Effectiveness of completely round nails with both-ends-threaded locking screws for tibial shaft fractures

Completely round nails, in contrast to conventional locked nails with surface grooves, for postoperative endosteal revascularization may increase the nail rigidity and decrease the manufacture cost. Both-ends-threaded screws with higher fatigue strength require smaller nail holes and can further increase the mechanical strength of the nails.

In this study, both-ends-threaded locking screws were used to treat 68 tibial fractures, including 56 acute fractures in 54 patients and 12 nonunions in 12 patients. There were 41 men and 25 women with a mean age of 39.6 years, and the average follow-up was 24 months. For acute fractures, there were 11 type I, 9 type II, 5 type IIIA, and 3 type IIIB open fractures. Acute fractures were treated with closed nailing. Five hypertrophic nonunions were treated with closed exchanged nailing, and seven oligotrophic nonunions were treated with open nailing and iliac bone grafting.

With a single nailing procedure, 53 acute fractures and all nonunions achieved union with mean times of 17.4 weeks and 18.4 weeks, respectively. Three patients underwent exchange nailing and bone grafting and had eventual fracture union. Three fractures with compartment syndrome were treated with fasciotomy. Deep infection occurred in two open fractures but was successfully treated. Nail breakage occurred in one distal fracture and screw backout occurred in another, but fracture union was not affected. Recovery of joint motion was essentially normal in patients without knee or ankle injury.

This study showed that completely round nails with both-ends-threaded locking screws could effectively treat tibial fractures. Completely round nails have the advantages of high mechanical strength and low manufacturing cost.