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Mechanical failure in intramedullary interlocking nails
A K Bhat1, S K Rao, K Bhaskaranand
1Department of Orthopaedics, Kasturba Medical College, Manipal, Karnataka, India. anilkbhat@yahoo.com
Journal of Orthopaedic Surgery (Hong Kong)
|August 18, 2006
Summary
Interlocking nail failure is common in distal fractures, especially tibial ones. Using longer, larger nails and protected weight-bearing can prevent interlocking nail failure.
Area of Science:
- Orthopedic surgery
- Biomechanical engineering
- Trauma care
Background:
- Interlocking nails are widely used for fracture fixation.
- Understanding factors leading to nail failure is crucial for improving patient outcomes.
Purpose of the Study:
- To identify clinical and mechanical factors contributing to interlocking nail failure.
- To provide recommendations for preventing such failures.
Main Methods:
- Retrospective review of 286 femoral, 211 tibial, and 47 humeral fractures treated with interlocking nails (1996-2002).
- Analysis of fracture pattern, level, site, nail characteristics, weight-bearing status, and union.
- Mean follow-up of 22 months.
Main Results:
- Nail failure occurred in 27 cases (9.4%), predominantly in distal fractures (55%).
- A high failure rate was observed in tibial fractures.
- Failures were noted in both institutionally treated and referred cases.
Conclusions:
- Distal fracture location and stress at distal screws are key factors in interlocking nail failure.
- Protected weight-bearing and the use of longer, larger nails can mitigate failure risks.
- Routine bone grafting is not necessary for re-nailing if adequate reaming and larger nails are employed.