Painful locking screws with tibial nailing, an underestimated complication.

BACKGROUND

Tibial fractures represent approximately 3-4% of reported fractures. Locked, intramedullary nails are commonly used to restore length and alignment and provide rotational stability. Few studies have assessed the complication rate of locking screws.

MATERIALS AND

METHODS

We conducted a retrospective observational study of all patients who underwent tibial nailing at our institution between the 01/01/15 and 30/06/17. All patients were followed up for at least 1 year post-operatively. For inclusion, patients had to be over 16 years of age and had undergone tibial nail fixation following a traumatic fracture. Post-operative radiographs were used to assess the configuration and features of locking screws.

RESULTS

One hundred and twenty-six individuals underwent tibial nailing over the 30-month period, with 95 followed up at least 1 year. Twenty-seven per cent of individuals reported pain attributed to locking screws at follow-up. Upon radiographic assessment, no significant difference was seen between symptomatic and asymptomatic cohorts in terms of proud screw heads proximally (7% vs 5%, p > 0.99) or distally (14% vs 17%, p > 0.99), long screw tips proximally (52% vs 48%, p = 0.81) or distally (51% vs 50%, p > 0.99), or tibiofibular joint penetration proximally (31% vs 23%, p = 0.60). However, there was a higher incidence of distal tibiofibular joint penetration in symptomatic versus asymptomatic individuals (4% vs 25%, p = 0.025).

CONCLUSION

Twenty-seven per cent of patients with a tibial nail report painful locking screws. Patients with symptomatic distal locking screws had a higher incidence of radiographic distal tibiofibular joint penetration.