The effect of retained intramedullary nails on tibial bone mineral density

J. C. Allen, Ronald Lindsey, J. A. Hipp, Zbigniew Gugala, N. Rianon, A. LeBlanc

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Background: Intramedullary nailing has become a standard treatment for adult tibial shaft fractures. Retained intramedullary nails have been associated with stress shielding, although their long-term effect on decreasing tibial bone mineral density is currently unclear. The purpose of this study was to determine if retained tibial intramedullary nails decrease tibial mineral density in patients with successfully treated fractures. Methods: Patients treated with statically locked intramedullary nails for isolated, unilateral tibia shaft fractures were studied. Inclusion required that fracture had healed radiographically and that the patient returned to the pre-injury activity level. Data on patient demographic, fracture type, surgical technique, implant, and post-operative functional status were tabulated. Dual energy X-ray absorptiometry was used to measure bone mineral density in selected regions of the affected tibia and the contralateral intact tibia. Image reconstruction software was employed to ensure symmetry of the studied regions. Findings: Twenty patients (mean age 43; range 22-77 years) were studied at a mean of 29 months (range 5-60 months) following intramedullary nailing. There was statistically significant reduction of mean bone mineral density in tibiae with retained intramedullary nails (1.02 g/cm2 versus 1.06 g/cm2; P = 0.04). A significantly greater decrease in bone mineral density was detected in the reamed versus nonreamed tibiae (-7% versus +6%, respectively; P < 0.05). Interpretation: The present study demonstrates a small, but statistically significant overall bone mineral density decrease in healed tibiae with retained nails. Intramedullary reaming appears to be a factor potentiating the reduction of tibia bone mineral density in long-term nail retention.

Original languageEnglish (US)
Pages (from-to)839-843
Number of pages5
JournalClinical Biomechanics
Volume23
Issue number6
DOIs
StatePublished - Jul 2008
Externally publishedYes

Fingerprint

Nails
Tibia
Bone Density
Intramedullary Fracture Fixation
Post and Core Technique
Tibial Fractures
Computer-Assisted Image Processing
Photon Absorptiometry
Minerals
Software
Demography
Wounds and Injuries

Keywords

  • Bone mineral density
  • Intramedullary nailing
  • Tibia fracture

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

The effect of retained intramedullary nails on tibial bone mineral density. / Allen, J. C.; Lindsey, Ronald; Hipp, J. A.; Gugala, Zbigniew; Rianon, N.; LeBlanc, A.

In: Clinical Biomechanics, Vol. 23, No. 6, 07.2008, p. 839-843.

Research output: Contribution to journalArticle

Allen, J. C. ; Lindsey, Ronald ; Hipp, J. A. ; Gugala, Zbigniew ; Rianon, N. ; LeBlanc, A. / The effect of retained intramedullary nails on tibial bone mineral density. In: Clinical Biomechanics. 2008 ; Vol. 23, No. 6. pp. 839-843.
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