Nailing of diaphyseal ulna fractures in adults : biomechanical evaluation of a novel implant in comparison with locked plating
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Abstract
Background: Adult forearm fractures require surgical treatment in most cases. Open reduction and internal fixation
with plate osteosynthesis is the therapy of choice. Intramedullary fixation offers several advantages compared to
plate fixation but is not routinely used. The aim of our study was to compare a newly designed ulna nail with
angular stable plating in a biomechanical testing setup of an ulna shaft fracture with a diaphyseal defect.
Methods: Ten pairs of sawbones with a defect osteotomy of the ulna shaft (OTA 2U2C3) were fixed with an
interlocked nail or locked plate osteosynthesis. The constructs were tested under four-point bending, torsional
loading and axial loading in a servo-pneumatic testing machine to compare the stiffness of both stabilization
methods.
Results: The nail constructs show lower yet sufficient bending stiffness (62.25 ± 6.64 N/mm) compared to the plate
constructs (71.2 ± 5.98 N/mm, p = 0.005). The torsional loading test shows superior stiffness of the plate constructs
(0.24 ± 0.03 Nm/deg vs. 0.1 ± 0.01 Nm/deg; p < 0.001), while the axial loading shows superior stiffness of the nail
constructs (1028.9 ± 402.1 N/mm vs. 343.9 ± 112.6 N/mm; p < 0.001).
Conclusions: Intramedullary nailing of ulna shaft fractures obtains sufficient but lower stability in bending and
torsional loading when compared to rigid angular stable plating and could be an alternative technique to plate
fixation. The lower stability and the closed stabilization technique allow for a rapid periosteal healing, which is not
present in stiffer constructs.
Keywords: Nailing, Ulna shaft, Biomechanical study
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Journal of orthopaedic surgery and research, 15, Biomed Central, London, 2020, https://doi.org/10.1186/s13018-020-01656-z