Development of a Stable, Fatigue Resistant, Interlocked Intramedullary Nail Used to Treat Critical Sized Segmental Defects of the Tibia
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Tibia fractures are the most common of all long bone fractures. Large segmental defects (also known as critical-sized defects) of the tibia are difficult to treat due to the tibia's reduced blood supply and incomplete circumferential muscle coverage. Multiple techniques, including casting, rigid plating, external fixation, and intramedullary nailing have been developed in order to treat these kinds of defects. However, until more recently, most cases ultimately ended in amputation of the limb due to complications such as malunion or nonunion of the bone fragments. In order to successfully treat critical-sized defects of the tibia, an orthopedic implant of sufficient strength and stiffness, capable of resisting axial and rotational forces, must be employed. Therefore, it is proposed that the ideal treatment method for a critical-sized defect of the tibia should include reamed, interlocked, intramedullary nailing in conjunction with an autogenous cancellous bone graft packed around the defect. Interlocked intramedullary nailing was chosen because it provides the most rigid form of axial and rotational stability, while still allowing for controlled, interfragmentary movements, an essential component of proper bone regeneration.