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This study aimed to evaluate screw\u2013bone interface stability under combined axial and torsional cyclic loading for different distal locking configurations of intramedullary nails, focusing on the effects of screw number, spatial distribution, interscrew distance, and multiplanar versus coplanar fixation using a standardized synthetic bone model. Six distal locking configurations (n\u2009=\u20095 per group) were tested under stepwise cyclic axial compression, superimposed with a constant torsional moment (\u00b1\u20092 Nm, 2 Hz). Primary endpoints were cycles to failure, cycles to 1 mm axial displacement, and cycles to 0.5\u00b0 rotation. All constructs failed by progressive screw cut-through within the synthetic bone. The three-screw multiplanar configuration exhibited the highest endurance (\u2248\u200936,000 cycles to failure) and lowest micromotion (\u2248\u200934,000 cycles to 1 mm displacement), significantly outperforming the two-screw configurations overall (p\u2009=\u20090.002). Increasing interscrew distance from 10 mm to 34 mm improved migration resistance by approximately 25%, whereas the short 10 mm spacing led to premature failure. Blocked and free-hand configurations showed comparable behavior to the standard setup, indicating no added benefit from toggle elimination alone. Locking configuration decisively influences the performance of the implant-bone interface in intramedullary nail constructs. Multiplanar distal locking with adequate screw spacing enhances interface stability and may provide biomechanical advantages for metaphyseal fixation to reduce screw migration and early loss of fixation.<\/jats:p>","DOI":"10.1007\/s00068-026-03235-z","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T12:49:01Z","timestamp":1783514941000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Interface stability of intramedullary nail locking configurations under combined axial and torsional loading"],"prefix":"10.1007","volume":"52","author":[{"given":"Hollensteiner","family":"Marianne","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winkler","family":"Martin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gerber","family":"Claus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Borowsky","family":"Anja","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augat","family":"Peter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"3235_CR1","doi-asserted-by":"publisher","unstructured":"Attal R, Blauth M. 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Therefore, ethical approval and informed consent were not required.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"The authors declare that this study was conducted with institutional research funding from Stryker Trauma GmbH. The funding source had no influence on the study design, experimental setup, data collection, data analysis, interpretation of the results, or the preparation of the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"218"}}