J Korean Orthop Assoc.  2017 Jun;52(3):240-248. 10.4055/jkoa.2017.52.3.240.

The Usefulness of Blocking Screw in Intramedullary Nail of Distal Tibial Metaphyseal Fracture

• Jo S
• Lee SH
• Lee JY
• Jun YC

• KMID: 2384554
• DOI: http://doi.org/10.4055/jkoa.2017.52.3.240

Abstract

PURPOSE
To evaluate the usefulness of blocking screws in distal tibial metaphyseal fractures treated with intramedullary nailing.
MATERIALS AND METHODS
A total of 18 patients with distal tibial metaphyseal fractures, who underwent intramedullary nailing treatment with blocking screws between January 2012 and December 2014 and had a minimum follow-up of 1 year, were retrospectively reviewed for analysis. There were 7 patients with open fracture and 4 patients with intra-articular fracture. The location of the blocking screws was previously determined according to the fracture pattern. Moreover, the preoperative and postoperative angular alignment was measured. Patients received regular postoperative radiographic check-up, and the time-to-bone union and the incidence of nonunion were recorded. The clinical outcome was evaluated using the modified functional Kalstrom-Olerud score.
RESULTS
All fractures healed completely without nonunion at an average of 17.7 weeks. The mean coronal/sagittal alignment improved from 6.4/4.8 degrees preoperatively to 2.5/1.9 degrees postoperatively. The alignment was maintained until complete union. There were 3 cases of anterior knee pain but no complications related to the blocking screw and wound infection. Using a modified functional Karlstrom-Olerud score, the outcome was considered good to excellent in 83.4% of the patient cohort.
CONCLUSION
We conclude that the blocking screws may help the maintenance of reduction and alignment in distal tibial metaphyseal fractures treated with intramedullary nailing.

Keyword

blocking screw; distal tibial metaphyseal fracture; intramedullary nail

MeSH Terms

Cohort Studies
Follow-Up Studies
Fracture Fixation, Intramedullary
Fractures, Open
Humans
Incidence
Intra-Articular Fractures
Knee
Retrospective Studies
Wound Infection

Figure

• 

  Figure 1 (A) Anteroposterior and lateral radiograph of a 58-year-old male showing distal tibial metaphyseal fracture due to motor vehicle accident. (B) Postoperative radiographs showing well maintained alignment with intramedullary nailing. (C) Interlocking screw breakage and valgus angulation at 4 months postoperatively.

• 

  Figure 2 (A) To determine the position of the blocking screw, a line is drawn along the long axis of the distal fragment. Bisecting the first line, a second line is drawn along the plane of the main fracture line. The blocking screw (circle) is placed in the acute angle of the metaphyseal segment. (B) Three-dimensional reconstruction image of distal tibial metaphyseal fracture for positioning the blocking screw. Cited from the article of Hannah et al. (Injury. 2014;45:1011-4).11)

• 

  Figure 3 (A) Fluoroscopic view showing blocking screw placement in the preselected position after guidewire insertion. Satisfactory reduction obtained after nail insertion, anteroposterior view (B), and lateral view (C). Posteoperative anteroposterior (D) and lateral view (E).

• 

  Figure 4 (A) Radiograph showing distal tibial metaphyseal fracture with intraarticular extension in a 56-year-old female due to a car accident. (B) After in situ fixation of intraarticular fracture, blocking screw assisted interlocking nailing was performed. (C) Healed fracture 5 months postoperatively.

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