Adnan Siddique P.1, Prateek Chandak M.2, Sasikumar Sasidharan3
BACKGROUND
Fractures of both proximal and distal metaphyses with small distal fragment of
tibia are not uncommon. Internal fixation using intramedullary nails alone could
lead to misalignment. Using blocking screws (Poller screws) in addition to
intramedullary nails would help in narrowing the medullary cavity and decreases
the degree of misalignment and chances of displacement. The present study was
conducted to evaluate functional and radiological outcome of blocking screws with
intramedullary nail in the treatment of proximal and distal metaphyses fractures
of tibia with short distal fragment.
METHODS
A prospective observational study of 34 patients with proximal and distal tibial
metaphyses fractures was treated with statically locked intramedullary nailing with
supplementary blocking screws. The study was conducted from January 2018 to
December 2020 with a maximum follow up of 18 months. Medullary canal diameter
was measured at the levels of fracture and isthmus.
RESULTS
Among the 34 patients, 29 (85.29 %) were males and 05 (14.70 %) were females
with a male to female ratio of 5.8 : 1. The mean age was 34.97 ± 3.10 years. The
mean healing period was 20 ± 1.45 weeks. 25/34 (73.52 %) of the patients
showed Karlstrom and Olerud functional grading score of excellent. The fracture
varus/valgus alignment was 1.9 ± 0.3 degrees. The mean
antecurvatum/recurvatum alignment was 0.3 degrees.
CONCLUSIONS
Blocking screws act as reduction tools, help in reducing the medullary lumen of
distal metaphyses and prevent failures in initial reduction. They extend the
indication of intramedullary nailing to the distal segment of tibia and minimize the
misalignment in terms of varus /valgus and/or antecurvatum/recurvatum.
