Key result
Statically locked intramedullary nailing with blocking screws is linked to ~74% excellent tibial fracture outcomes.
Why the study?
Intramedullary nails alone for proximal and distal tibial metaphyses fractures can lead to misalignment, while supplementary blocking screws may narrow the canal and prevent displacement.
Does statically locked intramedullary nailing with supplementary blocking screws improve functional and radiological outcomes in patients with proximal and distal tibial metaphyses fractures?
Observational (n=34)
No
Does statically locked intramedullary nailing with supplementary blocking screws improve functional and radiological outcomes in patients with proximal and distal tibial metaphyses fractures?
Blocking screws used with intramedullary nails for tibial metaphyses fractures provide excellent functional outcomes and minimize misalignment.
May support blocking screws with nailing for tibial fractures; leaves open need for RCTs to confirm benefit.
BACKGROUND Fractures of both proximal and distal metaphyses with small distal fragment of tibia are not uncommon. Internal fixation using intramedullary nails alone could lead to misalignment. Using blocking screws (Poller screws) in addition to intramedullary nails would help in narrowing the medullary cavity and decreases the degree of misalignment and chances of displacement. The present study was conducted to evaluate functional and radiological outcome of blocking screws with intramedullary nail in the treatment of proximal and distal metaphyses fractures of tibia with short distal fragment. METHODS A prospective observational study of 34 patients with proximal and distal tibial metaphyses fractures was treated with statically locked intramedullary nailing with supplementary blocking screws. The study was conducted from January 2018 to December 2020 with a maximum follow up of 18 months. Medullary canal diameter was measured at the levels of fracture and isthmus. RESULTS Among the 34 patients, 29 (85.29 %) were males and 05 (14.70 %) were females with a male to female ratio of 5.8 : 1. The mean age was 34.97 ± 3.10 years. The mean healing period was 20 ± 1.45 weeks. 25/34 (73.52 %) of the patients showed Karlstrom and Olerud functional grading score of excellent. The fracture varus/valgus alignment was 1.9 ± 0.3 degrees. The mean antecurvatum/recurvatum alignment was 0.3 degrees. CONCLUSIONS Blocking screws act as reduction tools, help in reducing the medullary lumen of distal metaphyses and prevent failures in initial reduction. They extend the indication of intramedullary nailing to the distal segment of tibia and minimize the misalignment in terms of varus /valgus and/or antecurvatum/recurvatum.
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P. et al. (2021) conducted an observational in Proximal and distal tibial metaphyses fractures (n=34). Statically locked intramedullary nailing with supplementary blocking screws was evaluated on Functional and radiological outcome (Karlstrom and Olerud functional grading score). Statically locked intramedullary nailing with supplementary blocking screws yielded excellent functional outcomes in 73.52% of patients with tibial metaphyses fractures.
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