[A break or bend in the unreamed tibial intramedullary nail. Experimental study]

The intramedullary tibial nail with a proximal angle according to Herzog was developed in order to facilitate implantation. However, the modified technique of unreamed nailing also required a shift of the point of insertion; as a consequence the proximal angle required a considerable increase in the force necessary to introduce the nail. In a study using-four cadaver bones and five commercially available unreamed femoral and tibial nails, the authors demonstrate this considerable increase in insertion force and the development of pressure in the medullary cavity. The measurements made with our experimental setup clearly show that the proximal angle of the unreamed tibial nails available for our series does not have a favourable influence on insertion behaviour. As it appears, it results in an increase in the force required for insertion of the nail, thus also causing a greater strain on the bone and an increase in pressure in the medullary cavity. In contrast, the continuous bend of the nail results in a much smoother course of pressure development in the medullary cavity, which does not reach the same high values as with the unreamed tibial nails, despite the fact that less time is required for insertion of the nail. In our opinion, modification of the axial shape of the nail would result both in better implantability and easier removal. We therefore advocate such a modification of the axial shape of intramedullary tibia nails.