Fixation of proximal and distal tibial fractures by intramedullary nail and blocking screws

Abstract

Introduction Intramedullary fixation of the metaphyseal fractures of the tibia with a short proximal or distal fragment is associated with an increased rate of malalignment. The use of blocking screws (Poller screws) bedside the intramedullary nail narrows the medullary cavity and decreases the degree of nail translation and malalignment. Patients and methods Between January 2012 and May 2013, 20 cases of metaphyseal tibial fractures were included in the study. There were 12 males and eight females, with the mean age of these patients was 36 years (range: 19–60 years). Fracture site was the proximal segment in seven cases and the distal segment in 13 cases. Intramedullary fixation supplemented by blocking screws was done in all cases. Results The average duration of the follow-up was 33 weeks (range: 19–54 weeks). A total of 16 patients achieved union with maintenance of the alignment of their fractures. One patient progressed to 5° of valgus and healed at this position, and three patients had persistent 2° of varus deformity. One of these patients experienced fissure fracture at the site of blocking screw. Delayed weight bearing and casting was done for 6 weeks, and the fracture was healed with 3° of varus of the proximal segment. Conclusion This technique is recommended to treat proximal and distal tibial fractures that minimizes the malalignment rate and allow early return to activities.