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Angle Stable Locking Reduces Interfragmentary Movements and Promotes Healing After Unreamed NailingStudy of a Displaced Osteotomy Model in Sheep Tibiae
K. Kaspar, MD1; H. Schell, DVM1; P. Seebeck, DVM1; M.S. Thompson, PhD1; M. Schütz, MD1; N.P. Haas, MD1; G.N. Duda, PhD1
1 Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Free and Humboldt-University of Berlin, Augustenburger Platz 1, D-13 353 Berlin, Germany. E-mail address for G.N. Duda: georg.duda@charite.de
View Disclosures and Other Information
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the AO Foundation, Davos, Switzerland, and the German Research Foundation (DFG KFG 102/1). None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at the Center for Musculoskeletal Surgery, Charité-Universitaetsmedizin Berlin, Free and Humboldt-University of Berlin, Berlin, Germany

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2005 Sep 01;87(9):2028-2037. doi: 10.2106/JBJS.D.02268
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Background: Large interfragmentary movements may delay bone-healing. The hypothesis of the present study was that a reduction of interfragmentary movements, especially of torsional rotation and bending angles, would support the healing process and lead to improved healing following unreamed tibial nailing. The objective of this study was to investigate healing of an unstable tibial osteotomy site following stabilization with unreamed nailing with a modified tibial device that had angle stable holes for the locking bolts. We compared those findings with healing after stabilization of such sites with standard unreamed tibial nailing. The duration of the study period was nine weeks.

Methods: The site of a standardized displaced osteotomy (3-mm gap) in twelve ovine tibiae was stabilized with unreamed tibial nailing: six animals were treated with a modified nail that had angle stable holes for the locking bolts, and six were treated with standard unreamed tibial nailing. In vivo gait analysis with optical measurements of interfragmentary movements and simultaneous measurements of ground reaction parameters were performed three days after the operation and once weekly afterward. After the animals were killed at nine weeks, the treated and contralateral tibiae were explanted, the implants were removed, and radiographs were made and evaluated for bridged cortices. Each pair of tibiae was also mechanically tested until torsional failure, after which the whole callus region was subjected to histological and histomorphometric analysis.

Results: Throughout the examination period, the interfragmentary movements in all directions were significantly smaller in the group treated with the angle stable tibial nail than they were in the group treated with standard unreamed tibial nailing. The limbs treated with the angle stable tibial nails returned to almost full weight-bearing during the period of the investigation, whereas those treated with standard nailing did not. Histomorphometric analysis, radiographic data, and mechanical testing showed superior bone-healing following treatment with the angle stable tibial nail.

Conclusions: Use of an angle stable tibial nail may help to reduce interfragmentary movements in vivo and thus lead to superior bone-healing compared with that following standard unreamed tibial nailing.

Clinical Relevance: The reduction of the interfragmentary movements by unreamed nailing seems to combine the advantages of favorable biological conditions with the mechanical advantages of systems with a higher biomechanical stiffness. The general concept of "optimizing" interfragmentary movements by using unreamed nailing with angle stable bolts needs to be confirmed in a prospective randomized clinical investigation.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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