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Review Question - QID 2989

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QID 2989 (Type "2989" in App Search)
A 38-year-old male sustains the closed injury shown in Figures A and B. When treating this injury with an intramedullary nail, addition of blocking screws into which of the following positions can prevent the characteristic malunion deformity?
  • A
  • B

Anterior to the nail in the proximal segment; medial to the nail in the proximal segment

7%

137/2031

Anterior to the nail in the proximal segment; lateral to the nail in the proximal segment

11%

216/2031

Posterior to the nail in the proximal segment; lateral to the nail in the proximal segment

74%

1510/2031

Anterior to the nail in the distal segment; lateral to the nail in the distal segment

3%

51/2031

Posterior to the nail in the distal segment; medial to the nail in the proximal segment

5%

100/2031

  • A
  • B

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Figures A and B show a proximal tibia fracture, which is prone to malreduction/malunion into a characteristic valgus and procurvatum (apex anterior) deformity. Placement of screws in this instance posterior to the nail (medial to lateral) and lateral to the nail (anterior to posterior) in the proximal segment will prevent iatrogenic malalignment.

Intramedullary nails will not effect a reduction in metaphyseal proximal tibia fractures. Valgus and apex anterior deformities in these injuries may be caused by deforming muscular forces, limb positioning in hyper flexion, as well as iatrogenic deformity created by improper nail insertion technique. Blocking (Poller) screws are utilized to redirect intramedullary nails by creating an artificial cortex to guide the nail into appropriate position.

The referenced biomechanical study by Krettek et al noted that addition of blocking screws added increased stability to metaphyseal fractures.

Ricci et al noted no malalignment intraoperatively or at final follow-up of proximal tibia fractures treated with intramedullary nails if blocking screws were used.

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