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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2016 | Research article

Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Authors: Beat Schmutz, Jayani Amarathunga, Stanley Kmiec Jr., Prasad Yarlagadda, Michael Schuetz

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2016

Abstract

Background

The radius of curvature (ROC) misfit of cephalomedullary nails during anterograde nailing can lead to complications such as distal anterior cortical encroachment. This study quantified the anatomical fit of a new nail with 1.0-m ROC (TFN-ADVANCED^™ Proximal Femoral Nailing System [TFNA]) compared with a nail with 1.5-m ROC (Gamma3 Long Nail R1.5 [Gamma3]).

Methods

We generated 63 three-dimensional models (48 female, 45 right femur) representing the cortical surfaces of the femora (31 Caucasian, 28 Japanese, and 4 Thai). The mean age of the specimens was 77 years (±8.1), and the mean height was 158.5 cm (±9.6). Utilizing a customized software tool, nail fit was determined from the total surface area of nail protrusion from the inner cortex surface and maximum distance of nail protrusion in the axial plane; the position of the distal nail tip within the canal was also determined.

Results

Overall, TFNA had both a significantly smaller mean total surface area of nail protrusion (915.8 vs. 1181.6 mm²; P < 0.05) and a mean maximum distance of nail protrusion in the axial plane (1.9 vs. 2.1 mm; P = 0.007) when compared with Gamma3. The mean total surface area of nail protrusion was significantly smaller with TFNA versus Gamma3 in both the Caucasian (P = 0.0009) and Asian (Japanese and Thai) samples (P = 0.000002); the mean maximum distance of TFNA protrusion was significantly smaller in Asians (P = 0.04), but not in Caucasians (P = 0.08). Most tip positions for both nail types were anterior, but TFNA had a higher number of center positions than Gamma3 (13 vs. 7) and a shift from the far anterior cortex to the center of the medullary canal (overall and in Caucasians). In Asians, the most prominent position was far anterior for both nails.

Conclusions

The 1.0-m ROC TFNA nail resulted in better fit than the 1.5-m ROC Gamma3 nail. Clinical trials and case studies should be conducted in the future to verify if these findings would also result in clinical improvements.

Wolinsky P, Tejwani N, Richmond JH, Koval KJ, Egol K, Stephen DJ. Controversies in intramedullary nailing of femoral shaft fractures. Instr Course Lect. 2002;51:291–303.PubMed

Ostrum RF, Levy MS. Penetration of the distal femoral anterior cortex during intramedullary nailing for subtrochanteric fractures: a report of three cases. J Orthop Trauma. 2005;19:656–60.CrossRefPubMed

Bazylewicz DB, Egol KA, Koval KJ. Cortical encroachment after cephalomedullary nailing of the proximal femur: evaluation of a more anatomic radius of curvature. J Orthop Trauma. 2013;27:303–7.CrossRefPubMed

Collinge CA, Beltran CP. Does modern nail geometry affect positioning in the distal femur of elderly patients with hip fractures? A comparison of otherwise identical intramedullary nails with a 200 versus 150 cm radius of curvature. J Orthop Trauma. 2013;27:299–302.CrossRefPubMed

Stryker. Osteosynthesis. Why one million Gamma™ nails have been implanted worldwide. Available at: https://www.yumpu.com/en/document/view/25072032/one-million-gamma-nails-flyer-stryker. Accessed 20 April 2016.

The 2011 US trauma market. Orthopedic Network News. 2013;24(2). Available at: http://www.orthopedicnetworknews.com. Accessed 1 June 2015.

Schmutz B, Wullschleger ME, Kim H, Noser H, Schuetz MA. Fit assessment of anatomic plates for the distal medial tibia. J Orthop Trauma. 2008;22:258–63.CrossRefPubMed

Schmutz B, Rathnayaka K, Wullschleger ME, Meek J, Schuetz MA. Quantitative fit assessment of tibial nail designs using 3D computer modelling. Injury. 2010;41:216–9.CrossRefPubMed

Schmutz B, Kmiec S, Wullschleger ME, Altmann M, Schuetz MA. 3D computer graphical anatomy study of the femur: a basis for a new nail design. Kobe: Presented at the 88th Annual Meeting of the Japanese Orthopaedic Association; 2015. May 21–25.

10.

Messmer P, Matthews F, Jacob AL, Kikinis R, Regazzoni P, Noser H. A CT database for research, development and education: concept and potential. J Digit Imaging. 2007;20:17–22.CrossRefPubMedPubMedCentral

11.

Noser H, Heldstab T, Schmutz B, Kamer L. Typical accuracy and quality control of a process for creating CT-based virtual bone models. J Digit Imaging. 2011;24:437–45.CrossRefPubMedPubMedCentral

12.

Rathnayaka K, Sahama T, Schuetz MA, Schmutz B. Effects of CT image segmentation methods on the accuracy of long bone 3D reconstructions. Med Eng Phys. 2011;33:226–33.CrossRefPubMed

13.

Haidukewych GJ. Intertrochanteric fractures: ten tips to improve results. J Bone Joint Surg Am. 2009;91:712–9.PubMed

14.

Stryker. Gamma3®. Long Nail R1.5 and R2.0: operative technique. Available at: http://www.strykermeded.com/media/1310/gamma3-long-nail-r15-and-r20-operative-technique.pdf. Accessed 20 April 2016.

15.

Amarathunga JP, Schuetz MA, Yarlagadda PK, Schmutz B. Automated fit quantification of tibial nail designs during the insertion using computer three-dimensional modelling. Proc Inst Mech Eng H. 2014;228:1227–34.CrossRefPubMed

16.

Mahaisavariya B, Sitthiseripratip K, Oris P, Chaichanasiri E, Suwanprateeb J. Fit-and-fill analysis of trochanteric Gamma nail for the Thai proximal femur: a virtual simulation study. J Med Assoc Thai. 2004;87:1315–20.PubMed

17.

Chantarapanich N, Mahaisavariya B, Siribodhi P, Sitthiseripratip K. Geometric mismatch analysis of retrograde nail in the Asian femur. Surg Radiol Anat. 2011;33:755–61.CrossRefPubMed

18.

Leung KS, Procter P, Robioneck B, Behrens K. Geometric mismatch of the Gamma nail to the Chinese femur. Clin Orthop Relat Res. 1996;323:42–8.CrossRefPubMed

19.

Zhang S, Zhang K, Wang Y, Feng W, Wang B, Yu B. Using three-dimensional computational modeling to compare the geometrical fitness of two kinds of proximal femoral intramedullary nail for Chinese femur. Scientific World Journal. 2013;2013:978485.PubMedPubMedCentral

Title: Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs
Authors: Beat Schmutz
Jayani Amarathunga
Stanley Kmiec Jr.
Prasad Yarlagadda
Michael Schuetz
Publication date: 01-12-2016
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2016
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-016-0389-7

At a glance: The STEP trials

Springer Medicine

Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: a comparison between 1.0 and 1.5m bow designs

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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