Do two distal locking screws in two planes offer the best option in the nailing of diaphyseal tibial fractures?

• Published in: Journal of clinical orthopaedics and trauma 2024-12, Vol.59, p.102802, Article 102802
• Main Authors: Pereira, Sebastian, Garabano, Germán, Alamino, Leonel Perez, Bidolegui, Fernando, Angel Pesciallo, Cesar
• Format: Article
• Language: English
• Subjects: Biplanar; Distal lock configuration; Distal locking screw; Intramedullary nailing; Tibial shaft fractures
• ISSN: 0976-5662
• DOI: 10.1016/j.jcot.2024.102802

Although the intramedullary nail represents the treatment for most tibia diaphyseal fractures, there is no agreement on the configuration of the distal locking screws. Therefore, this study aimed to investigate the impact of the configuration of distal locking bolts on the healing of a tibial shaft fracture. We retrospectively analyzed 170 closed fractures of the tibia diaphyseal operated consecutively between 2018 and 2021. Patients with postoperative unacceptable reduction (>5° in any plane or gap >4 mm), nail-canal ratio 30, diabetes), fracture type (OTA/AO), the number (one, two, three distal locking screws), and configuration (uniplanar, biplanar, triplanar) of distal locking screws between patients with and without a bone union. One hundred and forty-two fractures were available for analysis. The bone union and non-union rates were 89.4 % (n = 127) and 10.6 % (n = 15), respectively. The multivariate analysis showed that type A fractures (OR 6.67, p = 0.010) and using two distal locking screws with a biplanar configuration (OR 3.63, p = 0.036) were independent variables related to bone union. In contrast, smoking habit (OR 0.12, p = 0.041), fractures type B (OR 0.22, p = 0.013), and uniplanar fixation (OR 0.51, p = 0.003) were related to non-union. The findings of this study suggest that using two distal locking screws (anteroposterior + mediolateral) in the nailing of closed tibial diaphyseal fracture represents the optimal configuration, offering a higher likelihood of healing compared to other locking options.