Biomechanics finite element analysis of the comminuted distal tibia fractures treated with retrograde intramedullary nail at the distal tibia medial malleolus
Yao Xiaotao, Liu Qingjun, Ding Zhenqi, Zhong Yuanfu, Chen Xiaolan
Department of Orthopaedics, the 909th Hospital of PLA, Affiliated Southeast Hospital of Xiamen University, Orthopaedic Center of People's Liberation Army, Zhangzhou 363000, China
Abstract：Objective This study aimed to investigate the biomechanical effect of retrograde intramedullary nail in the treatment of comminuted fracture of distal tibia by finite element analysis. Methods A 30-year-old healthy male volunteer with 172 cm height and 60 kg weight was selected in the 909th Hospital of PLA. Thin-layer continuous scanning of the entire tibia was performed using helical computed tomography. On the basis of the tibia CT data, a 3D model of the tibia was constructed using digital medical software. The distal tibia was segmented to simulate a comminuted distal tibia fractures, and each model was fixed using one of the above four fixation methods. All four models were applied with the same constraints, vertical axial loads of 400, 800, and 1200 N, and torsional loads of 4, 8, and 12 N·m. The equivalent stress and displacement of the models under different fixation methods were observed. Results Under the compression load of 400, 800, and 1 200 N, the maximum stress of the distal medial tibial plate was 35.08, 69.26, and 103.52 MPa, respectively; that of the expert-type tibial intramedullary nail was 24.45, 46.26, and 71.00 MPa, respectively; that of the anterolateral L-shaped plate at the distal tibia was 13.69, 27.76, and 34.10 MPa, respectively; and that of the retrograde intramedullary nail at the distal tibia malleolus was 16.07, 28.91, and 41.25 MPa. The stress peak value of distal medial tibial plate fixation was significantly higher than that of the other three groups. The expert-type tibial intramedullary nail fixation had a moderate effect, and the distal tibial medial malleolar retrograde intramedullary nail fixation and distal tibial anterolateral L-shaped plate fixation had a low effect and produced similar stress peaks. Under the three compression loads, the difference of peak displacement caused by the four different internal fixation methods was very small. Under the torsional load of 4, 8, and 12 N·m, the maximum stress of the distal medial steel plate of tibia was 284.66, 568.87, and 950.00 MPa, respectively; that of the expert-type tibial intramedullary nail was 187.74, 373.06, and 558.19 MPa, respectively; that of the anterolateral distal tibial L-shaped plate was 219.75, 439.50, and 649.01 MPa, respectively; and that of the retrograde intramedullary nail at the distal tibial malleolus was 194.45, 368.32, and 544.89 MPa, respectively. The peak value of fixed stress in the distal medial tibial plate was the highest. The distal tibial anterolateral L-shaped plate was fixed at the median level, and the distal tibial medial malleolar retrograde and expert tibial intramedullary fixations showed low and similar stress peaks. Under the torsional loads of 4, 8, and 12 N·m, the peak displacement of the distal medial tibial plate fixation (3.37, 6.67, and 11.12 mm) was also higher than those of the expert tibial intramedullary nails (2.49, 5.01, and 7.51 mm), anterolateral L-shaped plates (2.36, 4.73, and 7.12 mm) and distal tibial medial malleolus retrograde intramedullary nail fixation (1.32, 2.62, and 3.92 mm). The expert tibial intramedullary nail fixation and distal tibial anterolateral L-shaped plate fixation were located at the median level and had similar peak displacement. Meanwhile, the peak displacement of distal tibial medial malleolar retrograde intramedullary nail fixation was low. Conclusion The treatment of comminuted fracture of distal tibia with retrograde intramedullary nail-fixation of distal tibia medial malleolus has better biomechanical stability, safer and more reliable than the traditional internal fixation method, and which is recommended as the first choice in clinic.
姚小涛, 刘庆军, 丁真奇, 钟渊福, 陈肖兰. 胫骨远端内踝逆行髓内钉治疗胫骨远端粉碎性骨折的生物力学有限元分析[J]. 中华解剖与临床杂志, 2024, 29(3): 193-198.
Yao Xiaotao, Liu Qingjun, Ding Zhenqi, Zhong Yuanfu, Chen Xiaolan. Biomechanics finite element analysis of the comminuted distal tibia fractures treated with retrograde intramedullary nail at the distal tibia medial malleolus. Chinese Journal of Anatomy and Clinics, 2024, 29(3): 193-198.
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2024, Vol. 29 
