Does the Use of Blocking Screws Improve Radiological Outcomes Following Intramedullary Nailing of Distal Tibia Fractures?

Fawdington, Ross A; Lotfi, Naeil; Beaven, Alastair; Fenton, Paul

doi:10.5005/jp-journals-10080-1418

Cited by 9 publications

(10 citation statements)

References 18 publications

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“…When only RCT articles were included, the number of references did not support the analysis. After reading the full text, 20 articles [12,25–43] were finally included and used to provide primary data for further analysis, there were 4 randomized controlled trials, [31–33,36] 16 case-control studies, [12,25–30,34,35,37–43] 5 English literatures [12,25–27,41] and 15 Chinese literatures, [28–40,42,43] including 1267 patients. The study selection process and reasons for exclusion are summarized in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Bryan 2018 [27] America CCT BS vs NBS 46 36.6 ± 15.1 (4)(5)(6) 70 39.9 ± 17.7 Adam 2019 [12] America CCT BS vs NBS 30 43 ± 18 (5)(6) 54 41 ± 19 Ross 2019 [25] Britain CCT BS vs NBS 10 22-61 (5) 20 17-93 Guo WY 2020 [29] China CCT BS vs NBS 17 36.9 ± 12.8 (1)(2)(3)(4)(5) 19 34.1 ± 15.3 Wang GH 2019 [37] China CCT BS vs NBS 26 40.5 ± 2.1 (3)(6) 26 40.0 ± 2.3 Huang WZ 2017 [31] China RCT BS vs NBS 42 36.7 ± 2.9…”

Section: Age (Year) Outcomementioning

confidence: 99%

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Clinical efficacy and complications of blocking screw in the treatment of lower limb long bone fracture: An updated systematic review and meta-analysis

Chen,

Chen

2024

Medicine

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Background: Blocking screw technique has been widely applied in the treatment of long shaft fractures. However, the evidence with regard to whether intramedullary nail combined with blocking screw technique has better clinical efficacy over other is not clear. The aim of the study was to explore the clinical efficacy and complications of intramedullary nail combined with blocking screw technique in the treatment of femoral or tibial shaft fractures. Methods: The PuMed, Embase, OVID, Cochrane library, Web of Science, Wanfang, CNKI and Weipu data were searched for studies of intramedullary nail combined with blocking screw in treatment of femoral or tibial shaft fracture published up to Aug 31 2023. Methodological quality of the trials was assessed, relevant data were extracted, and RevMan 5.3 and Stata 15.0 software were used to perform the meta-analysis of parameters related to the consequences. Result: Twenty articles were included, including 1267 patients. Meta-analysis results showed that compared with the non-blocking screw group, the blocking screw group had longer operation time (WMD = 13.24; 95% CI = 5.68–20.79, P = .0006) and more intraoperative fluoroscopy times (WMD = 57.62; 95% CI = 25.82–89.42, P = .0002). However, the postoperative therapeutic response rate was higher (OR = 5.60; 95% CI = 2.10–14.93, P = .0006), postoperative ankle joint function was better (OR = 3.48; 95% CI = 1.20–10.13, P = .02), and fracture healing rate was higher (OR = 3.56; 95% CI = 1.43–8.89, P = .006), fracture healing time was shorter (WMD = −3.59; 95% CI = −4.96 to −2.22, P < .00001), intraoperative blood loss was less (WMD = −54.80; 95% CI = −88.77 to −20.83, P = .002), hospitalization time was shorter (WMD = −1.66; 95% CI = −2.08 to −1.24, P < .00001), and complications were less (OR = 0.38; 95% CI = 0.16–0.89, P = .01). There was no statistical significance in the range of motion of knee joint between the 2 groups (WMD = 10.04; 95% CI = −1.51 to 21.59, P = .09). Conclusions: Current evidence shows that intramedullary nail combined with blocking screw technique in the treatment of lower limb long bone fracture has the advantages of good clinical efficacy, high fracture healing rate, short fracture healing time, good joint function, less complications and so on, which is worthy of clinical recommendation.

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Section: Resultsmentioning

confidence: 99%

Section: Age (Year) Outcomementioning

confidence: 99%

Clinical efficacy and complications of blocking screw in the treatment of lower limb long bone fracture: An updated systematic review and meta-analysis

Chen,

Chen

2024

Medicine

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“…Thereafter, indications for blocking screws expanded to treating distal tibia and metadiaphyseal femur fractures. [4][5][6][7][8][9][10][11] Since the original description of the Poller screw, medullary nailing has changed substantially. The use of open reduction techniques, cannulated nails, larger diameter interlocking bolts, multiple and multiplanar proximal and distal interlocking options with fixed-angle ability, and semiextended tibial nailing have given surgeons additional tools with which to achieve and maintain alignment during end-segment nailing.…”

Section: Introduction and Historymentioning

confidence: 99%

“…Thereafter, indications for blocking screws expanded to treating distal tibia and metadiaphyseal femur fractures. 4-11…”

Section: Introduction and Historymentioning

confidence: 99%

Updated Blocking Techniques for Lower Extremity Medullary Nailing: Beyond the Concavity of Deformity

DeBaun

Barei

Ricci

et al. 2023

J Am Acad Orthop Surg

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Modern blocking techniques are useful to achieve anatomic alignment and stable fixation during end-segment nailing. Whether with screws or drill bits, blocking implants can correct both angular and translational deformities. Understanding the biomechanics of blocking implants allows the surgeon to properly plan their placement based on principles rather than dogma. We use case examples to highlight updates in blocking techniques during acute surgical fixation and chronic deformity correction.

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“…Compared with plates, the anterograde tibial nail (ATN) reduces the impact on local soft tissue and periosteal blood flow. However, due to the gradual widening of the distal tibial medullary cavity, poor repositioning and instability of fixation are likely to appear ( 4 – 6 ). In recent years, Kuhn et al designed a novel retrograde tibial intramedullary nail, which provides a new option for minimally invasive treatment of distal tibial fractures ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Novel Retrograde Tibial Intramedullary Nailing for Distal Tibial Fractures

et al. 2022

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PurposePostoperative distal tibial fractures are often associated with complications such as difficulties in fracture healing and surgical incision infection. The purpose of this study is to evaluate the fracture healing time and functional recovery after a retrograde tibial intramedullary nail treatment for distal tibial fractures.MethodsWe retrospectively studied 9 cases of patients with distal tibial fractures treated with retrograde intramedullary nailing (IMN). Fracture healing time was based on monthly postoperative x-ray imaging results, and functional outcomes were defined according to the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score.ResultsAmong the 9 patients with distal tibial fractures from July 2020 to April 2021, the mean age was 51.8 ± 13.8 years. The classification of distal tibial fractures in the 9 patients according to OTA (Orthopaedic Trauma Association) includes 6 extra-articular fractures (3 of type A1, 2 of type A2, and 1 of type A3) and 3 intra-articular fractures (1 of type C1 and 2 of type C2). Among them, there were 5 closed fracture cases and 4 open fracture cases (according to Gustilo classification: 2 of type I, 2 of type II). We treated the fractures surgically with new retrograde tibial intramedullary nailing. The mean follow-up time for this group was 7.9 months (5–12 months). According to monthly postoperative radiographs performed to monitor fracture healing, the mean healing time was 3.3 months (3–4 months). Final postoperative function according to the AOFAS ankle-hindfoot score shows 6 excellent cases, 3 good cases. No serious complications such as postoperative infection, bone and internal fixation exposure, osteofascial compartment syndrome, or vascular nerve injury occurred.ConclusionThe new retrograde tibial intramedullary nail (RTN) has some unique advantages, and its treatment of distal tibial fractures can achieve good efficacy, but further studies are still needed to verify it.

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Does the Use of Blocking Screws Improve Radiological Outcomes Following Intramedullary Nailing of Distal Tibia Fractures?

Cited by 9 publications

References 18 publications

Clinical efficacy and complications of blocking screw in the treatment of lower limb long bone fracture: An updated systematic review and meta-analysis

Clinical efficacy and complications of blocking screw in the treatment of lower limb long bone fracture: An updated systematic review and meta-analysis

Updated Blocking Techniques for Lower Extremity Medullary Nailing: Beyond the Concavity of Deformity

Novel Retrograde Tibial Intramedullary Nailing for Distal Tibial Fractures

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