PubMed · 6866467
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K M Sivash, K M Sherepo, G E Parshutin, M S Podgornov. 1983. [A pin for tibia osteosynthesis].. https://pubmed.ncbi.nlm.nih.gov/6866467/
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The main feature of osteogenesis imperfecta is an excessive fragility and deformability of the bones owing to reduced mass and bone quality. This leads to angular deformity and frequent fractures. These fractures usually heal rapidly, and conservative treatment is the norm. In displaced and unstable fractures, elastic intramedullary nailing is a treatment option. We report a case of a 3-year-old child with osteogenesis imperfecta type I who suffered an undisplaced femoral shaft fracture in the presence of a preexisting 32 degrees femoral antecurvation. This deformity greatly increases the risk of a refracture due to the pathological induction of stress risers. Therefore, fracture treatment by unreamed elastic intramedullary nailing was combined with simultaneous correction osteotomy, resulting in anatomic alignment and uncomplicated fracture healing. The single-stage surgical stabilization performed allowed rapid mobilization along with a decreased likelihood of refracture.
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Intramedullary nails are routinely used in the treatment of fractures of the femur. While their effectiveness has been demonstrated clinically, a number of complications, including bone refracture and implant failure, persist. This paper presents novel three-dimensional finite element (FE) models, at four stages of gait, of: (i) a realistic femur analogue known as third generation composite bone, and (ii) a system consisting of an intramedullary nail implanted in the femur of (i). A comparison of experimentally measured strains on the surface of the femur with those predicted by the FE model revealed good agreement. The models were then used to identify implant/bone load sharing patterns, and areas of stress concentration in both the intramedullary nail and the bone, when statically locked by one or two screws at either end. The results of this study can be used to guide future implant design and surgical procedure.