Biomechanical comparison of humeral nails with different distal locking mechanisms: Insafelock nails versus conventional locking nails.

OBJECTIVE: The aim of this study was to compare the biomechanical resistance to rotational and axial forces of a conventional locking nail with a newly designed intramedullary humeral nail developed for humeral shaft fractures with a secure locking mechanism through the distal part of the nail. METHODS: InSafeLOCK humeral nail system (group 1, TST, Istanbul, Turkey) and Expert humeral nail system (group 2, DePuy Synthes, Bettlach, Switzerland) of the same size (9 × 300 mm) were examined. In total, 24 fourth-generation humerus sawbones were used in the experiment. Osteotomy was performed at the humerus shaft, and a defect was created by removing 1 cm of bone. After pre-loading 5000 cycles at a frequency of 2 Hz and a force of 50-250 N for axial loading and 5000 torsion torques between 0.5 Nm and 6.5 Nm at a 2 Hz frequency for torsional loading, the failure load values of each load were recorded. Distal interlocking was performed with an endopin in group 1, while a double cortex screw was used in group 2. RESULTS: All samples successfully passed the cyclic loading. The initial and final stiffness values were similar between the groups after axial loading (p = 0.873 and p = 0.522, respectively). The mean axial failure load values in groups 1 and 2 were 2627 ± 164 N and 7141 ± 1491 N, respectively. A significant difference was found in the axial failure load values (p = 0.004). Significant differences were observed between the initial and final torsional stiffness between the two groups (p = 0.004 and p = 0.004, respectively). No significant difference was found in the failure load values after torsional loading (11791 ± 2055 N.mm and 16997 ± 5440 N.mm) (p = 0.055). CONCLUSION: These results provide a biomechanical demonstration of the adequate stability of both nails after axial and rotational loading. The reliability of the newly developed InSafeLOCK humeral nail system, which does not require fluoroscopic control and an additional incision for distal locking, supports its use in the clinic.

Biomechanical comparison of three different plate configurations for comminuted clavicle midshaft fracture fixation.

BACKGROUND: The aim of this study was to compare the fixation rigidity of anterior, anterosuperior, and superior plates in the treatment of comminuted midshaft clavicle fractures. METHODS: Six-hole titanium alloy plates were produced according to anatomic features of fourth-generation artificial clavicle models for anterior (group I; n = 14), anterosuperior (group II; n = 14), and superior (group III; n = 14) fixation. After plate fixation, 5-mm segments were resected from the middle third of each clavicle to create comminuted fracture models. Half the models from each group were tested under rotational forces; the other half were tested under 3-point bending forces. Failure modes, stiffness values, and failure loads were recorded. RESULTS: All models fractured at the level of the distalmost screw during the failure torque, whereas several failure modes were observed in 3-point bending tests. The mean stiffness values of groups I to III were 636 ± 78, 767 ± 72, and 745 ± 214 N ∙ mm/deg (P = .171), respectively, for the torsional tests and 38 ± 5, 20 ± 3, and 13 ± 2 N/mm, respectively, for the bending tests (P < .001 for group I vs. groups II and III; P = .015 for group II vs. group III). The mean failure torque values of groups I to III were 8248 ± 2325, 12,638 ± 1749, and 10,643 ± 1838 N ∙ mm (P = .02 for group I vs. II), respectively, and the mean failure loads were 409 ± 81, 360 ± 122, and 271 ± 87 N, respectively (P = .108). CONCLUSIONS: In the surgical treatment of comminuted midshaft clavicle fractures, the fixation strength of anterosuperior plating was greater than that of anterior plating under rotational forces and similar to that of superior plating.