Spiral fractures of tibia are relatively difficult to nail in anatomical or close to anatomical position. The main reason very likely lies in fracture configuration itself. As the spiral fractures have only one degree of freedom, they will either reduce perfectly or will not reduce at all.
Nailing of spiral fracture requires at least one poller screw in the fragment with broader medullary canal. If we want to apply epicentric/non-epicentric concept, than we need at last two poller screws. One on the each side of the fracture, ideally more or less at the same distance from the fracture. Interestingly, epicentric concepts is in our practice related to a significant lower pain postoperatively, which we can only explain at the moment by lower shearing at the fracture side. Any other explanations are more than welcome.
Mr Matija Krkovic, MD, PhD
I am Consultant Orthopaedic Trauma Surgeon with special interest in Limb reconstructions and bone infections.