Fractures of the Proximal Third Tibia Treated With Intramedullary Interlocking Nails and Blocking Screws

Abstract

BACKGROUND: Internal splintage of proximal metaphyseal tibial fractures has gained acceptance as a method of early stabilization of such injuries. Intramedullary nailing is a challenging procedure. This study tries to evaluate treatment outcomes of closed reduction and intramedullary nailing with the aid of blocking screws to maintain the reduction and stabilize theses injuries.

METHOD: Thirty patients (23 males and 7 females) with proximal metaphyseal tibial fractures were treated and followed from June 2010 and February 2014 (44 months) with average 19 months. Age ranged between 23 to 55 years (average, 38 years). According to A.O. Classification 13 cases were Type A2.1, 9 cases were Type A2.1 (II), and 8 cases were Type A3.2. Seven cases were open fractures and according to Gustilo Anderson classification 4 cases were Grade (I), 3 cases were Grade (II). All cases were treated by interlocking intramedullary tibial nailing assisted by the use of blocking screws technique.

RESULTS: The results had been evaluated through the following parameters: (pain, union, malunion, infection, range of motions, walking capacity, extension lag, knee stability and implant and technical failure. All cases had been united. Excellent alignment obtained in 27 fractures (90%). Knee and Ankle joints range of motions were equivalent to the unaffected side in 25 patients (82%). Two patients got superficial wound infection (2.7%). The final functional results were evaluated through modified Karlstrom-Olerud Score and we get: Excellent: 20 cases (66.7%), Good: 7 cases (23.3%), Satisfactory: 2 cases (6.7%) and Poor: 1 case (3.3%).

DISCUSSION: Intramedullary nailing of proximal tibial fracture is a load sharing procedure, sparing the extraosseous blood supply, avoiding additional soft-tissue dissection, thereby minimizing the risk of postoperative complications. Also, it reduces the length of hospital stay and costs, enables early mobilization and achieves satisfactory outcomes. However; it is a technically demanding procedure and may result in malalignment. Our aim is evaluating the clinical use of Pollar screws (blocking screws) as a supplement to stability fixation of these fractures with statically locked intramedullary nails.

CONCLUSION: Utilizing intramedullary interlocking nailing supplemented with blocking screws to aid in stabilizing proximal tibial fractures whether closed or open is a good method of treatment. The high proportions of excellent and good results in our series confirm that this technique is equal to other known methods of fracture fixation.