Biomechanics of intramedullary fracture fixation

Intramedullary rodding allows excellent control of bending forces on long bone fractures when adequate sized rods are used. This is made possible by reaming when necessary. Torsional stability is poor if adequate bone nail contact is not obtained and there is little bone fragment interdigitation. This can be optimized with the interlocking system, especially with proximal and distal fractures. Intramedullary rods allow transmission of compressive load so there must be adequate bone to bone contact without comminution to prevent shortening. If a great deal of comminution is present, an interlocking system must be used to resist compressive loads. The interlocked devices have not been proven to be a detriment to union and indeed are a semi-rigid fixation system when used in comminuted shaft fractures. The strength of an osteosynthesis with an intramedullary rod depends on the geometry of the rod and the geometry of the fracture complex. Both locked and nonlocked intramedullary rods perform extremely well when one understands the mechanical principles involved in intramedullary rodding and pays close attention to detail.