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.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to InjuryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Minimally invasive reduction and percutaneous fixation versus open reduction and internal fixation for displaced intra-articular calcaneal fractures: a systematic review of the literature.EFORT Open Rev. 2018; 3: 418-425https://doi.org/10.1302/2058-5241.3.170043
- Different types and epidemiological patterns of calcaneal fractures based on reviewing CT images of 957 fractures.Foot Ankle Surg. 2022; 28: 88-92https://doi.org/10.1016/j.fas.2021.02.002
- Operative versus nonoperative treatment for displaced intra-articular calcaneal fractures: a meta-analysis of randomized controlled trials.J Foot Ankle Surg. 2016; 55: 821-828https://doi.org/10.1053/j.jfas.2016.01.035
- Calcaneal fractures-which approach for which fracture?.Orthop Clin N Am. 2021; 52: 433-450https://doi.org/10.1016/j.ocl.2021.05.012
- Management of calcaneal fractures: systematic review of randomized trials.Br Med Bull. 2009; 92: 153-167https://doi.org/10.1093/bmb/ldp030
- Calcaneus traction compression with orthopaedic reduction forceps combined with percutaneous minimally invasive treatment of intra-articular calcaneal fractures: an analysis of efficacy.Biomed Pharmacother. 2020; 128110295https://doi.org/10.1016/j.biopha.2020.110295
- Outcome of minimally invasive open and percutaneous techniques for repair of calcaneal fractures: a systematic review.J Foot Ankle Surg. 2016; 55: 1256-1263https://doi.org/10.1053/j.jfas.2016.07.003
- Percutaneous reduction and screw fixation for all types of intra-articular calcaneal fractures.Musculoskelet Surg. 2021; 105: 97-103https://doi.org/10.1007/s12306-019-00635-w
- Use of intramedullary locking nail for displaced intraarticular fractures of the calcaneus: what is the evidence?.Arch Orthop Trauma Surg. 2021; : 1-12https://doi.org/10.1007/s00402-021-03944-7
- C-Nail versus plate osteosynthesis in displaced intra-articular calcaneal fractures-a comparative retrospective study.J Orthop Surg Res. 2021; 16: 203https://doi.org/10.1186/s13018-021-02349-x
- Locked nailing for the treatment of displaced articular fractures of the calcaneus: description of a new procedure with calcanail(®).Eur J Orthop Surg Traumatol. 2012; 22: 345-349https://doi.org/10.1007/s00590-012-0968-1
- Biomechanical comparison of modified Calcanail system with plating fixation in intra-articular calcaneal fracture: a finite element analysis.Med Eng Phys. 2019; 70: 55-61https://doi.org/10.1016/j.medengphy.2019.06.004
- The sustentaculum tali screw fixation for the treatment of Sanders type II calcaneal fracture: a finite element analysis.Pak J Med Sci. 2014; 30: 1099-1103https://doi.org/10.12669/pjms.305.5301
- Does the position of a sustentacular screw influence the stability of a plate osteosynthesis of a calcaneal fracture? A biomechanical study.Proc Inst Mech Eng H. 2021; 235: 993-1000https://doi.org/10.1177/09544119211019509
- 2D and 3D assessment of sustentaculum tali screw fixation with or without screw targeting clamp.Injury. 2017; 48: 2864-2871https://doi.org/10.1016/j.injury.2017.10.035
- Fracture mapping of complex intra-articular calcaneal fractures.Ann Transl Med. 2021; 9: 333https://doi.org/10.21037/atm-20-7824
- Computational models of the foot and ankle for pathomechanics and clinical applications: a review.Ann Biomed Eng. 2016; 44: 213-221https://doi.org/10.1007/s10439-015-1359-7
- Biomechanical analysis of a novel double-point fixation method for displaced intra-articular calcaneal fractures.Front Bioeng Biotechnol. 2022; 10791554https://doi.org/10.3389/fbioe.2022.791554
- Biomechanical analysis of minimally invasive crossing screw fixation for calcaneal fractures: implications to early weight-bearing rehabilitation.Clin Biomech. 2020; 80 (Bristol, Avon)105143https://doi.org/10.1016/j.clinbiomech.2020.105143
- Finite element analysis of subtalar joint arthroereisis on adult-acquired flexible flatfoot deformity using customised sinus tarsi implant.J Orthop Translat. 2021; 27: 139-145https://doi.org/10.1016/j.jot.2020.02.004
- Biomechanical comparison of locking plate and crossing metallic and absorbable screws fixations for intra-articular calcaneal fractures.Sci China Life Sci. 2016; 59: 958-964https://doi.org/10.1007/s11427-016-0010-9
- Finite element comparison of retrograde intramedullary nailing and locking plate fixation with/without an intramedullary allograft for distal femur fracture following total knee arthroplasty.Knee. 2014; 21: 224-231https://doi.org/10.1016/j.knee.2013.03.006
- Primary stability of an intramedullary calcaneal nail and an angular stable calcaneal plate in a biomechanical testing model of intraarticular calcaneal fracture.Injury. 2014; 45: S49-S53https://doi.org/10.1016/j.injury.2013.10.031
- Interlocking nailing versus interlocking plating in intra-articular calcaneal fractures: a biomechanical study.Foot Ankle Int. 2016; 37: 891-897https://doi.org/10.1177/1071100716643586
- Dynamic nature of abutment screw retightening: finite element study of the effect of retightening on the settling effect.J Prosthet Dent. 2015; 113: 412-419https://doi.org/10.1016/j.prosdent.2014.09.017
- Functional restoration and risk of non-union of the first metatarsocuneiform arthrodesis for hallux valgus: a finite element approach.J Biomech. 2015; 48: 3142-3148https://doi.org/10.1016/j.jbiomech.2015.07.013
- Applied anatomy of the calcaneocuboid articular surface for internal fixation of calcaneal fractures.Injury. 2013; 44: 1428-1430https://doi.org/10.1016/j.injury.2012.08.023
- The sustentaculum tali: anatomic, radiographic, and surgical considerations.Foot Ankle Int. 2000; 21: 400-403https://doi.org/10.1177/107110070002100507
- Anatomical parameters of sustentaculum Tali screw placement in the Asian population: a retrospective radio-anatomical study.J Orthop Surg. 2022; 30 (Hong Kong)10225536221082343https://doi.org/10.1177/10225536221082343
- A windows technique for sustentaculum tali screw fixation using the sinus tarsi approach for calcaneal fractures: a cadaveric study.Arch Orthop Trauma Surg. 2021; : 1-7https://doi.org/10.1007/s00402-021-04102-9
- Finite element method based parametric study of Gastrocnemius-soleus recession: implications to the treatment of midfoot-forefoot overload syndrome.Comput Methods Biomech Biomed Eng. 2021; 24: 913-921https://doi.org/10.1080/10255842.2020.1858817
- An instrument for methodological quality assessment of single-subject finite element analysis used in computational orthopaedics.Med Novel Technol Dev. 2021; 11100067https://doi.org/10.1016/j.medntd.2021.100067
- Computational biomechanical analysis of postoperative calcaneal fractures with different placement of the sustentaculum screw.Orthop Surg. 2020; 12: 661-667https://doi.org/10.1111/os.12541
- Biomechanical evaluation of reconstruction plates with locking, nonlocking, and hybrid screws configurations in calcaneal fracture: a finite element model study.Med Biol Eng Comput. 2017; 55: 1799-1807https://doi.org/10.1007/s11517-017-1623-0
- Finite element analysis of tongue type calcaneal fracture with open reduction and internal fixation with locking plate.J Med Biol Eng. 2018; 38: 1-9https://doi.org/10.1007/s40846-017-0296-3
- Influence of arch support heights on the internal foot mechanics of flatfoot during walking: a muscle-driven finite element analysis.Comput Biol Med. 2021; 132104355https://doi.org/10.1016/j.compbiomed.2021.104355
- Different design feature combinations of flatfoot orthosis on plantar fascia strain and plantar pressure: a muscle-driven finite element analysis with taguchi method.Front Bioeng Biotechnol. 2022; 10853085https://doi.org/10.3389/fbioe.2022.853085
Article info
Publication history
Published online: September 25, 2022
Accepted:
September 22,
2022
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
