilization of a segmental defect at the distal femoral metaphyseal-diaphyseal junction created in an artificial pediatric bone model.


METHODS
Two 3.5-mm titanium elastic nails (TEN) were introduced intramedullary into pediatric femur models, and a 7.0-mm-thick segmental defect was created at the distal diaphyseal-metaphyseal junction. Nondestructive 4-point bending, axial-bending, and torsion tests were conducted. After this, the end caps were inserted into the external tips of the nails and then screwed into the bone cortex. The mechanical tests were repeated. Stiffness, displacement, and torque were analyzed using the Wilcoxon nonparametric test for paired samples.


RESULTS
In the combined axial-bending tests, the TEN+CAP combination was 8.75% stiffer than nails alone (P<0.01); in torsion tests, the TEN+CAP was 14% stiffer than nails alone (P<0.01). In contrast, the 4-point bending test did not show differences between the methods (P=0.91, stiffness; P=0.51, displacement). Thus, the end caps contributed to an increase in the construct stability for torsion and axial-bending forces but not for 4-point bending forces.


CONCLUSIONS
These findings indicate that end caps fitted to elastic nails may contribute to the stabilization of fractures that our model mimics (small distal fragment, bone comminution, and distal bone fragment loss).


CONCLUSIONS
Type II [therapeutic study: lesser-quality randomized controlled trial (eg, <80% follow-up, no blinding, or improper randomization)].
Laboratory of Bioengineering, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil. jbvolpon@fmrp.usp.br
José Batista
JB
Volpon
Maurício Martins
MM
Perina
Rodrigo
R
Okubo
Daniel Augusto Carvalho
DA
Maranho
D001696:Biomechanical Phenomena; D001858:Bone Nails; D002648:Child; D018483:Diaphyses; D005264:Femoral Fractures / Q000601:surgery*; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D006801:Humans; D008953:Models, Anatomic; D018709:Statistics, Nonparametric; D014025:Titanium; D019415:Torque
D014025:Titanium