Intramedullary Nailing at Different Distal Tibial Fracture Levels: A Biomechanical Study

Abstract

Abstract Purpose: Distal tibial fractures remains a significant challenge in orthopedic trauma surgery. The aim of this study was to investigate the biomechanical stability of intramedullary nailing (IMN) at different distal tibial fracture levels and the effect of the number of locking screws. Methods: Using a total of 21 sawbone models, three different tibial fracture levels (3, 4.5, and 6cm proximally to the talocrural joint) were created and the fractures were fixed using two, three, or four distal locking screws. A single compression test and a cyclic compression test was applied to all tibia models. The applied weight and displacements from the fracture lines were recorded and evaluated. Results: There was no statistically significant difference in fixation with two distal locking screws in groups 1, 2, and 3 (single test p=0.9689) (cyclic test p=0.8050). Therefore, if two distal screws are used, the fracture level does not affect the strength of fixation. In fractures located 6 cm proximal to the talocrural joint, all four holes of the nail can be used to insert screws, which provides a stronger fixation. When two screws are used, a statistically weaker fixation is obtained than with three or four screws. Conclusion: Our findings support the use of IMN with two distal locking screws as a viable option for the management of distal tibial fractures. We found that it provides sufficient fixation regardless of the fracture level, suggesting that there is no need to choose an alternative fixation technique due to concerns of inadequate fixation as the fracture line moves distally. In cases where more stable fixation is desired, an additional locking screw can be used.