Journal of Musculoskeletal Trauma

How to obtain the desired results from distal tibial nailing based on anatomy, biomechanics, and reduction techniques: Jungtae Ahn, Se-Lin Jeong, Gu-Hee Jung; J Musculoskelet Trauma 2025;38(2):74-85. Published online March 31, 2025; DOI: https://doi.org/10.12671/jmt.2025.00024

Abstract PDF: Distal tibial metaphyseal fractures are commonly caused by high-energy injuries in young men and osteoporosis in older women. These fractures should be clearly distinguished from high-energy pilon fractures. Although the optimal surgical intervention methods for distal tibial metaphyseal fractures remain uncertain and challenging, surgical treatments for nonarticular distal tibia fractures can be broadly divided into two types: plate fixation and intramedullary nail (IMN) fixation. Once functional reduction is achieved using an appropriate technique, distal tibial nailing might be slightly superior to plate fixation in reducing postoperative complications. Thus, the surgical strategy should focus on functional realignment and proceed in the following sequence: (1) restoring the original tibial length, regardless of whether fibular fixation is to be done; (2) making the optimal entry point through an anteroposterior (AP) projection based on the overlapping point between the fibular tip and lateral plateau margin; (3) placing Kirschner wires (Ø2.4 mm) as blocking pins (in the AP orientation for coronal control and in the mediolateral [ML] orientation for sagittal control) as close to the upper locking hole as possible without causing further comminution on the concave aspect of the short fragment; and (4) making the the distal fixation construct with at least two ML and one AP interlocking screw or two ML interlocking screws and blocking screws. After the IMN is adequately locked, blocking pins (Ø2.4 mm) need to be replaced by a 3.5 mm screw.

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Subtrochanteric Fracture Reduction during Intramedullary Nailing: Technical Note: Gyu Min Kong; J Korean Fract Soc 2019;32(2):107-111. Published online April 30, 2019; DOI: https://doi.org/10.12671/jkfs.2019.32.2.107

Abstract PDF: The subtrochanteric area is the place where mechanical stress is most concentrated in the femur. When a fracture happens, bone union is delayed and nonunion often occurs. The recommended treatment for atypical fractures is an anatomical reduction of the fracture site as the frequency of nonunion is higher than that of ordinary fractures. Various reduction methods have been suggested, and good results have been obtained. On the other hand, the occurrence of posterior displacement of the distal fragment during the insertion of an intramedullary nail is often overlooked. This is probably because the bone marrow of the femur tends to form an elliptical shape in the anteroposterior direction. The author attempted to insert a blocking screw into the distal part of the fracture to prevent posterior displacement of the distal fragment while performing intramedullary nailing of the femur fracture and achieved a good reduction state easily.

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The Usefulness of Blocking Screw in Intramedullary Nail on Proximal Tibial Fracture: Jun Young Yang, June Kyu Lee, Young Mo Kim, Chang Hwa Hong, Kyung Cheon Kim, Sung Hwan Ahn; J Korean Fract Soc 2005;18(1):17-21. Published online January 31, 2005; DOI: https://doi.org/10.12671/jkfs.2005.18.1.17

Abstract PDF: PURPOSE
To evaluate the effectiveness of a blocking screw in intramedullary nailing at the tibia proximal shaft fracture.
MATERIALS AND METHODS
63 tibia proximal shaft fractures from January 2000 to December 2002 treated with only intramedullary nailing were referred to as group I, and 8 fractures from January 2003 to December 2003 treated with both intramedullary nailing and the blocking screw were referred to as group II. Retrospective studies were done for group I and II. The incidence of nonunion and the postoperative angular alignments were compared. Malalignment was defined as an angle of 5 degrees anteroposteriorly or mediolaterally.
RESULTS
There were 7 nonunion (11%) in group I in compare with none in group II. There were 21 angular malalignments (33%) in group I and 1 in group II (12%) and most of them had valgus deformity or anterior anglulation. No complications were directly due to the use of the Blocking screw.
CONCLUSION
The technique of the blocking screw used to be one of the option for proximal tibial nailing at tibial proximal shaft fracture helps to overcome angular malalignments of bones.

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