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Review Question - QID 5571

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QID 5571 (Type "5571" in App Search)
Figures A and B demonstrate a proximal tibial metaphyseal fracture which will be treated with an intramedullary nail. Placing blocking screws at the sites marked with x's in the figures would help to prevent what type of malreduction deformity?
  • A
  • B

Valgus and procurvatum

85%

2688/3158

Valgus and recurvatum

5%

156/3158

Varus and procurvatum

6%

195/3158

Varus and recurvatum

3%

85/3158

Varus and external rotation

0%

9/3158

  • A
  • B

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Placing blocking screws at the sites shown would help to prevent a valgus and procurvatum deformity. This represents the most common pattern of malreduction for this fracture pattern.

Proximal tibial metaphyseal fractures being treated with an intramedullary nail are known to commonly fall into a valgus and procurvatum deformity due to lack of cortical fit in the metaphyseal segment. To help prevent this deformity blocking screws may be used. As a general rule, a blocking screw should be placed in the concavity of the deformity you intend to prevent. Thus, to prevent a valgus deformity you would place a screw just lateral to the nail. Likewise, to prevent a procurvatum deformity you would place a blocking screw just posterior to the nail. These screws would provide a buttress to keep the metaphyseal segment in line with the tibial shaft.

Ricci et al. present a prospective cohort of 12 patients who presented with a proximal tibial metaphyseal fracture treated with an intramedullary nail and blocking screws. They found that all 12 patients went on to heal with less than 5° of angulation in all planes in which a blocking screw was used. They concluded that blocking screws are effective at maintaining proper alignment for this type of fracture being treated with an intramedullary nail.

Hiesterman et al. present a review on treatment techniques for extraarticular proximal tibia fractures treated with an intramedullary nail. They note that valgus and apex anterior deformities are most common. They cite several techniques for preventing this deformity including alternate patient positioning or approach, a universal distractor, unicortical plates, and blocking screws.

Figure A is an AP radiograph of a proximal third tibia fracture with a marking to indicate placement of a blocking screw just lateral to the central axis of the tibia. Figure B is a lateral radiograph of a proximal third tibia fracture with a marking to indicate placement of a blocking screw just posterior to the central axis of the tibia. Illustration A and B are AP and lateral radiographs of the tibia fracture seen above treated with an intramedullary nail and no blocking screws. Note the resulting valgus and procurvatum deformity about the fracture even with the nail in place. Illustrations C and D are diagrams illustrating the use of lateral and posterior blocking screws to properly align the fracture.

Incorrect Answers:
Answers 2, 3, 4, and 5: These do not correctly identify the deformity that would be prevented with locking screws placed lateral and posterior to the intramedullary nail.

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