Single or double distal locking in intramedullary nailing of tibial shaft fractures: a prospective randomized study

BACKGROUND
The number of distal locking screws may have an effect on union, complication rates and operation time. The purpose of this study was to determine the effect of one or two distal locking screws in unreamed intramedullary nailing of closed or grade 1 open, simple or wedge tibial shaft fractures on the incidence of malunion, delayed union, non-union, and screw failure.
METHODS
Fifty-seven patients (39 male, 18 female; mean age 38.5±10.7 years) were randomized to two groups as either one or two distal locking screws and were evaluated prospectively for the incidences of malunion, delayed union, non-union, and screw failure. Twenty-nine patients were included in the two distal screws group and 28 patients in the single distal screw group. Groups were then subdivided to end fractures (proximal+distal end fractures) or mid-shaft fractures and reevaluated for the incidences of complications. Mann-Whitney U, chi-square and T tests were used for statistical analysis.
RESULTS
Mean follow-up was 2.4 years (range, 1.5-4.7 years). There was no case of malunion in either group. The incidences of delayed union, non-union or screw failure were not different (p>0.05). However, complication rate for end fractures in the two screw group was higher than that in the one screw group (p: 0.04).
CONCLUSION
For non-complex, closed or grade 1 open tibial shaft fractures, locking of an intramedullary nail with a single distal screw is safe, and may help to decrease operation time and radiation exposure.

Tibia cisim kýrýklarýnýn intramedüller çivilemesinde tek veya çift distal kilitleme: Prospektif randomize bir çalýþma

AMAÇ
Distal kilit sayýsýnýn kaynamaya, komplikasyon oranýna ve ameliyat süresine etkisi olabilir. Bu çalýþmada, bir veya iki distal kilit vidasýnýn, kapalý veya tip 1 açýk, basit veya kama tipi tibia cisim kýrýklarýnda oymasýz yapýlan intramedüller çivilemede yanlýþ, gecikmiþ kaynama, kaynamama ve vida yetersizliði görünme sýklýðýna etkisi incelendi.
GEREÇ VE YÖNTEM
Elli yedi hasta (39 erkek, 18 kadýn; ortalama yaþ 38,5±10,7) prospektif olarak tek distal kilit veya iki distal kilit gruplarýna ayrýldý. Gruplar yanlýþ, gecikmiþ kaynama, kaynamama ve vida yetersizliði sýklýðý açýsýndan deðerlendirildi. Yirmi dokuz hasta iki vida grubunda, 28 hasta tek vida grubundaydý. Gruplar daha sonra uç kýrýklar (üst uç+alt uç) ve orta cisim kýrýklar olarak ayrýldý ve komplikasyon sýklýðý açýsýndan incelendi. Ýstatistiksel deðerlendirme, Mann-Whitney U, ki-kare ve T testleriyle yapýldý.
BULGULAR
Ortalama takip süresi 2,4 yýldý (daðýlým 1,5-4,7 yýl). Ýki grupta da yanlýþ kaynama yoktu. Gecikmiþ kaynama, kaynamama veya vida yetersizliði gruplar arasýnda farklý deðildi (p>0,05). Fakat, komplikasyon oraný iki vida grubun da uç kýrýklarý için tek vida grubuna göre daha fazla idi (p=0,04).
SONUÇ
Kompleks olmayan, kapalý veya tip 1 açýk kýrýklarda tek distal kilitleme güvenli olup, cerrahi süreyi ve radyasyon maruziyetini azaltmaya yardýmcý olabilir.