The Logic and Clinical Applications of Blocking Screws

The ideal form of fixation for displaced, extra-articular fractures of the distal tibia remains controversial. In the UK, open reduction and internal fixation with locking-plates and intramedullary nailing are the two most common forms of treatment. Both techniques provide reliable fixation but both are associated with specific complications. There is little information regarding the functional recovery following either procedure.We performed a randomised pilot trial to determine the functional outcome of 24 adult patients treated with either a locking-plate (n = 12) or an intramedullary nailing (n = 12). At six months, there was an adjusted difference of 13 points in the Disability Rating Index in favour of the intramedullary nail. However, this was not statistically significant in this pilot trial (p = 0.498). A total of seven patients required further surgery in the locking-plate group and one in the intramedullary nail group.This study suggests that there may be clinically relevant, functional differences in patients treated with nail versus locking-plate fixation for fractures of the distal tibia and differences in related complications. Further trials are required to confirm the findings of this pilot investigation.The mechanism of injury and the prognosis of displaced, extra-articular fractures of the distal tibia is different to that for pilon fractures. Their proximity to the ankle, however, makes the surgical treatment more complicated than the treatment of diaphyseal fractures of the tibia.

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“…'Blocking' (Poller) screws were used in four cases. 14 The fibula was fixed with a plate and screws in two cases.…”

Section: Resultsmentioning

confidence: 99%

A randomised pilot trial of “locking plate” fixation versus intramedullary nailing for extra-articular fractures of the distal tibia

Mauffrey

McGuinness

Parsons

et al. 2012

The Journal of Bone and Joint Surgery. British volume

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“…Since being introduced by Krettek et al [10,11], a blocking screw has been established as an important adjunct for intramedullary nailing and fracture reduction [4]. It can direct the intramedullary nail, control angular deformity, and increase stability of the bone-nail construct [4,16,19]. For tibial lengthening with the LON technique, the distraction-resisting force causes angulation of the nail in a limited medullary space, resulting in valgus deviation (Fig.…”

Section: Discussionmentioning

confidence: 99%

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Park

Ryu

Kim

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background During tibial lengthening, the soft tissues of the posterolateral compartment produce distraction-resisting forces causing valgus angulation. Although this occurs with the classic Ilizarov method, whether a valgus deformity develops with the lengthening over nail (LON) technique is questioned, because the intramedullary nail is thought to resist deforming forces and adequately maintain alignment of the distracted bone. Questions/purposes The purposes of this study were to (1) determine the amount of valgus deviation during tibial lengthening with the LON technique; and (2) analyze the factors that may be associated with valgus deviation with the LON technique. Methods Between June 2009 and September 2013, we performed 346 tibial lengthenings using the LON technique, lengthening and then nail technique, or lengthening with an intramedullary lengthening device. Sixty patients (120 tibias) who underwent bilateral lower leg lengthening with the LON technique were enrolled in this retrospective study. To limit the number of variables, we analyzed only the right tibia in all patients (60 tibias). The mean followup was 42 months (range, 26-71 months). The mean age of the patients was 25 years (range, 18-40 years). There were 36 male and 24 female patients. The mean final length gain was 67 ± 9 mm. The mean time for distraction was 100 ± 25 days. The overall valgus deviation was assessed by measuring the change in the medial proximal tibial angle and mechanical femorotibial angle on radiographs obtained before and after surgery and after completion of lengthening. Several demographic, surgical, and distraction-related variables were considered possible factors to prevent valgus deviation: proximal fixation method; presence of a blocking screw; diameter and length of the intramedullary nail; degree of nail insertion; length of the nail in the distal segment after completion of distraction; final length gain; and patient's BMI. During the period studied, the blocking screw was to maintain the mechanical axis in patients who had neutral or valgus alignment preoperatively, or to prevent more valgus change in patients who underwent acute correction of varus deformity intraoperatively. Uni-and multivariate analyses were conducted. Results Valgus deviation occurred during the tibial LON. The medial proximal tibial angle increased from 86°(95% CI, 85°-86°) to 90°(95% CI, 89°-91°) (p \ 0.001). The mechanical femorotibial angle changed from 2.2°varus (95% CI, 3°-1.4°varus) to 2.6°valgus (95% CI, 1.8°-3.4°E

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“…Bei nicht optimaler Platzierung können sie u. U. die Einbringung des Nagels unmög-lich machen oder, falls der Kontakt zum Nagel nicht ausreichend ist, funktionslos werden. Die Verwendung kräftiger Kirschner-Drähte, die nach Verriegelung des Nagels entfernt oder gegen eine Schraube ausgetauscht werden, kann das Prozedere bei der Verwendung von Pollerschrauben erleichtern [3,4,9]. The supplement containing this article is not sponsored by industry.…”

Section: Diskussionunclassified

Ausbleibende knöcherne Heilung bei proximaler Tibiaschaftfraktur

Meyer

2014

Trauma Berufskrankh

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The Logic and Clinical Applications of Blocking Screws

Cited by 118 publications

References 3 publications

A randomised pilot trial of “locking plate” fixation versus intramedullary nailing for extra-articular fractures of the distal tibia

A randomised pilot trial of “locking plate” fixation versus intramedullary nailing for extra-articular fractures of the distal tibia

Is there an Increase in Valgus Deviation in Tibial Distraction Using the Lengthening Over Nail Technique?

Ausbleibende knöcherne Heilung bei proximaler Tibiaschaftfraktur

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