Comparison of the bone modeling effects caused by curved and straight nickel-titanium intramedullary nails

Nitinol (NiTi) shape memory metal alloy makes it possible to prepare functional implants. A curved intramedullary NiTi nail has been shown to cause bending of the bone, bone thickening, increase in cortical area, and reduction in bone longitudinal growth. The purpose of the present study was to find out whether these changes are caused by the bending force of the curved nail or by the intramedullary nailing itself. Pre-shaped intramedullary NiTi nails were implanted in the cooled martensitic form into the medullary cavity of the right femur in 12 rats, where they started to restore their austenitic form, causing a bending force. Straight nails were used as controls in another 12 rats. After 12 weeks, the operated femurs were compared with their non-operated contralateral counterparts and the differences were compared between the groups. Anteroposterior radiographs demonstrated bone bowing only in the curved nail group. Retardation of longitudinal growth was observed in both groups, showing that the growth effect seems to be due to the intramedullary nailing itself. Increase in bone cross-sectional area and cortical thickness were found in both groups. However, this increase was more evident with the curved nail, indicating that the bending force of the functional nail seems to induce these changes.