A METHOD TO MODIFY ANGLE-STABLE INTRAMEDULLARY.pdfVIP

68 The Iowa Orthopaedic Journal ABSTRACT Traditional interlocked intramedullary (IM) nails have recently been modified to provide enhanced angular stability. These so-called ‘angle-stable’ IM nails are designed to eliminate construct toggle and also provide increased axial, bending, and torsional stiffness. While this added stability is needed for small fracture gaps to heal, angle-stable nails may be too stiff for large fracture gaps to unite. Even though relative stability is recommended for large fracture gaps, recent in vivo data indicates that traditional nails may allow for too much motion for healing to occur. The current study evaluated a modified technique for implanting an angle-stable nail which allows for an intermediate amount of stability. The compliance of the nail construct was adjusted by over-drilling the near cortex interlock- ing hole. This led to increased construct motion in torsion, but less so in axial compression and bending. This modification creates stability which is partway between angle-stable and traditional IM nail designs. These findings were unchanged after 50,000 fatigue loading cycles. By carefully select- ing the magnitude of over-drilling, the compliance of the construct can easily be modified as it is be- ing implanted. This design modification may lead to more reliable fracture union since the surgeon can tailor the nail compliance to the injury and bone quality. INTRODUCTION Interlocked intramedullary nailing has been used for several decades to treat a variety of long bone fractures1. One recent innovation is the so-called ‘angle-stable’ nail which eliminates screw-to-nail toggle2-6. Such toggle is inherent in traditional interlocked nails which use screws that are intentionally undersized by ~0.13 mm relative to the nail holes (Figure 1a)7. The slightly oversized nail holes assist in targeting and insertion of the screws without binding5,7. However, the screw-to-nail toggle leads to interfr