Distal Tibial Metaphyseal Fractures: Does Blocking Screw Extend the Indication of Intramedullary Nailing?

Abstract

Aim. To evaluate the clinical use of blocking screws as a supplement to stability in distal tibial metaphyseal fractures treated with statically locked intramedullary nail. Main Outcome Measurement. Alignment and reduction preoperatively, postoperatively, and at healing were the main outcome measured with an emphasis on maintenance of initial reduction on followup. Patients and Methods. This was a prospective study of 20 consecutive cases of distal tibial metaphyseal fractures treated with statically locked intramedullary nailing with supplementary blocking screw between August 2006 and September 2007 with a maximum followup of 3 years. Medullary canal diameter was measured at the levels of fracture and isthmus. Results. The mean diameter of tibia at the level of isthmus was 11.9 mm and at the fracture site was 22.9 mm. Mean length of distal fracture segment was 4.6 cm. Mean varus/valgus alignment was 10.3 degrees preoperatively and 1.7 degrees immediatly postoperatively and was maintained till union. Using Karlstrom-Olerud score the outcome was excellent to good in 90%. Conclusion. We conclude that the use of blocking screw as a supplement will aid in achieving and maintaining the reduction of distal tibial metaphyseal fractures when treated with intramedullary nailing thereby extending the indication of intramedullary nailing.

Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta‐Analysis

“…The result reported a clear benefit of angular‐stable locking system (ASLS) about increasing the stability of IMN by measured coronal and sagittal alignment 3–6 months after IMN. Moongilpatti Sengodan et al . performed a prospective study of approximately 20 patients with distal tibial metaphyseal fractures, and all of the participants were treated with statically locked intramedullary nailing with supplementary blocking screw.…”

Clinical and Radiographic Comparisons of Distal Tibia Shaft Fractures Stabilized with an Intramedullary Nail: Blocking Pin Versus Blocking Screw

“…Previous literature suggested using permanent BS as a supplement to IMN [9,11,23,24]. However, it must be noticed that our and their studies differed in several aspects.…”

“…The blocking screw (BS), introduced by Kretek et al [8,9], can narrow the medullary cavity and direct IMN to a desired position, which has become a popular surgical procedure for nailing a distal tibia shaft fracture. However, it has potential complications such as screw breakage, iatrogenic fracture, soft tissue irritation, and hardware removal [10][11][12][13][14].…”

Treatment Strategies for Nonunion After Intramedullary Nailing for Femoral Fracture: Experiences of Fifty Nonunion Patients

“…In addition, when the length of the intramedullary nail exceeds the fracture line, the longer part of the anti-swing force arm will be secured so that stronger anti-swing ability will be achieved. Thus the choice of intramedullary nail should be as long as possible and blocking screws can be used to limit this swing phenomenon [15]. Sometimes, however, exchange of intramedullary nails and increased blocking screws cannot prevent the torsion and pendulum of the fracture end, but the additional plate reduces rotation instability and pendulum due to its angular stability, making it a better choice.…”