Review Question - QID 4366

Apex anterior and valgus deformity of the proximal tibia fracture can be prevented by inserting blocking screws lateral and posterior to the nail in the proximal segment.

Blocking screws may be used to prevent deformity when performing intramedullary fixation of proximal tibia fractures. Insertion of the blocking screw lateral to the nail prevents valgus deformity, and insertion of the blocking screw posterior to the nail prevents apex anterior deformity. A more lateral starting point for nail insertion can also help to prevent valgus deformity. Stability screws can be placed prior to insertion of the nail to prevent deformity during nail passage, or after nail insertion to prevent post-operative deformity from developing.

Ricci et al. describe the technique and results of using blocking screws and intramedullary nails to treat patients with fractures of the proximal third of the tibial shaft. Post-operatively, all patients in their series had less than 5 degrees of angular deformity in the planes in which blocking screws were used to control alignment. At 6 months follow-up, 10/11 patients maintained this alignment.

Figures A and B demonstrate a segmental tibial shaft fracture. Illustration A shows an intraoperative fluoroscopic image demonstrating insertion of the blocking screws intraoperatively. Illustrations B and C show post-operative radiographs demonstrating placement of the blocking screws and adequate alignment of the proximal segment.