Relationship between the Apex of Flexible Nail and the Level of Fracture: A Biomechanical Study



The use of flexible nails in paediatric femoral fractures is widely accepted. Flexible nails are uniformly bent in a C-shaped curve and apex (maximum curve of the nail) is matched to the fracture site. This biomechanical study analyzes how the relationship of the apex of the elastic nails to the level of the fracture influences the stiffness in a synthetic bone model.

Materials Methods

Twelve synthetic femurs were divided into three groups (n=4/group) depending on the level of fracture. Retrograde elastic nailing was performed with a pair of pre-bent C-shaped nails and inserted with the apex of the nail in middle of the shaft. We compared Group A (fracture 2.5cms distal to the middle of the shaft) group B (fracture in the middle of the shaft) and group C (fracture 2.5cms proximal to the middle of the shaft) using 4-point testing 90º (antero-posterior) and 0º (medio-lateral) to the plane of the nails.


Group A showed significantly higher stiffness in antero-posterior and medio-lateral planes.


This study demonstrates that when the cortical entry point and the apex of the nails are on either side of fracture has highest stiffness characteristics.

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