Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: A comparison between 1.0 and 1.5m bow designs

Schmutz, Beat, Amarathunga, Jayani P., Kmiec, Stanley, Yarlagadda, Prasad K., & Schuetz, Michael (2016) Quantification of cephalomedullary nail fit in the femur using 3D computer modelling: A comparison between 1.0 and 1.5m bow designs. Journal of Orthopaedic Surgery and Research, 11, Article Number-53.

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  • The radius of curvature (ROC) misfit of cephalomedullary nails during anterograde nailing can lead to complications such as distal anterior cortical encroachment. This study quantified the anatomical fit of a new nail with 1.0-m ROC (TFN-ADVANCED™ Proximal Femoral Nailing System [TFNA]) compared with a nail with 1.5-m ROC (Gamma3 Long Nail R1.5 [Gamma3]).


  • We generated 63 three-dimensional models (48 female, 45 right femur) representing the cortical surfaces of the femora (31 Caucasian, 28 Japanese, and 4 Thai). The mean age of the specimens was 77 years (±8.1), and the mean height was 158.5 cm (±9.6). Utilizing a customized software tool, nail fit was determined from the total surface area of nail protrusion from the inner cortex surface and maximum distance of nail protrusion in the axial plane; the position of the distal nail tip within the canal was also determined.


  • Overall, TFNA had both a significantly smaller mean total surface area of nail protrusion (915.8 vs. 1181.6 mm2; P < 0.05) and a mean maximum distance of nail protrusion in the axial plane (1.9 vs. 2.1 mm; P = 0.007) when compared with Gamma3. The mean total surface area of nail protrusion was significantly smaller with TFNA versus Gamma3 in both the Caucasian (P = 0.0009) and Asian (Japanese and Thai) samples (P = 0.000002); the mean maximum distance of TFNA protrusion was significantly smaller in Asians (P = 0.04), but not in Caucasians (P = 0.08). Most tip positions for both nail types were anterior, but TFNA had a higher number of center positions than Gamma3 (13 vs. 7) and a shift from the far anterior cortex to the center of the medullary canal (overall and in Caucasians). In Asians, the most prominent position was far anterior for both nails.


  • The 1.0-m ROC TFNA nail resulted in better fit than the 1.5-m ROC Gamma3 nail. Clinical trials and case studies should be conducted in the future to verify if these findings would also result in clinical improvements.

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ID Code: 97888
Item Type: Journal Article
Refereed: Yes
Keywords: Intramedullary nail, Nail fit, 3D modelling, Fracture fixation, Femur, Cephalomedullary
DOI: 10.1186/s13018-016-0389-7
ISSN: 1749-799X
Subjects: Australian and New Zealand Standard Research Classification > ENGINEERING (090000) > BIOMEDICAL ENGINEERING (090300) > Medical Devices (090304)
Divisions: Current > Institutes > Institute of Health and Biomedical Innovation
Current > QUT Faculties and Divisions > Science & Engineering Faculty
Copyright Owner: 2016 Schmutz et al.
Copyright Statement: This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Deposited On: 04 Aug 2016 00:57
Last Modified: 04 Aug 2016 21:56

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