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A Biomechanical Comparison of Unlocked or Locked Reamed Intramedullary Nails in the Treatment of Mid-Third Simple Transverse Femoral Shaft Fractures

Author(s): Chi-Chuan Wu | Ching-Lung Tai

Journal: Chang Gung Medical Journal
ISSN 2072-0939

Volume: 29;
Issue: 03;
Start page: 275;
Date: 2006;
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Keywords: biomechanical comparison | unlocked nail | locked nail | femoral shaft fracture.

Background: Despite that a mid-third simple transverse femoral shaft fracture has beentraditionally treated with an unlocked reamed intramedullary nail, recently astatic locked reamed intramedullary nail has been favored by some orthopediststo avoid missing extended fracture lines. A prospective comparison ofboth nails was conducted to investigate the superiority between the nailsfrom biomechanical viewpoints.Methods: Seven pairs of fresh healthy cadaver femora underwent mid-third transverseosteotomy. Consequently, all seven left femora were stabilized usingKuntscher nails and all seven right femora, static Russell-Taylor locked nails.Finally, all 14 femora were tested using a Material Testing System (MTS)machine to investigate the sustained mechanical loads, the maximal failureload, and the relative fragment displacement.Results: The locked nails produced the larger mechanical loads (p = 0.02). Theunlocked nails had the larger fragment displacement (p = 0.02) and the highermaximal failure load (6090 verse 5590 newtons, p = 0.02). All tests endeddue to basal neck oblique fractures.Conclusions: Biomechanically, an unlocked nail, being a load-sharing device, is superiorto a static locked nail, being a load-bearing device, in the treatment of a midthirdsimple transverse femoral shaft fracture. Clinically, careful investigationof the fracture types and adequate selection of the nail type should beperformed in treating these types of fractures.

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