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Malalignment is a common complication in the treatment of distal fractures of the tibia. Numerous efforts have been made to reduce the malalignment ratio. However, the reported cases with this disorder are still high. This study aimed at investigating an adaptive design of an intramedullary nail with a novel interlocking mechanism (AINIM), as an alternative for the customary nailing, in reducing malalignment ratio. A verified finite element model was employed to compare the performance of AINIM with the customary nail. The finite element model of the tibia follows the exact shape of the medullary canal, and nonhomogeneous material properties were assigned to the bone from bone ash density. It was assumed that the nails were implanted and interlocked in the tibia according to surgical protocols, and physiological-like loading was applied to finite element models. The results of this study showed that AINIM reduces the mean shear interfragmentary strains by about 30%, and the axial interfragmentary strain by 55%, also it increases the uniformity in the interfragmentary movements, compared to the customary nail. It was also found that AINIM caused a reduction of the stress on the nail by 60%, and an increase of 25% on the bone, compared to the customary nail. Moreover, average compressive principal strains in the tibia fixed by AINIM increased by 40% from 485 to 678 με, compared to the tibia fixed by the customary nailing method. The results of this work also showed that AINIM causes an increase in the contact area with the intramedullary canal, particularly at the fracture site, and it also escalates the magnitude of contact pressure. Results of this work indicate that, from the biomechanical standpoint, the adaptive nail, i.e. AINIM, with an innovative interlocking mechanism, compared to the customary nailing, can lessen intra- and post-operative malalignment occurrence, and it also mitigates the side effects of stress shielding, and thus better conserves neighboring bone density in a long period.

Design and numerical investigation of an adaptive intramedullary nail with a novel interlocking mechanism