Functional outcome of distal third Metaphyseal Tibial fractures operated with reamed Intramedullary Tibia Nailing: Two versus three distal locking screws

Abstract

Introduction: Fractures of the distal metaphysis of the tibia can be nailed if a sufficient amount of bone is available distal to the fracture site to insert two or three locking screws. However, fractures in this region operated with nail fixation provide less stability as a result of metaphyseal flare, which reduces the contact between the nail and the endosteal surface. Aim: The purpose of this retrospective study was to assess the union and complications associated with distal third tibial fractures which were operated with reamed tibia nail with two versus three distal locking screws. Materials & Methods: The study was carried out between 2017-2019 in which fifty-seven patients were included in the study. In 25 patients 2 distal screws were inserted and in 32 patients 3 distal screws. Patients were followed up to the tibial fracture union (5–12 months with a mean of 7 months). Results: Our results showed, 4% of delayed unions in distal third fractures with two distal screws compared to 3.12% who had three distal screws. This is statistically insignificant (p>0.01). None of the patients developed non-union nor had screw breakage and residual ankle or knee pain. Conclusion: Our study showed that there was no statistically significant difference in the time taken for radiographic union and complications such as delayed union and non-union in distal third tibia fractures operated with tibia nailing when two or three distal locking screws were used. Therefore, we conclude that two distal locking screws are a necessity and three are a luxury. The increased distal locking screws do not influence the fracture union.

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