Erdal Eren1, Halil Büyükdoğan2, Cemil Ertürk2, Julide Hazal Türkcan3, Ergün Keleşoğlu4

1Department of Orthopedics and Traumatology, University of Health Sciences, Bağcılar Training and Research Hospital, Istanbul, Türkiye
2Department of Orthopedics and Traumatology, University of Health Sciences, Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Türkiye
3Department of Metallurgical and Materials Engineering, Yıldız Technical University, Chemistry-Metallurgy Faculty, Istanbul, Türkiye
4Department of Material Science and Technology, Turkish-German University, Faculty of Science, Istanbul, Türkiye

Keywords: Biomechanics, diaphyseal fractures, elastic nail augmentation, plate fixation, three-point bending


Objectives: The aim of this study was to evaluate the bending strength of plate-screw fixation augmented with titanium elastic nails (TENs) in a simple long bone fracture model using lamb cadaver femurs.
Materials and methods: A total of 24 lamb cadaveric femurs that were osteotomized transversely from the mid-diaphysis with a bone saw were used to obtain a simple fracture model. The femurs were divided randomly into three groups. In Group 1, only plate-screw was used for fixation. In Group 2, plate-screw fixation was augmented with a 2.5-mm TEN. In Group 3, plate-screw fixation was augmented with two 2.5-mm TENs. Each bone model was positioned on a mechanical testing machine. Subsequently, three-point bending loads were applied to each bone to measure the force required for failure at the osteotomy site. The data were recorded on a computer connected to the test device and the bending strengths of all samples were calculated.
Results: There was no statistically significant difference in the bending strength (megapascals) between Groups 1 and 2 or between Groups 2 and 3 (p>0.05). However, the bending strength in Group 3 was significantly higher than in Group 1 (p<0.05).
Conclusion: The application of intramedullary TEN during surgery in long bone fractures, combined with a bridge plate, may be helpful to strengthen the fixation stability.

Citation: Eren E, Büyükdoğan H, Ertürk C, Türkcan JH, Keleşoğlu E. Does intramedullary elastic nail augmentation increase resistance to bending stress in plate fixation of long bones? A biomechanical study on lamb cadaveric femurs. Jt Dis Relat Surg 2023;34(3):620-627. doi: 10.52312/jdrs.2023.1041.

Ethics Committee Approval

Ethics committee decision is not required as the study was performed on sheep cadaver femurs.

Author Contributions

Idea/concept: C.E., E.E.; Design: E.E., C.E.; Control/supervision, critical review: C.E., H.B.; Data collection and/or processing, materials: E.E., J.H.T., E.K.; Analysis and/or interpretation: E.E., H.B., J.H.T.; Literature review, writing the article: E.E., H.B.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.