A comparison of one versus two distal locking screws in tibial fractures treated with unreamed tibial nails: a prospective randomized clinical trial

Abstract

The objective was to determine whether the number of interlocking screws have an impact on hardware failure. In a clinical prospective randomized study of skeletally mature patients with diaphyseal tibial fractures, 44 were randomized pre-operatively into the two treatment arms over a two-year period. Two patients, one from each group, were excluded later. Of eligible patients, 22 had one distal locking screw and 20 had two distal locking screws. One distal screw failed (59.1 per cent) significantly more often than two distal screws (5 per cent). Screw failure occurred more often in heavier patients and usually between six and 12 weeks. Proximal screw failure was seen in 17 per cent of patients. There was no significant difference between groups with respect to fracture union.