Quick blocking screw insertion in closed reduction and intramedullary nailing for distal tibial meta-physeal fractures

Abstract

Objective To explore the technique and clinical efficacy of quick blocking screw insertion in closed reduction and internal fixation with intramedullary nails for distal tibial metaphyseal fractures. Methods The data of 24 distal tibial metaphyseal fractures were retrospectively analyzed which had been treated with closed reduction and internal fixation with intramedullary nails from October 2013 to December 2014 at Department of Orthopaedics, Zhoukou Central Hospital. They were 17 males and 7 females, with an average age of 39.7 years (from 21 to 60 years). There were 2 open fractures of Gustilo type I. According to AO/OTA classification, 3 cases belonged to type 42-A2, 4 to type 42-A3, 6 to type 42-B1, 2 to type 42-B2, 3 to type 42-B3, 2 to type 42-C1, 3 to type 42-C2, and 1 to type 42-C3. In the internal fixation with in-tramedullary nails, the varus or valgus malalignment of the distal tibia was corrected by manual reduction. According to the fracture type, a 3.0 mm Schanz pin was placed in the concave or convex side of deformity first and then gradually replaced by a 4.5 mm blocking screw to maintain reduction. The operation time, bleeding volume, fracture healing time, and complications (including infection, hardware loosening or breakage, delayed union and nonunion) were recorded. The reduction quality and alignment were evaluated by postoperative X-ray and CT 3D reconstruction. The clinical efficacy was evaluated at the final follow-up based on the Johner-Wruhs criteria. Results The 22 patients were followed up for a mean time of 35.5 months (from 24 to 48 months). The average operation time was 68.3 minutes (from 50 to 85 minutes), and the average bleeding volume was 95 mL (from 60 to 150 mL). One case of delayed union was healed after dynamic treatment. The average healing time was 3.9 months (from 3 to 8.5 months). No infection, hardware loosening or breakage, or malunion was observed. According to the Johner-Wruhs evaluation at the final follow-up, 12 cases were excellent, 10 good and 2 fair, giving an excellent to good rate of 91.7%. Conclusion In the closed reduction and internal fixation with intramedullary nails for distal tibial metaphyseal fractures, the varus or valgus malalignment of the distal fragment can be quickly corrected by manual reduction and quick insertion of a blocking screw to gradually replace a preceding Schanz pin. Key words: Tibia; Fracture fixation, internal; Bone nails; Distal tibial metaphyseal fractures