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Nail tibia-come-implants have become a popular choice in trauma and orthopedic surgeries. They are characterized by their design, which allows them to serve as intramedullary nails with the addition of multiple threaded holes situated around or on the external screw channel. This feature makes the nails suitable for both locked intramedullary applications and utilization as bone plates that would span distal fractures and amalgamate with other fixed hardware.
Tibial nails are available in various designs today, with each serving a specific purpose. They include:
Straight intramedullary nails
Straight intramedullary nails imbedded in the center of straight bone, allow for proper alignment and stability. It is important to note that the straight structure means these nails can be easily implemented on many lower limb bones.
Lag screw nails
A lag screw nail utilizes a combination of screw-and-slot design in which bone compressing screws firmly anchor the nail in place. This design encourages primary stability and reduces stiffness and faster healing, making it an ideal candidate in peri-fracture cases.
Anti-rotation nails
Anti-rotation nails include special features that prevent their rotation within the bone. This reduces the chances of metal failure and allows a patient to have longer bone integrity. Such features include anti-rotational bars and transverse screws that will help create a rigid construct that inhibits twisting and rotation even under intense activity.
Cannulated nails
Cannulated nails contain hollow shafts with smaller threaded cannulations allowing the surgeon to use guide wires for properly positioning the nails. This minimizes soft tissue irritation and significantly reduces surgery timeframe, as cannulated nails can be inserted under fluoroscopic technology.
Proximal femoral nail anti-rotation (PFNA)
As is clear from the name, proximal femoral nail anti-rotation is meant to fix fractures around the femoral head and neck. The design of the tibia nail includes an anti-rotation mechanism to hinder any rotational motion, which reduces the tendency of cut-outs occurring on the femoral head and improves fracture union.
Tibia nail surgery is an important aspect of bone fracture surgeries. This is because tibia nails are used to provide structural support during the healing process. Some of the tibia nails include Intramedullary tibial nail, and threaded intra-tibial cone/fatigue/vibrational test/IM tibial canal reamer is a minimally invasive surgical technique used to aid in fracture treatment. There are also several factors medical professionals must consider when purchasing tibia nail implants, including:
Nail material and biomechanical properties
The material used in constructing a tibia nail and its biomechanical features should differ according to the patient's requirement and the type of fracture they have. More robust materials like titanium and stainless iron are suitable for patients with low bone density or complex fractures in need of long-term support. These materials differ in their biomechanical properties, such as rigidity, elasticity, and tensile strength, which can affect the healing process. For example, elastic materials will reduce stress shielding and allow physiological bone loading, which in turn encourages natural bone healing.
Fracture characteristics and patient factors
The fixation device for fragility fractures in aged patients should be minimally invasive. It should also be something that doesn't require much force for fixation. On the other hand, for younger patients who are prone to high-energy fractures, bicortical screws, or more rigid implants, should be used to offer better stability against forceful activities.
Radiographic monitoring
The device type is selected based on how well the operating practitioner can monitor the device progression radiographically. Most external fixators allow better visual monitoring during healing compared to locked plated devices. Increased visibility can allow practitioners to make timely and essential decisions regarding the patient's treatment process.
Locking configurations and angular stability
With multiple locking configurations, angular stability and rotational stability are guarded against screw cut-out in osteoporotic bones and decrease stress concentration around the fracture area. Such locking-nail combinations are recommended for comminuted unstable fractures or in patients with low bone density.
Infection risks and surgical time
Infection is one of the highly rated postoperative complications. This is especially true for implants that puncture the skin layer, like external fixators. Such surgical procedures are usually accompanied by longer surgical times and increased tissue dissection, which increase the risk of infection. For this reason, internal fixation devices with a lesser tendency of puncturing the skin and requiring smaller incisions should be prioritized for patients with high tolerance to infections.
Tibia nail surgery is meant to perform structural support to bone fractures. This procedure uses an intramedullary tibial nail with associated reamers to complete the implantation of the nail into the canal of the tibia bone. Close monitoring of vital signs, fasting for several hours, and signing surgical procedure consent papers are some of the preparations a patient must prepare for before undergoing the surgery.
Surgeons usually perform tibia nail surgeries in therapy rooms equipped with all the tools necessary, including intramedullary nails, tibial reamers, screwdrivers, and locking screws. Moreover, general anesthesia is applied to put the patient in a supine position. Afterward, through small incisions, the surgeon inserts a guide wire into the fracture site, then uses a tibial reamer to create a canal in the tibia bone. The intramedullary tibial nail is carefully inserted over the guide wire and fixed into position using locking screws. Lastly, the incision is closed, and the patient is scheduled for rehabilitation and follow-up for bone healing and nail.
Some common postoperative and rehabilitation procedures usually emphasized after tibia surgeries include physical therapy with restricted movements in the early phase of rehabilitation. Additionally, regular follow-up with radiographic assessments for monitoring bone healing and implant position is done.
The integration between the implant and the bone is crucial for one to ensure a successful surgical outcome of tibia fracture surgery. Tibia nails are commonly constructed from robust biocompatible materials like titanium alloys and stainless steel, which, apart from having great tensile strength and corrosion resistance, are also very elastic. These properties enable them to withstand forces such as body weights and muscle pulls while reducing stress to the bony tissues and ensuring effective healing.
Meta analysis studies done a long time ago revealed that about 90% of fractures consolidated within 6 months. Fixation plays an essential role in whether the fracture will heal. Locked nails allow some minor movements, which are good for the healing process. The device type, fracture characteristics, and bone quality determine how long it will last. A locked nail with a rigid fixation should be used for complex fractures or elderly people with osteoporotic bones.
As for the maintenance of tibia nails, limited physical activities like jogging and high-impact sports should be done for several months are advised. Patients should be monitored for signs of infection around the surgical site. Patients are also advised to eat a calcium-rich diet for bone health. In that regard, regular check-ups and radiographs for monitoring implant position and bone healing are also advised.
A1: Tibia nails are made of robust materials, usually titanium alloys and stainless steel. These materials are highly elastic and have corrosion resistance properties. These two properties combined with the strength makes the material very elastic and hard to destroy, thus ideal for usage in tibia nail implants.
A2: Meta analysis studies have shown that 90% of fractures complete consolidation within 6 months. Though several factors play an important role in the duration of tibia nails, including fixation type, fracture characteristics, and bone quality, the general consensus is that tibia nails last up to 6 months, within which time the fracture completes consolidation.
A3: Low-impact activities like jogging should be done within the first months of the surgery to ensure the durability of the tibia nails. One should also be very cautious about signs of infection at the surgery site and make it a point to monitor the status of the nails regularly through radiographic assessments.
A4: Tibial nails act as an internal scaffold providing surgical support while the bone heals. Because of this structural support, the body weight and muscle activity during the healing process are neutralized and minimized.
