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Principles

Bending, shearing and torsional forces may cause screw loosening

Indications

Nonoperative treatment

Spiral fractures of the tibial diaphysis can be treated nonoperatively. However, some shortening must be expected. The initial x-ray usually shows the expected final shortening. Displacement of more than 30%, particularly for distal fractures, suggests an increased risk of secondary displacement with nonoperative treatment.

Malrotation is a risk which must be looked for and corrected, particularly during the first weeks of nonoperative treatment.

Operative treatment with a nail
Nailing is usually a good option in tibial fractures. However, in long spiral fractures, malrotation can be a problem and must be addressed by the surgeon.


Operative treatment with lag screws and protection plate
For the treatment of simple spiral fractures in the diaphyseal area, absolute stability is recommended. For this, anatomical reduction and interfragmentary compression are necessary. Interfragmentary compression is achieved with at least two lag screws, but the strength of this fixation is often insufficient for clinical use.

Protection plate
Bending, shearing and torsional forces acting on an unprotected lag screw may cause screw loosening, loss of compression, or fracture of the bone. In order to protect the lag screw from these forces, a protection plate should be applied.