The Role of Biplanar Distal Locking in Intramedullary Nailing of Tibial Shaft Fractures

Abstract

Background: To compare the union times of the uncomplicated tibial shaft fractures, which were distally locked by two<br />coronal and one sagittal screws and by only two coronal screws.<br />Methods: 45 patients with tibial shaft treated with intramedullary nailing included in this study. 23 of 45 fractures<br />were treated with uniplanar two distal interlocking (Group 1) and 22 fractures were treated with biplanar three distal<br />interlocking (Group 2). Patients with closed fractures treated by closed nailing and having a full set of radiographs on<br />PACS system was included. Fracture unions were evaluated by two authors.<br />Results: Union time was significantly shorter in biplanar distal interlocking group (Group 2) compared to uniplanar<br />distal interlocking group (Group 1) (P=0.02). Mean union time in groups 1 and 2 were 14.63±4.5 and 10.77±3.0<br />weeks, respectively .When only distal third tibial shaft fractures were evaluated, Group 2 [11.2±3.1 weeks (n:17)] had<br />significantly lower union time compared to Group 1 [15.07±4.8 weeks (n:14)] (P=0.01). Inter-observer reliability for<br />fracture union times was high with rho= 0.89 with SE of 0.51 (P<0.001).<br />Conclusion: Biplanar distal interlocking procedure had a significantly shorter union time. Biplanar distal interlocking<br />procedure allows a faster fracture union probably because of a more stable fixation construct.