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 twocoronal 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 fractureswere treated with uniplanar two distal interlocking (Group 1) and 22 fractures were treated with biplanar three distalinterlocking (Group 2). Patients with closed fractures treated by closed nailing and having a full set of radiographs onPACS 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 uniplanardistal interlocking group (Group 1) (P=0.02). Mean union time in groups 1 and 2 were 14.63±4.5 and 10.77±3.0weeks, respectively .When only distal third tibial shaft fractures were evaluated, Group 2 [11.2±3.1 weeks (n:17)] hadsignificantly lower union time compared to Group 1 [15.07±4.8 weeks (n:14)] (P=0.01). Inter-observer reliability forfracture 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 interlockingprocedure allows a faster fracture union probably because of a more stable fixation construct.