Functional outcome of proximal third tibial fractures with intramedullary tibial locking nail and poller screws

Abstract

Background: Non-articular fractures of the proximal third of the tibia account for 5 to 11% of tibial shaft injuries. Closed management often leads to varus malunion, especially when the fibula is intact. Although intramedullary nailing may lead to valgus malunion, it can be useful for stabilising fractures with proximal fragments longer than 5 to 6 cm. Intramedullary nailing for metaphyseal tibial fractures with a short proximal fragment is associated with an increased risk of frontal- and sagittal-plane malalignment. This can be solved by the use of blocking screws or Poller screws. Methods: 20 men and 15 women aged 20 to 60 (mean, 35.4) years underwent intramedullary nailing supplemented with Poller screws for acutely displaced fracture. 90% of the fractures were caused by road traffic accidents. 29 cases had closed fractures and 6 had grade I or II compound fractures. Clinical and radiological outcome was evaluated. Results: In 32 cases, healing occurred after a mean of 4.2 (range, 3–9) months. In 1 case, there was non-union, which was resolved by bone grafting. One case was mal-united. 32 patients had recovered a full range of knee motion (0o–130o), and the remaining 3 patients attained flexion of 0o to 90o. According to the knee rating scale of the Hospital for Special Surgery, outcome was excellent in 32 patients, good in 2 and poor in 1 at final follow up. Preoperatively, of the 35 cases, 20 were varus, 15 were valgus. The range of varus to valgus was +22o to -10o. Postoperatively, 34 cases had