A Retrospective Comparison of Headless Versus Standard Interlocking Screw Fixation of Tibia Intramedullary Nails

Area of Science:

• Orthopedic surgery
• Biomedical engineering
• Trauma care

Background:

• Symptomatic interlocking screws are a frequent complication following intramedullary nail fixation for tibia fractures.
• The advent of low-profile headless interlocking screws presents a potential solution to mitigate the incidence of symptomatic screws.

Purpose of the Study:

• To compare the rates of symptomatic screws between low-profile headless and standard headed interlocking screws.
• To evaluate the difference in symptomatic screw removal rates for both screw types.

Main Methods:

• Retrospective review of tibia shaft fractures treated with intramedullary nails between August 2018 and September 2023.
• Comparison of patients treated with low-profile headless screws versus standard headed screws.
• Analysis included symptomatic screws, symptomatic screw removals, screw failure, and bone union procedures.

Main Results:

• No symptomatic screws (0.0%) were reported in the headless screw group, compared to 23.9% in the standard screw group (P = 0.002).
• Symptomatic screw removal occurred in 0.0% of the headless screw group versus 13.0% in the standard screw group (P = 0.03).
• No significant differences were observed in bone union procedures or screw backout between the groups.

Conclusions:

• Low-profile headless interlocking screws demonstrate a significant reduction in symptomatic screw occurrence and subsequent removal.
• These findings suggest headless screws are a favorable alternative for intramedullary fixation of tibia fractures, enhancing patient outcomes.