In-vitro evaluation of fatigue failure of locking screws in solid tibial nails

Unreamed nailing with solid tibial nails is an accepted method of treatment for open tibial shaft fractures up to grade III and of closed tibial fract ures with severe soft tissue damage. However, fatigue failure of the distal locking bolts is a frequent complication. We report a mechanical study inv estigating the fatigue limit of six different types of locking bolts used i n solid tibial nails (Biorigid Tibial nail/aap, UTN/ace, STN/Howmedica, TLN / Howmedica, Delta R & T Tibial nail/Smith & Nephew, AO/ASIF UTN/Synthes). Our results prove a direct correlation between the bolt's diameter and mech anical properties. Further more we found that bolts with a continuing threa d were weaker than bolts of the same diameter with only a short thread and an increased diameter at the nail's aperture. Our results suggest that mobi lization with half of the average body weight (350N) allows osseous consoli dation without fatigue failure of any of the tested locking bolts. Some of the tested locking bolts may even withstand full weight-bearing in a physio logical walking cycle, but will not withstand the stress of a running cycle .