Biomechanical effects of the nail entry zone and anterior cortical bone loss on the proximal tibia
Abstract
The aims of this study were as follows: to determine if the presence of the nail entry zone alters the biomechanics of the proximal tibia after intramedullary (IM) nailing using a computational model; to determine if nail removal restores normal biomechanics to the proximal tibia; and to determine if these effects are magnified with anterior cortical bone loss. Three-dimensional finite element (FE) tibial models were developed and used for this study: an intact tibia, a nailed tibia, and a tibia with the nail removed. One matched pair of fresh-frozen cadaver tibias was obtained to construct and validate the FE model. The tibias underwent computed tomography scanning, and geometric models were obtained from computed tomography data through volumetric reconstruction. The left tibia was implanted with an unlocked IM nail. The experimental validation of the models was performed by comparing experimental and FE data. Anterior cortical bone of the proximal tibia was removed down to the tibial tubercle on the models to simulate a worst-case scenario of its removal during an IM nailing procedure. Three load cases were considered for each FE tibial model: standing, walking, and single-limb kneeling. The principal strain values of the pr...Continue Reading
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Biomechanics
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