Retrograde tibial nailing of far distal tibia fractures: a biomechanical evaluation of double- versus triple-distal interlocking

Objectives Retrograde tibial nailing using the Distal Tibia Nail (DTN) is a novel surgical option in the treatment of distal tibial fracture. Its unique retrograde insertion increases the range of surgical options in far distal fractures of the tibia beyond the use of plating. The aim of this study was to assess the feasibility of the DTN for far distal tibia fractures where only double rather than triple-distal locking is possible due to fracture localisation and morphology. Methods Six Sawbones® were instrumented with a DTN and an AO/OTA 43-A3 fracture simulated. Samples were tested in two configurations: first with distal triple locking, second with double locking by removing one distal screw. Samples were subjected to compressive (350 N, 600 N) and torsional (± 8 Nm) loads. Stiffness construct and interfragmentary movement were quantified and compared between double and triple-locking configurations. Results The removal of one distal screw resulted in a 60–70% preservation of compressive stiffness, and 90% preservation of torsional stiffness for double locking compared to triple locking. Interfragmentary movement remained minimal for both compressive and torsional loading. Conclusions The DTN with a distal double locking can, therefore, be considered for far distal tibia fractures where nailing would be preferred over plating.

Iterative Methods for the Biomechanical Evaluation of Corneal Response. A Case Study in the Measurement Phase

the number of corneal surgeries steadily grew in recent years and boosted the development of corneal biomechanical models. These models can contribute to simulating surgery by reducing associated risks and the need for secondary interventions due to ectasias or other problems related to correcting other diseases. Biomechanical models are based on the geometry obtained with corneal topography, which is affected by intraocular pressure and material properties. Knowledge of stress distribution in the measurement phase is a key factor for improving the accuracy of in silico mechanical models. In this work, the results obtained by two different methods: prestress method and displacements method were compared to evaluate the stress and strain distribution in a general geometric model based on the Navarro eye geometry and two real corneal geometries. The results show that both methods are equivalent for the achievement of the stress distribution in the measurement phase. Stress distribution over the corneal geometry in the measurement phase is a key factor for accurate biomechanical simulations, and these simulations could help to develop patient-specific models and reduce the number of secondary interventions in clinical practice.