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Modified Ni-Nail and C-Nail systems for intra-articular fractures of the calcaneus: A biomechancial study

  • Author Footnotes
    1 These authors contributed equally to this work.
    Zihuan Xu
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
    Wanju Sun
    Footnotes
    1 These authors contributed equally to this work.
    Affiliations
    Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China
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  • Pengfei Li
    Affiliations
    School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
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  • Yongqin Wang
    Affiliations
    School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
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  • Duo Wai-Chi Wong
    Affiliations
    Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
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  • James Chung-Wai Cheung
    Affiliations
    Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong 999077, China
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  • Wenxin Niu
    Correspondence
    Corresponding author at: Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China.
    Affiliations
    Yangzhi Rehabilitation Hospital, Tongji University School of Medicine, Shanghai 201619 China

    Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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  • Haowei Zhang
    Correspondence
    Corresponding author.
    Affiliations
    School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai 200093, China
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  • Ming Ni
    Correspondence
    Corresponding author at: Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China.
    Affiliations
    Department of Orthopaedics, Shanghai Pudong New Area Peoples' Hospital, Shanghai 201299, China

    Department of Orthopaedics, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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  • Author Footnotes
    1 These authors contributed equally to this work.
Published:September 25, 2022DOI:https://doi.org/10.1016/j.injury.2022.09.037

      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

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