Philip Beak1, Shyam Moudhgalya2, Thomas Anderson3, Caroline B Hing3. 1. Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK. Philip.beak@nhs.net. 2. St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK. 3. Department of Trauma and Orthopaedics, St George's Hospital, St George's University Hospitals NHS Foundation Trust, London, UK.
Abstract
BACKGROUND: Tibial fractures represent approximately 3-4% of reported fractures. Locked, intramedullary nails are commonly used to restore length and alignment and provide rotational stability. Few studies have assessed the complication rate of locking screws. MATERIALS AND METHODS: We conducted a retrospective observational study of all patients who underwent tibial nailing at our institution between the 01/01/15 and 30/06/17. All patients were followed up for at least 1 year post-operatively. For inclusion, patients had to be over 16 years of age and had undergone tibial nail fixation following a traumatic fracture. Post-operative radiographs were used to assess the configuration and features of locking screws. RESULTS: One hundred and twenty-six individuals underwent tibial nailing over the 30-month period, with 95 followed up at least 1 year. Twenty-seven per cent of individuals reported pain attributed to locking screws at follow-up. Upon radiographic assessment, no significant difference was seen between symptomatic and asymptomatic cohorts in terms of proud screw heads proximally (7% vs 5%, p > 0.99) or distally (14% vs 17%, p > 0.99), long screw tips proximally (52% vs 48%, p = 0.81) or distally (51% vs 50%, p > 0.99), or tibiofibular joint penetration proximally (31% vs 23%, p = 0.60). However, there was a higher incidence of distal tibiofibular joint penetration in symptomatic versus asymptomatic individuals (4% vs 25%, p = 0.025). CONCLUSION: Twenty-seven per cent of patients with a tibial nail report painful locking screws. Patients with symptomatic distal locking screws had a higher incidence of radiographic distal tibiofibular joint penetration.
BACKGROUND: Tibial fractures represent approximately 3-4% of reported fractures. Locked, intramedullary nails are commonly used to restore length and alignment and provide rotational stability. Few studies have assessed the complication rate of locking screws. MATERIALS AND METHODS: We conducted a retrospective observational study of all patients who underwent tibial nailing at our institution between the 01/01/15 and 30/06/17. All patients were followed up for at least 1 year post-operatively. For inclusion, patients had to be over 16 years of age and had undergone tibial nail fixation following a traumatic fracture. Post-operative radiographs were used to assess the configuration and features of locking screws. RESULTS: One hundred and twenty-six individuals underwent tibial nailing over the 30-month period, with 95 followed up at least 1 year. Twenty-seven per cent of individuals reported pain attributed to locking screws at follow-up. Upon radiographic assessment, no significant difference was seen between symptomatic and asymptomatic cohorts in terms of proud screw heads proximally (7% vs 5%, p > 0.99) or distally (14% vs 17%, p > 0.99), long screw tips proximally (52% vs 48%, p = 0.81) or distally (51% vs 50%, p > 0.99), or tibiofibular joint penetration proximally (31% vs 23%, p = 0.60). However, there was a higher incidence of distal tibiofibular joint penetration in symptomatic versus asymptomatic individuals (4% vs 25%, p = 0.025). CONCLUSION: Twenty-seven per cent of patients with a tibial nail report painful locking screws. Patients with symptomatic distal locking screws had a higher incidence of radiographic distal tibiofibular joint penetration.
Authors: Roy W Sanders; Thomas G DiPasquale; Charles J Jordan; John A Arrington; H Claude Sagi Journal: J Orthop Trauma Date: 2014-08 Impact factor: 2.512
Authors: Mohit Bhandari; Gordon Guyatt; Paul Tornetta; Emil H Schemitsch; Marc Swiontkowski; David Sanders; Stephen D Walter Journal: J Bone Joint Surg Am Date: 2008-12 Impact factor: 5.284