title: Biomechanical assessment of composite versus metallic intramedullary nailing system in femoral shaft fractures: A finite element study.
abstract: BACKGROUND
  Intramedullary nails are the primary choice for treating long bone fractures. However, complications following nail surgery including non-union, delayed union, and fracture of the bone or the implant still exist. Reducing nail stiffness while still maintaining sufficient stability seems to be the ideal solution to overcome the abovementioned complications.
  
  
  METHODS
  In this study, a new hybrid concept for nails made of carbon fibers/flax/epoxy was developed in order to reduce stress shielding. The mechanical performance of this new implant in terms of fracture stability and load sharing was assessed using a comprehensive non-linear FE model. This model considers several mechanical factors in nine fracture configurations at immediately post-operative, and in the healed bone stages.
  
  
  RESULTS
  Post-operative results showed that the hybrid composite nail increases the average normal force at the fracture site by 319.23N (P<0.05), and the mean stress in the vicinity of fracture by 2.11MPa (P<0.05) at 45% gait cycle, while only 0.33mm and 0.39mm (P<0.05) increases in the fracture opening and the fragments' shear movement were observed. The healed bone results revealed that implantation of the titanium nail caused 20.2% reduction in bone stiffness, while the composite nail lowered the stiffness by 11.8% as compared to an intact femur.
  
  
  CONCLUSIONS
  Our results suggest that the composite nail can provide a preferred mechanical environment for healing, particularly in transverse shaft fractures. This may help bioengineers better understand the biomechanics of fracture healing, and aid in the design of effective implants.
authors.affiliation: Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada.
authors.forename: Saeid
authors.initials: S
authors.lastname: Samiezadeh
authors.affiliation: Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada.
authors.forename: Pouria
authors.initials: P
authors.lastname: Tavakkoli Avval
authors.affiliation: Department of Aerospace Engineering, Ryerson University, Toronto, ON, Canada.
authors.forename: Zouheir
authors.initials: Z
authors.lastname: Fawaz
authors.affiliation: Department of Mechanical and Industrial Engineering, Ryerson University, Toronto, ON, Canada. Electronic address: habiba.bougherara@ryerson.ca.
authors.forename: Habiba
authors.initials: H
authors.lastname: Bougherara
mesh_terms: D001696:Biomechanical Phenomena; D001858:Bone Nails; D001842:Bone and Bones / Q000601:surgery*; D017076:Computer-Aided Design; D004548:Elasticity; D005264:Femoral Fractures / Q000601:surgery*; D005269:Femur / Q000503:physiopathology / Q000601:surgery; D020342:Finite Element Analysis; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D005684:Gait; D006801:Humans; D016268:Internal Fixators; D011184:Postoperative Period; D011312:Pressure; D033081:Shear Strength; D013314:Stress, Mechanical; D014025:Titanium / Q000737:chemistry*
chemical_list: D014025:Titanium
keywords: Femoral fracture; Finite element method; Hybrid composite; Intramedullary nail; Stress shielding