Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella, Malaga, Spain.
Injury. 2012 Dec;43 Suppl 2:S59-62. doi: 10.1016/S0020-1383(13)70181-5.
Unreamed intramedullary nailing (UIMN) is an effective treatment procedure for the majority of tibial fractures, with locking constituting the technical support for the buttressing and neutralisation principles underlying intramedullary nailing. It has been claimed that the added versatility obtained from the use of more bolts in distal locking is very important. Several studies have been made concerning the optimum number of locking bolts in distal tibial fractures; however, to the best of our knowledge, no study has dealt with the question of whether two or three bolts should be used in diaphyseal fractures.
In this paper, we evaluate the results of treating 86 diaphyseal tibial fractures (type 42 according to the AO classification) with Expert Tibial UIMN (Synthes™, West Chester, PA, USA) and distal blocking with either two or three bolts. Mean patient age was 35 years (21-51).
We found that the consolidation time is shorter, less radiation time is needed and the material cost is lower when two bolts are used. No other differences were found regarding mean operative time, wound healing, pain at fracture site, joint function, angular deviation or rotation.
For type 42 AO tibial fractures treated with Expert Tibial UIMN, distal blocking should be performed with only two bolts.
非扩髓髓内钉（UIMN）是治疗大多数胫骨骨折的有效方法，锁定构成了髓内钉支撑和中和原理的技术支持。据称，在远端锁定中使用更多螺栓可获得更大的通用性非常重要。已经有几项关于在胫骨远端骨折中使用最佳锁定螺栓数量的研究；但是，据我们所知，尚无研究涉及在骨干骨折中应使用两个还是三个螺栓的问题。
在本文中，我们评估了使用 Expert Tibial UIMN（Synthes™，宾夕法尼亚州西切斯特，美国）治疗 86 例骨干胫骨骨折（AO 分类 42 型）的结果，并使用两个或三个螺栓进行远端阻挡。平均患者年龄为 35 岁（21-51 岁）。
我们发现，当使用两个螺栓时，骨痂形成时间更短，所需的辐射时间更少，材料成本更低。在平均手术时间，伤口愈合，骨折部位疼痛，关节功能，角度偏差或旋转方面没有发现其他差异。
对于使用 Expert Tibial UIMN 治疗的 42 型 AO 胫骨骨折，远端阻挡仅应使用两个螺栓。
