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Objectives: Using finite element analysis and biomechanical tests, the biomechanical behaviors of Medial Sustainable Nail (MSN) and Proximal Femoral Nail Antirotation (PFNA) were compared for the fixation of fracture type of AO/OTA 31-A2.3.Methods: Finite element software Abaqus 6.14 was used to conduct axial loading of 2100 N and we analyzed the von Mises stress distribution and the model displacement of two implant models. Biomechanical tests were separately conducted in the axial stiffness test and axial cyclical loading test on a mechanical testing machine.Results: The results indicate that von Mises stress of MSN was lower than that of PFNA, and the model displacement in the MSN group was lower than that in the PFNA group. In the axial stiffness tests, MSN group was stiffer than PFNA construct. With respect to the axial load to ultimate failure, the PFNA construct exhibited higher loads exceeding 4000 N while the MSN construct withstood 3313.8 ± 92.8 N. Specifically, F10mm was 2178.6 ± 133.2 N of the MSN group and 1822.6 ± 93.1 N of the PFNA group (P = 0.001). Additionally, X2100N was 9.8 ± 0.5 mm of the MSN group and 11.7 ± 0.7 mm of the PFNA group (P = 0.002). The MSN group exhibited superior performances in terms of the mean value of the vertical displacement, frontal rotation angle, and lateral rotation angle.Conclusions: The results indicated that the MSN construct might exhibit a better biomechanical performance when compared with that of the PFNA in reducing displacement and anti-varus in fracture type of AO/OTA 31-A2.3. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study was to evaluate the effectiveness of the treatment of massive tibial bone defects by ipsilateral fibula transport.Materials and Methods: Nine patients with massive tibial bone defects were retrospectively reviewed. There were 7 males and 2 females with an average age of 32.22 years. The mean length of bone defect was 15.67cm (range 13-25cm).Results: All patients were followed up and the mean time of follow up was 40.11 months (range 26-60 months). All the patients achieved bone union and the average external fixation time was 11.67 months (range 9-14 months). The mean degrees of knee extension were 2.2°(range 0-5°) and the mean degrees of knee flexion were 131.7° (range 120-140°). The mean degrees of ankle dorsiflexion were 8.9° (range 0-15°) and the mean degrees of ankle plantar flexion were 30° (range 20-40°).Conclusion: Our study suggested that ipsilateral fibula transport in the treatment of massive tibial bone defects acquired satisfying functional results. It may be a better choice for the patients without suitable proximal or distal tibia remnant to transport. [ABSTRACT FROM AUTHOR]