A new femoral nail with single distal locking screw for maximum interfragment rotational stability

Abstract

Objective: One of the problems for interlocking nailing of the femur is interfragment rotation motion, affecting fracture healing. The nails with single distal locking screw are advantageous for decreasing operation time and radiation exposure. We investigated which single distal screw nail is the best for interfragment rotational stability.
Methods: We used a total of 30 composite femurs, ten for each group. We determined interfragment rotational displacement of composite femurs with three types of single distal screw nails (10 interlocking nails, 10 compression nails and 10 Mehmet anti-rotation nails compressed by tube) at 6-Nm external− 6 Nm internal and 10 Nm extern– 6 Nm internal torques, which imitating respectively the level walking and descending stairs, using an axial distraction testing machine and a custom designed rotation apparatus.
Results: Between 10 Nm external and 6 Nm internal torques with single distal locking screw, the interfragment rotational displacement in the Mehmet nail compressed by the 8 Nm torque wrench was mean 1.14 mm and 540% less than mean 7.31 mm in interlocking nails and 400% less than 5.72 mm in compression nails compressed by the 2.5 Nm torque wrench.
Conclusion: The single distal screw Mehmet nail is superior than other single (or even some double) distal screw nails for maximum rotational stability, with no interfragment distraction gap, no superior nail migration, decreased operation time, and less radiation exposure in axially stable transverse and short oblique femur fractures in daily activities like stair descending or level walking.

Keywords

• Femur fractures; fracture union; interfragmentary distraction; interfragmentary rotation.