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Angle-Stable and Compressed Angle-Stable Locking for Tibiotalocalcaneal Arthrodesis with Retrograde Intramedullary NailsBiomechanical Evaluation
Thomas Mückley, MD1; Konrad Hoffmeier, Dipl-Ing1; Kajetan Klos, MD1; Alexander Petrovitch, MD1; Geert von Oldenburg, Dipl-Ing2; Gunther O. Hofmann, MD, Dr rer nat1
1 Departments of Traumatology, Hand and Reconstructive Surgery (T.M., K.H., K.K., and G.O.H.) and Diagnostic and Interventional Radiology (A.P.), Friedrich Schiller Universität Jena, Erlanger Allee 101, D-07740 Jena, Germany. E-mail address for T. Mückley: Thomas.Mueckley@med.uni-jena.de
2 Stryker Osteosynthesis, Prof.-Küntscher-Strasse 1-5, D-24232 Schönkirchen/Kiel, Germany
View Disclosures and Other Information
Disclosure: In support of their research for or preparation of this work, one or more of the authors received, in any one year, outside funding or grants of less than $10,000 from Stryker Trauma, Germany, and Stryker Osteosynthesis. Neither they nor a member of their immediate families 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, division, center, clinical practice, or other charitable or nonprofit organization with which the authors, or a member of their immediate families, are affiliated or associated.
Investigation performed at the Department of Traumatology, Hand and Reconstructive Surgery, Friedrich Schiller Universität Jena, Jena, Germany

The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2008 Mar 01;90(3):620-627. doi: 10.2106/JBJS.G.00010
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Background: Retrograde intramedullary nailing is an established procedure for tibiotalocalcaneal arthrodesis. The goal of this study was to evaluate the effects of angle-stable locking or compressed angle-stable locking on the initial stability of the nails and on the behavior of the constructs under cyclic loading conditions.

Methods: Tibiotalocalcaneal arthrodesis was performed in fifteen third-generation synthetic bones and twenty-four fresh-frozen cadaver legs with use of retrograde intramedullary nailing with three different locking modes: a Stryker nail with compressed angle-stable locking, a Stryker nail with angle-stable locking, and a statically locked Biomet nail. Analyses were performed of the initial stability of the specimens (range of motion) and the laxity of the constructs (neutral zone) in dorsiflexion/plantar flexion, varus/valgus, and external rotation/internal rotation. Cyclic testing up to 100,000 cycles was also performed. The range of motion and the neutral zone in dorsiflexion/plantar flexion at specific cycle increments were determined.

Results: In both bone models, the intramedullary nails with compressed angle-stable locking and those with angle-stable locking were significantly superior, in terms of a smaller range of motion and neutral zone, to the statically locked nails. The compressed angle-stable nails were superior to the angle-stable nails only in the synthetic bone model, in external/internal rotation. Cyclic testing showed the nails with angle-stable locking and those with compressed angle-stable locking to have greater stability in both models. In the synthetic bone model, compressed angle-stable locking was significantly better than angle-stable locking; in the cadaver bone model, there was no significant difference between these two locking modes. During cyclic testing, five statically locked nails in the cadaver bone model failed, whereas one nail with angle-stable locking and one with compressed angle-stable locking failed.

Conclusions: Regardless of the bone model, the nails with angle-stable or compressed angle-stable locking had better initial stability and better stability following cycling than did the nails with static locking.

Clinical Relevance: Angle-stable locking of retrograde nails used for tibiotalocalcaneal arthrodesis can enhance construct stability in the hindfoot and may reduce loosening, which may help to improve the clinical outcome.

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    Accreditation Statement
    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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