Elastic Stable Intramedullary Nailing for Treatment of Pediatric Tibial Fractures: A 20-Year Single Center Experience of 132 Cases

Impact of fractured tibia implant fixation devices on bone stiffness during bending test

This study focuses on evaluating the failure resistance of a previously reduced tibia with internal fixation implants as PLate (PL) or InterMedullary Nail (IMN), subjected later to a tibial lateral trauma. To replicate this type of trauma, which can be caused by a road accident, a three-point bending test is considered using experimental tests and numerical simulations. The withstand evaluation of the tibia-PL and tibia-IMN structures was conducted by following the load transfer through, the bone and the used implants. The analysis, up to tibia failure, required the use of an elasto-plastic behavior law coupled to damage. The model parameters were identified using experimental tests. Il was shown that the tibia-IMN structure provided a bending resistant load up to three-times higher than the tibia-PL. In fact, the used screws for plate fixation induced a high level of stress in the vicinity of threaded region, leading to a crack initiation and a damage propagation. However, in tibia-IMN structure the highest stress was generated in the trapped zone between the loader and the nail, promoting crack formation. From a biomechanical point of view, the structure with IMN is safer than the structure with PL, whose fixation induces earlier damage in bone.

Advances in Pediatric Fracture Diagnosis and Treatment Are Numerous but Great Challenges Remain

Broken bones are very common during childhood [...].