The Role of Biplanar Distal Locking in Intramedullary Nailing of Tibial Shaft Fractures

Background: To compare the unio‎n times of the uncomplicated tibial shaft fractures, which were distally locked by two coronal and one sagittal screws and by only two coronal screws. Methods: 45 patients with tibial shaft treated with intramedullary nailing included in this study. 23 of 45 fractures were treated with uniplanar two distal interlocking (Group 1) and 22 fractures were treated with biplanar three distal interlocking (Group 2). Patients with closed fractures treated by closed nailing and having a full set of radiographs on PACS system was included. Fracture unio‎ns were evaluated by two authors. Results: unio‎n time was significantly shorter in biplanar distal interlocking group (Group 2) compared to uniplanar distal interlocking group (Group 1) (P=0.02). Mean unio‎n time in groups 1 and 2 were 14.63±4.5 and 10.77±3.0 weeks, respectively .When only distal third tibial shaft fractures were evaluated, Group 2 [11.2±3.1 weeks (n:17)] had significantly lower unio‎n time compared to Group 1 [15.07±4.8 weeks (n:14)] (P=0.01). Inter-observer reliability for fracture unio‎n times was high with rho= 0.89 with SE of 0.51 (P<0.001). Conclusion: Biplanar distal interlocking procedure had a significantly shorter unio‎n time. Biplanar distal interlocking procedure allows a faster fracture unio‎n probably because of a more stable fixation construct.