Quantitative fit assessment of tibial nail designs using 3D computer modeling

Schmutz, B., Rathnayaka, K., Wullschleger, M. E., Meek, J. and Schuetz, M. A. (2010) Quantitative fit assessment of tibial nail designs using 3D computer modeling. Injury, 41 2: 216-219. doi:10.1016/j.injury.2009.10.012


Author Schmutz, B.
Rathnayaka, K.
Wullschleger, M. E.
Meek, J.
Schuetz, M. A.
Title Quantitative fit assessment of tibial nail designs using 3D computer modeling
Journal name Injury   Check publisher's open access policy
ISSN 0020-1383
1879-0267
Publication date 2010-02-01
Sub-type Article (original research)
DOI 10.1016/j.injury.2009.10.012
Volume 41
Issue 2
Start page 216
End page 219
Total pages 4
Place of publication Oxford, England, U. K.
Publisher Elsevier
Language eng
Formatted abstract
Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of the tibia in adults. The bends in modern tibial nails allow for an easier insertion, enhance the 'bone-nail construct' stability, and reduce axial malalignments of the main fragments. Anecdotal clinical evidence indicates that current nail designs do not fit optimally for patients of Asian origin. The aim of this study was to develop a method to quantitatively assess the anatomical fitting of two different nail designs for Asian tibiae by utilising 3D computer modelling. We used 3D models of two different tibial nail designs (ETN (Expert Tibia Nail) and ETN-Proximal-Bend, Synthes), and 20 CT-based 3D cortex models of Japanese cadaver tibiae. With the aid of computer graphical methods, the 3D nail models were positioned inside the medullary cavity of the intact 3D tibia models. The anatomical fitting between nail and bone was assessed by the extent of the nail protrusion from the medullary cavity into the cortical bone, in a real bone this might lead to axial malalignments of the main fragments. The fitting was quantified in terms of the total surface area, and the maximum distance by which the nail was protruding into the cortex of the virtual bone model. In all 20 bone models, the total area of the nail protruding from the medullary cavity was smaller for the ETN-Proximal-Bend (average 540 mm(2)) compared to the ETN (average 1044 mm(2)). Also, the maximum distance of the nail protruding from the medullary cavity was smaller for the ETN-Proximal-Bend (average 1.2mm) compared to the ETN (average 2.7 mm). The differences were statistically significant (p<0.05) for both the total surface area and the maximum distance measurements. By utilising computer graphical methods it was possible to conduct a quantitative fit assessment of different nail designs. The ETN-Proximal-Bend shows a statistical significantly better intramedullary fit with less cortical protrusion than the original ETN. In addition to the application in implant design, the developed method could potentially be suitable for pre-operative planning enabling the surgeon to choose the most appropriate nail design for a particular patient.
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
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Created: Wed, 02 Nov 2011, 04:13:25 EST by Martin Wullschleger on behalf of Surgery - Royal Brisbane and Women's Hospital