Prospective series from Level I trauma centers describing the technique and outcomes of blocking screws combined with intramedullary nailing for proximal third tibial shaft fractures — a pattern notorious for valgus and apex anterior malalignment that standard nailing cannot reliably prevent.
When nailing a proximal third tibial shaft fracture, place blocking screws on the convex side of the anticipated deformity — posterior for apex anterior angulation, lateral for valgus — before passing the nail; omitting the screw in the deforming plane, as this series demonstrates, reliably results in malalignment that progresses to union.
Use interlocking screws rather than 3.5mm cortical screws as blocking devices to avoid intraoperative bending.
Prospective series from Level I trauma centers describing the technique and outcomes of blocking screws combined with intramedullary nailing for proximal third tibial shaft fractures — a pattern notorious for valgus and apex anterior malalignment that standard nailing cannot reliably prevent.
When nailing a proximal third tibial shaft fracture, place blocking screws on the convex side of the anticipated deformity — posterior for apex anterior angulation, lateral for valgus — before passing the nail; omitting the screw in the deforming plane, as this series demonstrates, reliably results in malalignment that progresses to union.
Use interlocking screws rather than 3.5mm cortical screws as blocking devices to avoid intraoperative bending.