Abstract
Background
In a systematic review of 1125 distal tibia fractures treated with an intramedullary nail, the reported incidence of malalignment was 14%. The purpose of our study is to assess whether the addition of blocking screws during intramedullary nailing of a distal tibia fracture improved radiological outcomes. As a secondary outcome, the time to radiographic union was compared to see if a more rigid bone-implant construct had an effect on healing.
Methods
We searched computerised records at a UK level 1 major trauma centre. The joint alignment was measured on the immediate post-operative radiograph and compared to the most recent radiograph. We used a difference of 2 degrees to indicate a progressive deformity and a RUST score greater or equal to 10, to indicate radiographic fracture union.
Results
Twenty-seven patients were included. Nineteen patients had no blocking screw and 8 patients had a blocking screw. Five patients had a difference in their coronal plane alignment of 2 degrees or more (3/5 had no blocking screw). The results were analysed and found to be not statistically significant (p=0.88). The addition of a blocking screw has also been shown not to have an effect on the time to union.
Conclusion
We have changed our surgical practice. We use a 2.5mm blocking wire to aid in fracture reduction prior to reaming / nail insertion and then remove the wire when the nail has been adequately locked.
Implications
This could save surgical procedure time, radiation exposure for the patient, implant costs and potential complications.
