Using the intramedullary nails with just one interlocking screw with wonderful outcomes

Ahmadi Abdashti, AR; Zandi, Reza; Rahmanian, Mohamad

Using the intramedullary nails with just one interlocking screw with wonderful outcomes

Document Type : Case Report

Authors

AR Ahmadi Abdashti ¹

Reza Zandi ²

Mohamad Rahmanian ³

¹ Orthopedic Surgeon and Researcher at Musculoskeletal Injuries Research Center, Shahid Beheshti University of Medical Sciences

² Associate Professor of Orthopedic Surgery, Musculoskeletal Injuries Research Center, Shahid Beheshti University of Medical Sciences

³ General Physician, Musculoskeletal Injuries Research Center, Shahid Beheshti University of Medical Sciences

Abstract

Background and Objective: Distal tibial fractures, particularly those involving the diaphysis-metaphysis junction, represent a significant challenge in orthopedic trauma management, typically resulting from high-energy axial and rotational forces. Intramedullary nailing (IMN) has gained prominence as a standard treatment modality due to its associated benefits, including lower rates of wound complications, reduced operative duration, and accelerated postoperative rehabilitation. While the utilization of two or more distal interlocking screws is the conventional standard for achieving adequate construct stability, this is frequently precluded in distal fractures by restricted bone stock. This report evaluates the clinical feasibility and efficacy of IMN fixation utilizing a solitary distal interlocking screw in cases where additional screw placement is anatomically limited.
Materials & Methods: We present the case of a 38-year-old male who sustained a spiral fracture of the distal tibia accompanied by an associated proximal fibular fracture. The patient underwent surgical stabilization via an intramedullary nail secured by a single distal interlocking screw. Clinical and radiographic outcomes were assessed throughout a 6-month follow-up period to evaluate fracture healing and functional recovery.
Results: Clinical and radiographic assessments during the 6-month follow-up revealed no evidence of implant failure, fracture displacement, malunion, nonunion, or limb-length discrepancy. The patient achieved excellent functional outcomes, evidenced by an American Orthopaedic Foot & Ankle Society (AOFAS) score of 85 and a Visual Analog Scale (VAS) pain score of 1–2.
Conclusion: In simple, non-comminuted distal tibial fractures, the use of an intramedullary nail with a single distal interlocking screw constitutes a viable and safe therapeutic strategy when anatomical constraints preclude standard multi-screw fixation. While this approach benefits from the inherent advantages of intramedullary nailing, these findings should be corroborated by further prospective, comparative studies to establish definitive clinical guidelines for such complex scenarios.

Keywords

Distal tibia fracture

Intramedullary nail

Interlocking screw

Internal fixation

Fracture fixation techniques