Ramsey et al: Comparison of tibial alignment following bent or straight interlocking nail fixation for dogs with diaphyseal tibial fractures
Veterinary Surgery 8, 2025

Comparison of tibial alignment following bent or straight interlocking nail fixation for dogs with diaphyseal tibial fractures

🔍 Key Findings

  • Straight interlocking nails (sILN) resulted in a significantly higher postoperative TPA compared with the contralateral limb (+5°), whereas bent nails (bILN) increased TPA by only +1°.
  • Bent interlocking nails achieved closer-to-anatomic tibial plateau alignment than straight nails (p < .0001).
  • Both techniques resulted in mild valgus malalignment (~2°) compared with the contralateral limb, but this was not clinically significant.
  • No significant differences in medial mechanical proximal tibial angle (mMPTA) were detected between groups.
  • Medullary canal fill was higher with bent nails (by ~6.6%), suggesting improved coaxial nail placement.
  • Missed bolt hole frequency did not differ between straight and bent nail techniques.
  • Complication rates were very low, with only one clinically relevant malalignment reported in the bent nail group.
  • Despite higher TPA in the straight nail group, no increased incidence of CCL rupture was identified during follow-up.

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Ramsey et al: Comparison of tibial alignment following bent or straight interlocking nail fixation for dogs with diaphyseal tibial fractures
Veterinary Surgery 8, 2025

🔍 Key Findings

  • Straight interlocking nails (sILN) resulted in a significantly higher postoperative TPA compared with the contralateral limb (+5°), whereas bent nails (bILN) increased TPA by only +1°.
  • Bent interlocking nails achieved closer-to-anatomic tibial plateau alignment than straight nails (p < .0001).
  • Both techniques resulted in mild valgus malalignment (~2°) compared with the contralateral limb, but this was not clinically significant.
  • No significant differences in medial mechanical proximal tibial angle (mMPTA) were detected between groups.
  • Medullary canal fill was higher with bent nails (by ~6.6%), suggesting improved coaxial nail placement.
  • Missed bolt hole frequency did not differ between straight and bent nail techniques.
  • Complication rates were very low, with only one clinically relevant malalignment reported in the bent nail group.
  • Despite higher TPA in the straight nail group, no increased incidence of CCL rupture was identified during follow-up.

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Multiple Choice Questions on this study

In Ramsey 2025 et al., on tibial alignment, which alignment parameter did NOT differ significantly between straight and bent ILN techniques?

A. Tibial plateau angle
B. Coronal angulation
C. Medullary canal fill
D. Medial mechanical proximal tibial angle
E. Valgus deviation

Answer: Medial mechanical proximal tibial angle

Explanation: The mMPTA did not differ significantly between groups or from the contralateral limb.
In Ramsey 2025 et al., on tibial alignment, which statement regarding complications is most accurate?

A. Straight nails caused frequent implant failure
B. Bent nails significantly increased missed bolt rates
C. Bent nails were associated with frequent CCL rupture
D. Overall complication rates were very low
E. Both groups had high infection rates

Answer: Overall complication rates were very low

Explanation: Only one clinically relevant malalignment was reported and no increase in missed bolts or infection was identified.
In Ramsey 2025 et al., on tibial alignment, which technique most closely restored anatomic tibial plateau angle?

A. Straight ILN with larger diameter
B. Straight ILN with higher canal fill
C. Bent interlocking nail
D. Dynamic interlocking nail
E. Plate-rod construct

Answer: Bent interlocking nail

Explanation: Bent ILNs resulted in only ~1° increase in TPA, significantly closer to the contralateral limb than straight nails.
In Ramsey 2025 et al., on tibial alignment, what was the mean postoperative increase in tibial plateau angle (TPA) with straight interlocking nails?

A. ~1°
B. ~2°
C. ~3°
D. ~5°
E. ~10°

Answer: ~5°

Explanation: The straight ILN group showed an average increase in TPA of approximately 5° compared with the contralateral limb.
In Ramsey 2025 et al., on tibial alignment, what effect did bent interlocking nails have on medullary canal fill?

A. It was lower than straight nails
B. It was unchanged
C. It was higher by approximately 6.6%
D. It exceeded 95% in all cases
E. It was clinically irrelevant

Answer: It was higher by approximately 6.6%

Explanation: The bILN group demonstrated significantly greater medullary canal fill compared with the sILN group.

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