Innovative distal bolt-locking screw tibial nailing method and conventional nailing: A comparison of outcomes

Abstract

Objectives: Distal bolt-locking screw (DSBLS) tibial nailing offers an innovative method in which the nail is locked upon entering the screw. The current study compares the clinical, radiological, and functional outcomes of DSBLS tibial nails with conventional tibial nails. Patients and Methods: We retrospectively evaluated 38 tibial fractures of 37 patients treated with intramedullary nailing. In Group 1, 21 fractures were treated with DSBLS nailing, while in Group 2, 17 fractures were treated with conventional nailing. Duration of surgery, time to weight-bearing, time to union, presence of deformity, return to work and sports, complications, American Orthopedic Foot and Ankle Society Score (AOFAS) and Olerud-Molander Ankle Score (OMAS) values were compared between the groups. Results: Group 1 patients had significantly shorter time to full weight-bearing than patients in Group 2 (P=0.032). There was no significant difference between the groups in functional comparisons according to the AOFAS. In contrast, the outcomes of Group 2 were better than those of Group 1 according to the OMAS (P=0.475 and P=0.037). The outcomes for the other variables were similar. Conclusion: In this method, patients can bear weight in a shorter time. The results of DSBLS nailing are as good as conventional nails, and it can be safely preferred in treating tibial fractures with intramedullary nailing.

Keywords

• DSBLS
• Distal bolt-locking screw
• Tibia
• Tibia nailing
• Tibia fracture

References

1. Nork SE, Schwartz AK, Agel J, Holt SK, Schrick JL, Winquist RA. Intramedullary nailing of distal metaphyseal tibial fractures. J Bone Jt Surg – Ser A 2005;87:1213-21. doi:10.2106/ JBJS.C.01135.
2. Tejwani N, Polonet D, Wolinsky PR. Controversies in the intramedullary nailing of proximal and distal tibia fractures. J Am Acad Orthop Surg 2014;22:665-73. doi:10.5435/ JAAOS-22-10-665.
3. Tarr RR, Wiss DA. The mechanics and biology of intramedullary fracture fixation. Clin Orthop Relat Res 1986;212:10-7.
4. Lowenberg DW, DeBaun MR, Behn A, Sox-Harris A. Interlocking screw configuration influences distal tibial fracture stability in torsional loading after intramedullary nailing. Eur J Orthop Surg Traumatol 2020;30:1205-13. doi:10.1007/s00590-020-02686-3.
5. Horn J, Linke B, Höntzsch D, Gueorguiev B, Schwieger K.. Angle stable interlocking screws improve construct stability of intramedullary nailing of distal tibia fractures: A biomechanical study. Injury 2009;40:767-71. doi:10.1016/j. injury.2009.01.117.
6. Küçükdurmaz F, Akpinar F, Saka G, Sağlam N, Acı C. A newly designed intramedullary nail with distal interlocking system for tibia fractures in adults-the clinical results. Turkish J Trauma Emerg Surg Acil 2012;18:243-9. doi:10.5505/ tjtes.2012.08466.
7. Küçükdurmaz F, Sağlam N, Kurtulmuş T, Akpinar F. A novel intramedullary nail for use in the treatment of supramalleolar malunion and nonunion: A preliminary report of three cases. Acta Orthop Traumatol Turc 2016;50:57-83. doi:10.1016/J. AOTT.2014.11.001.
8. Meinberg EG, Agel J, Roberts CS, Karam MD, Kellam JF. Fracture and Dislocation Classification Compendium-2018. J Orthop Trauma. 2018;32 Suppl 1:S1-S170. doi:10.1097/ BOT.0000000000001063.

9. Kim PH, Leopold SS. Gustilo-Anderson classification. Vol. 470, Clinical Orthopaedics and Related Research. Springer New York LLC; 2012. p. 3270–4. doi:10.1007/s11999-012- 2376-6
10. Vallier HA, Cureton BA, Patterson BM. Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures. J Orthop Trauma 2011;25:736-41. doi:10.1097/BOT.0b013e318213f709.
11. Turhan E, Demirel M, Daylak A, Huri G, Doral MN, Çelik D. Translation, cross-cultural adaptation, reliability and validity of the Turkish version of the Olerud-Molander Ankle Score (OMAS). Acta Orthop Traumatol Turc 2017;51:60-4. doi:10.1016/j.aott.2016.06.012.
12. Van Lieshout EMM, De Boer AS, Meuffels DE, Den Hoed PT, Van Der Vlies CH, Tuinebreijer WE, et al. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle- Hindfoot Score: A study protocol for the translation and validation of the Dutch language version. BMJ Open 2017;7. doi:10.1136/bmjopen-2016-012884.
13. Im GI, Tae SK. Distal metaphyseal fractures of tibia: a prospective randomized trial of closed reduction and intramedullary nail versus open reduction and plate and screws fixation. J Trauma. 2005;59(5):1219-1223. doi:10.1097/01. ta.0000188936.79798.4e.
14. Mohammed A, Saravanan R, Zammit J, King R. Intramedullary tibial nailing in distal third tibial fractures: distal locking screws and fracture non-union. Int Orthop. 2008;32(4):547- 549. doi:10.1007/s00264-007-0356-3.
15. Behlmer RJ, Whiting PS, Kliethermes SA2, et al. Reduction techniques for intramedullary nailing of tibial shaft fractures: a comparative study. OTA Int 2021;4:e095. doi:10.1097/ OI9.0000000000000095.
16. Grimwood D, Harvey-Lloyd J. Reducing intraoperative duration and ionising radiation exposure during the insertion of distal locking screws of intramedullary nails: a small-scale study comparing the current fluoroscopic method against radiation-free, electromagnetic navigation. Eur J Orthop Surg Traumatol 2016;26:867-76. doi:10.1007/s00590-016-1835-2.
17. Moreschini O, Petrucci V, Cannata R. Insertion of distal locking screws of tibial intramedullary nails: A comparison between the free-hand technique and the SURESHOTTM Distal Targeting System. Injury 2014;45:405-7. doi:10.1016/J. INJURY.2013.09.023.
18. Uruc V, Ozden R, Dogramaci Y, et al. The comparison of freehand fluoroscopic guidance and electromagnetic navigation for distal locking of intramedullary implants. Injury 2013;44:863-6. https://doi:10.1016/j.injury.2012.12.009.
19. Langfitt MK, Halvorson JJ, Scott AT, et al. Distal locking using an electromagnetic field-guided computer-based real-time system for orthopaedic trauma patients. J Orthop Trauma 2013;27:367-72. doi:10.1097/BOT.0B013E31828C2AD1.
20. Robertson GAJ, Wood AM. Return to sport after tibial shaft fractures: A systematic review. Sports Health 2016;8:324-30. doi:10.1177/1941738115601425.
21. Atiç R. , Aydın A. Distal tibia kırıklarında yeni dizayn edilmiş intramedüller çivi ve distal kilit sistemi ile tedavinin klinik ve radyolojik sonuçları. CBU-SBED: Celal Bayar University- Health Sciences Institute Journal. 2018; 5(3): 151-156.
22. Houben IB, Raaben M, Van Basten Batenburg M, Blokhuis TJ. Delay in weight bearing in surgically treated tibial shaft fractures is associated with impaired healing: a cohort analysis of 166 tibial fractures. Eur J Orthop Surg Traumatol. 2018;28(7):1429-1436. doi:10.1007/s00590-018-2190-2.
23. Quan K, Xu Q, Zhu M, Liu X, Dai M. Analysis of risk factors for non-union after surgery for limb fractures: A case-control study of 669 subjects. Front Surg 2021;8:754150. doi:10.3389/ FSURG.2021.754150.
24. Dogra AS, Ruiz AL, Thompson NS, Nolan PC. Diametaphyseal distal tibial fractures – Treatment with a shortened intramedullary nail: A review of 15 cases. Injury 2000;31:799-804. doi:10.1016/S0020-1383(00)00129-7.
25. Arangio GA, Lehr S, Reed JF. Reemployment of patients with surgical salvage of open, high-energy tibial fractures: an outcome study. J Trauma 1997;42:942-5. doi:10.1097/00005373-199705000-00027.
26. Guo JJ, Tang N, Yang HL, Tang TS. A prospective, randomised trial comparing closed intramedullary nailing with percutaneous plating in the treatment of distal metaphyseal fractures of the tibia. J Bone Joint Surg Br 2010;92:984-8. doi:10.1302/0301-620X.92B7.22959.
27. Kariya A, Jain P, Patond K, Mundra A. Outcome and complications of distal tibia fractures treated with intramedullary nails versus minimally invasive plate osteosynthesis and the role of fibula fixation. Eur J Orthop Surg Traumatol 2020;30:1487-98. doi:10.1007/s00590-020- 02726-y.
28. Costa ML, Achten J, Griffin J, et al. Effect of locking plate fixation vs intramedullary nail fixation on 6-month disability among adults with displaced fracture of the distal tibia: The UK FixDT Randomized Clinical Trial. JAMA 2017;318:1767. doi:10.1001/JAMA.2017.16429.
29. Ibrahimi A El, Shimi M, Daoudi A, Loudyi D, Elmrini A, Boutayeb F. Intramedullary nailing in the management of distal tibial fractures. Curr Orthop Pract 2009;20:300-3. doi:10.1097/BCO.0b013e3181982201.
30. Uzumcugil O, Dogan A, Yalcinkaya M, Kabukcuoglu YS. The relationship between anterior knee pain occurring after tibial intramedullary nailing and the localization of the nail in the proximal tibia. Acta Orthop Traumatol Turc 2009;43:386-9. https://doi.org/10.3944/AOTT.2009.386.
31. Keating JF, Orfaly R, O’Brien PJ. Knee Pain after Tibial Nailing. J Orthop Trauma 1997;11:10-3. doi:10.1097/00005131- 199701000-00004.
32. Court-Brown CM, Gustilo T, Shaw AD. Knee Pain after Intramedullary Tibial Nailing: Its Incidence, Etiology, and Outcome. J Orthop Trauma 1997;11:103-5. doi:10.1097/00005131-199702000-00006.
33. Katsoulis E, Court-Brown C, Giannoudis PV. Incidence and aetiology of anterior knee pain after intramedullary nailing of the femur and tibia. J Bone Joint Surg Br. 2006;88(5):576-580. doi:10.1302/0301-620X.88B5.16875.