title: A new angle stable nailing concept for the treatment of distal tibia fractures.
abstract: OBJECTIVE
  Surgical treatment of distal tibial fractures demands a stable fracture fixation while minimizing the irritation to the soft tissues by approach and implant. Biomechanical studies have demonstrated superior performance for angular-stable locked nails over standard locked nails in distal tibial fractures. The experimental Retrograde Tibial Nail (RTN) is a minimally invasive local intramedullary osteosynthesis, which has been under design by our group. We conducted a biomechanical comparison in composite tibiae of the Retrograde Tibial Nail against the Expert Tibial Nail (Synthes®). Our hypothesis was that the RTN would provide equivalent biomechanical stability with respect to extra-axial compression, torsion and load to failure testing, in an extra-articular distal tibia fracture model.
  
  
  METHODS
  Biomechanical composite bone testing was conducted in 14 biomechanical composite tibiae in an AO 43 A3 fracture model. In both groups, triple angle stable interlocking was performed in the distal fragment.
  
  
  RESULTS
  Results show a statistically non-significant higher stability of the ETN during the axial loading tests. Torsional stability testing resulted in a statistically superior performance for the RTN (p = 0.018). Destructive extra-axial compression resulted in failure of six ETN constructs, while all RTN specimens survived the maximal load.
  
  
  CONCLUSIONS
  The experimental Retrograde Tibial Nail provides the key features for the treatment of distal tibial fractures. It combines a minimally invasive local intramedullary osteosynthesis with the ability to securely fix the fracture by multiple angle stable locking options.
authors.affiliation: Department of Orthopaedics and Traumatology, University Medical Centre of the Johannes Gutenberg University, Langenbeckstrasse 1, 55131, Mainz, Germany, sebastian.kuhn@unimedizin-mainz.de.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Kuhn
authors.forename: Philipp
authors.initials: P
authors.lastname: Appelmann
authors.forename: Philip
authors.initials: P
authors.lastname: Pairon
authors.forename: Dorothea
authors.initials: D
authors.lastname: Mehler
authors.forename: Frank
authors.initials: F
authors.lastname: Hartmann
authors.forename: Pol M
authors.initials: PM
authors.lastname: Rommens
mesh_terms: D064386:Ankle Fractures / Q000503:physiopathology / Q000601:surgery*; D001696:Biomechanical Phenomena; D001858:Bone Nails; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D008953:Models, Anatomic; D011474:Prosthesis Design; D013978:Tibial Fractures / Q000503:physiopathology / Q000601:surgery*