Advancing the Science

Mayo Clinic Medical Science Blog – an eclectic collection of research- and research education-related stories: feature stories, mini news bites, learning opportunities, profiles and more from Mayo Clinic.

October 18, 2019

Mayo colleagues design adjustable fracture nail to improve patient outcomes

By Advancing the Science contributor
Christine Mehner, M.D., and Toni Turnbull, Ph.D., teamed up to help orthopedic patients. Why? Because 'there must be something better'.

By Sandy Shortridge

Prompted by a health care innovation competition at Mayo Clinic’s Jacksonville, Florida, campus, two innovators recently joined forces and developed a new tool designed to reduce pain and shorten recovery time for patients with long bone fractures.

The idea for their adjustable fracture nail started when Christine Mehner, M.D., a predoctoral Ph.D. student, and Toni Turnbull, Ph.D., a neuroscience research fellow, heard about the Alligator Tank competition. Modeled after TV's "Shark Tank," the Alligator Tank competition is where aspiring Mayo entrepreneurs and inventors get a chance to pitch ideas to a panel of expert judges — alligators instead of sharks — to secure funding for their projects.

Drs. Mehner and Turnbull started brainstorming potential solutions to problems that they had faced in their work. From her time as an orthopedic surgery resident, Dr. Mehner had experienced firsthand the challenges surgeons encounter when setting fractures to long bones such as the tibia. She thought to herself, "There must be a better way."

A better way

Tibia fractures are difficult to set. In addition to the broken bone, the foot often is rotated out of alignment with the rest of the leg. Rotating the foot into an ideal position requires extensive manipulation in the operating room and, depending on the complexity of the fracture, adjustments can be challenging, especially for less-experienced surgeons.

"Unfortunately, in more than 50% of cases, patients have a rotation error after surgery, so the foot on the injured leg no longer mirrors the position of the healthy side," Dr. Mehner says.

If a patient's foot is rotated inward or outward beyond 30 degrees from its original position, over time it can severely affect the adjacent joints, including the knee, hip and ankle.

"Millions of patients worldwide suffer from this condition after surgery to repair a tibia fracture," Dr. Mehner says.

"Currently there's not a lot that can be done to help, except prescribing pain-reducing drugs and rehabilitation," Dr. Turnbull says.

Drs. Mehner and Turnbull set out to solve this problem by designing an adjustable nail that can be used in orthopedic surgery to stabilize long bone fractures. The nail allows for guided adjustment for each patient, resulting in better long-term outcomes. The adjustable nail uses internal rotation to open the fracture, move the alignment so the foot is in place, and then close the fracture. It provides for simple and fast fine-tuning of a fractured limb.

Though this work was a departure from their day-to-day duties, it is driven by an overarching interest in solving problems and helping patients. Dr. Mehner is a predoctoral student in molecular biology and biochemistry whose research focuses on ovarian cancer. Dr. Turnbull is a neuroscientist studying stroke and degenerative mechanisms in the brain.

A tale of 2 tanks: Swimming with alligators, walleyes

In October 2018, it was time for the innovators to share their solution at the event that inspired their big idea: the Alligator Tank competition in Florida. Dr. Mehner described the pitch competition as the "biggest rallying of support" and a great opportunity for exposure.

"After our two-minute pitch, it was clear this idea was going somewhere, which was really fantastic. It was a great feeling," she says.

The adjustable fracture nail was chosen as one of three winners in the 2018 Alligator Tank competition and advanced to the Walleye Tank competition in Rochester, Minnesota.

Following the Walleye Tank competition, enthusiasm continued to build. Mayo Clinic connected Drs. Mehner and Turnbull with a Minnesota-based engineering company that is creating a prototype of the adjustable fracture nail to be tested at Mayo Clinic in Florida later this year.

Both inventors say they are grateful for the support they've received, including guidance from Magdalena Cichon, Ph.D., of Mayo Clinic Ventures, as well as funding and encouragement from Jordan D. Miller, Ph.D., and Mayo Clinic's Surgery Research Center. Since the Walleye Tank competition counts as a public disclosure, Mayo helped secure a provisional patent for the adjustable fracture nail.

While Dr. Turnbull describes the past year as a huge learning curve, she's grateful for the backing from colleagues across Mayo Clinic. "It's really amazing because where else can you get this kind of opportunity to see something from an idea all the way through to prototype?" she says.

Drs. Mehner and Turnbull now have set their sights on helping surgeons and patients worldwide with the adjustable fracture nail. Once they have a functional prototype, they'll approach a surgical device company to develop the nail for broad use to repair varying types of long bone fractures, including the humerus and femur. They believe the adjustable fracture nail has the potential to completely replace current versions of intramedullary nails, making surgery easier and faster for surgeons, and helping patients by reducing pain, shortening recovery time, lessening rehab needs, and reducing permanent chronic pain and injury.

Thinking differently to meet patient needs

Dr. Mehner and Dr. Turnbull encourage fellow innovators.

"Learning to think innovatively is like all things — the more you do it, the better you get at it," Dr. Turnbull says. "The first time someone presents you with a problem, it's harder to get to a potential solution. But the more you do it, the easier it becomes."

Dr. Mehner agrees. "Almost any system, method or technology that we work with can be improved. For us, the need for improvement is driven by an unmet patient need," she says. "The goal of this invention is better patient outcomes, faster and improved healing, shorter surgery times, and a universally easier application."

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Tags: Christine Mehner, Innovations, medical innovation, orthopedics, People, Toni Turnbull

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