In vitro biomechanical evaluation of antegrade femoral nailing at early and late postoperative stages

The present study addresses the question of evaluating, by combining both experimental and numerical methods, the stress/strain distribution within a standardized composite femur implanted with an anterograde intramedullary nail. A transverse diaphyseal fracture has been introduced in order to evaluate the implant response in the early postoperative clinical stage. By comparing these experimental data with those obtained in the fully healed stage, in which the bone continuity had been recovered, it was possible to get information on load sharing between the bone and the intramedullary nail, location of high strain concentrations, bone relative motion at the fracture site, and stiffness reduction caused by bone discontinuity. Experimental data were correlated with those predicted by a validated 3D finite element model of the complete implant/femur assembly to investigate the full field stress distribution either in the cortical bone, in the nail or in the locking screws. The obtained results suggest that full weight bearing in the immediate post-operating stage should not be allowed since high stress levels are generated in the outer shell of the cortical bone either around the proximal screw hole or the upper locking screw hole. Long-term implant reliability should be guaranteed instead, since after fracture consolidation equivalent von Mises stresses never exceed critical levels neither in the bone nor in the implant.