Modified Ni-Nail and C-Nail systems for intra-articular fractures of the calcaneus: A biomechancial study. Issue 12 (December 2022)

• Record Type: Journal Article
• Authors: Xu, Zihuan; Sun, Wanju; Li, Pengfei; Wang, Yongqin; Wong, Duo Wai-Chi; Cheung, James Chung-Wai; Niu, Wenxin; Zhang, Haowei; Ni, Ming
• Is Part Of: Injury. Volume 53:Issue 12(2022)
• Page Start: 3904
• Page End: 3911
• Publication Date: 2022-12
• Subjects: Calcaneal fracture -- Fracture fixation -- Intramedullary nail -- Biomechanics -- Finite element analysis; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2022.09.037
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: A novel intramedullary nail was developed, which has better biomechanical stability than traditional C-Nail. The intramedullary nail and screws could be precisely placed under the guidance of navigation handle. The intramedullary nail system and navigation handle could be assembled and carried. Sustentaculum tali screws effectively enhance the stability of intramedullary nails. Abstract: Objectives: We have proposed a novel intramedullary nail (Ni-Nail) by incorporating a sustentaculum tali screw to improve the fixation stability of minimally invasive treatment for calcaneal fractures. This study aimed to evaluate the biomechanical characters of the Ni-Nail system and compare it with traditional C-Nail system. Methods: A finite element model of a Sanders type-IIIAB calcaneal fracture was reconstructed and fixed using two intramedullary nail systems, which was validated by a cadaver study. A vertical loading of 700 N was applied to the subtalar joint surfaces, and 525 N Achilles tendon tension was applied to the superior border of the Achilles tuberosity. The von Mises stresses and fracture displacements of both fixation models were evaluated. Results: The maximum von Mises stress of the screws of Ni-Nail and C-Nail were 27.92 MPa and 57.42 MPa, respectively, while that of the main nail were 67.44 MPa and 53.01 MPa. In addition, the maximum fracture displacement of the Ni-Nail was larger than that of C-Nail by 15.6% (0.37 mm vs.0.32 mm). Conclusions: Our static simulation analysis showed that both Ni-Nail and C-Nail demonstrated similar biomechanical stability for calcaneal fixation. The Ni-Nail features a simple structure that is easier to operate and less traumatizing. Future studies may consider to further evaluate the clinical effectiveness by clinical trials and follow-ups.