Adjunctive screw fixation and screw corridors for spiral tibial fractures involving the distal tibial articular surface: a retrospective case series
- 1Honghui Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi, China
- 2Medical College of Yan'an University, Yan'an, Shaanxi, China
Abstract
Objective: Building on a CT-based regional evaluation framework developed in our previous morphological study, this study retrospectively summarized the adjunctive screw corridors actually used and their fixation targets in spiral tibial fractures involving the distal tibial articular surface that were treated with intramedullary nailing combined with adjunctive screw fixation, and used representative intraoperative and postoperative images to illustrate the relationship between the adjunctive screws and the intramedullary nail.
Methods: This was a single-center retrospective case series of patients with spiral tibial fractures involving the distal tibial articular surface who underwent tibial intramedullary nailing combined with adjunctive screw fixation at the Department of Lower Limb Trauma, Honghui Hospital, Xi'an Jiaotong University, between May 2020 and May 2025. During the study period, 110 patients were treated with this combined fixation; 98 patients with a follow-up duration of at least 12 months and complete clinical and imaging records were included in the analysis, and 12 patients were excluded because of insufficient follow-up or incomplete imaging records. Two observers independently assessed the involvement of the posterior malleolar/Volkmann region, the anterior malleolar/Chaput region, and the medial malleolar region on preoperative CT, and Cohen's kappa was calculated from the original independent assessments obtained before consensus discussion. The four types of adjunctive screw corridors actually used were retrospectively summarized from operative records and postoperative imaging. All patients underwent adjunctive screw fixation before reaming and intramedullary nail insertion. Corridor use was summarized using descriptive statistics, and perioperative variables, time to full weight bearing, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS) pain score, the difference in ankle dorsiflexion angle between the affected and contralateral sides, and related complications were recorded.
Results: A total of 98 patients were included, comprising 62 men and 36 women, with a mean age of 45.67 ± 13.61 years. The posterior malleolar/Volkmann region, the anterior malleolar/Chaput region, and the medial malleolar region were involved in 76 (77.6%), 40 (40.8%), and 23 (23.5%) patients, respectively; single-region, two-region, and three-region involvement was present in 64, 27, and 7 patients. Interobserver agreement for the individual regions and for their combinations ranged from 95.9% to 98.0%, with kappa values of 0.924–0.957. The tibiofibular incisura, anterior cortical, posterior cortical, and medial malleolar corridors were used in 93, 8, 7, and 6 patients, respectively; 87 patients received a single corridor and 11 received multiple corridors. The number of adjunctive screws ranged from 1 to 4, with a mean of 1.23 ± 0.62. Mean operative time was 73.45 ± 7.88 min, mean intraoperative blood loss was 67.56 ± 10.46 mL, and mean follow-up was 16.13 ± 2.20 months. Ninety-seven patients were included in the analyses of time to full weight bearing and final functional outcomes. Mean time to full weight bearing was 64.81 ± 16.91 days; at the final follow-up, the mean AOFAS ankle-hindfoot score was 91.67 ± 3.13, the mean VAS pain score was 1.36 ± 0.50, and the mean difference in ankle dorsiflexion angle between sides was 6.06 ± 3.27 degrees. Two patients developed delayed healing of the anterior ankle incision used for distal locking screws, which healed after dressing changes, and one patient developed an infection at the tibial shaft fracture site and was treated with implant removal and antibiotic-loaded bone cement. Among the 98 patients with complete follow-up, no obvious articular redisplacement or fixation failure was observed on the available follow-up radiographs.
Conclusion: This retrospective case series summarized the four types of adjunctive screw corridors actually used when spiral tibial fractures involving the distal tibial articular surface were treated with intramedullary nailing combined with adjunctive screw fixation, and described the fixation target of each corridor. Representative images are used to illustrate, but do not systematically analyze, the relationship between the adjunctive screws and the intramedullary nail. These results provide descriptive information on the adjunctive fixation technique used in this cohort, and their value for guiding preoperative planning and surgical decision-making requires further validation.
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BibTeX
@article{ai2026adjunctive,
title = {{Adjunctive screw fixation and screw corridors for spiral tibial fractures involving the distal tibial articular surface: a retrospective case series}},
author = {Xianjie Ai and Zhimeng Wang and Yuhang Liu and Chengcheng Zhang and Hongfei Qi and Shuai Ji and Bing Du and Zhong Li and Ming Li and Bo Wu},
journal = {Frontiers in Surgery},
year = {2026},
month = oct,
doi = {10.3389/fsurg.2026.1944619},
url = {https://doi.org/10.3389/fsurg.2026.1944619},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Adjunctive screw fixation and screw corridors for spiral tibial fractures involving the distal tibial articular surface: a retrospective case series
AU - Xianjie Ai
AU - Zhimeng Wang
AU - Yuhang Liu
AU - Chengcheng Zhang
AU - Hongfei Qi
AU - Shuai Ji
AU - Bing Du
AU - Zhong Li
AU - Ming Li
AU - Bo Wu
PY - 2026
DA - 2026/10/22
JO - Frontiers in Surgery
DO - 10.3389/fsurg.2026.1944619
UR - https://doi.org/10.3389/fsurg.2026.1944619
AB - Objective: Building on a CT-based regional evaluation framework developed in our previous morphological study, this study retrospectively summarized the adjunctive screw corridors actually used and their fixation targets in spiral tibial fractures involving the distal tibial articular surface that were treated with intramedullary nailing combined with adjunctive screw fixation, and used representative intraoperative and postoperative images to illustrate the relationship between the adjunctive screws and the intramedullary nail. Methods: This was a single-center retrospective case series of patients with spiral tibial fractures involving the distal tibial articular surface who underwent tibial intramedullary nailing combined with adjunctive screw fixation at the Department of Lower Limb Trauma, Honghui Hospital, Xi'an Jiaotong University, between May 2020 and May 2025. During the study period, 110 patients were treated with this combined fixation; 98 patients with a follow-up duration of at least 12 months and complete clinical and imaging records were included in the analysis, and 12 patients were excluded because of insufficient follow-up or incomplete imaging records. Two observers independently assessed the involvement of the posterior malleolar/Volkmann region, the anterior malleolar/Chaput region, and the medial malleolar region on preoperative CT, and Cohen's kappa was calculated from the original independent assessments obtained before consensus discussion. The four types of adjunctive screw corridors actually used were retrospectively summarized from operative records and postoperative imaging. All patients underwent adjunctive screw fixation before reaming and intramedullary nail insertion. Corridor use was summarized using descriptive statistics, and perioperative variables, time to full weight bearing, the American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score, the visual analog scale (VAS) pain score, the difference in ankle dorsiflexion angle between the affected and contralateral sides, and related complications were recorded. Results: A total of 98 patients were included, comprising 62 men and 36 women, with a mean age of 45.67 ± 13.61 years. The posterior malleolar/Volkmann region, the anterior malleolar/Chaput region, and the medial malleolar region were involved in 76 (77.6%), 40 (40.8%), and 23 (23.5%) patients, respectively; single-region, two-region, and three-region involvement was present in 64, 27, and 7 patients. Interobserver agreement for the individual regions and for their combinations ranged from 95.9% to 98.0%, with kappa values of 0.924–0.957. The tibiofibular incisura, anterior cortical, posterior cortical, and medial malleolar corridors were used in 93, 8, 7, and 6 patients, respectively; 87 patients received a single corridor and 11 received multiple corridors. The number of adjunctive screws ranged from 1 to 4, with a mean of 1.23 ± 0.62. Mean operative time was 73.45 ± 7.88 min, mean intraoperative blood loss was 67.56 ± 10.46 mL, and mean follow-up was 16.13 ± 2.20 months. Ninety-seven patients were included in the analyses of time to full weight bearing and final functional outcomes. Mean time to full weight bearing was 64.81 ± 16.91 days; at the final follow-up, the mean AOFAS ankle-hindfoot score was 91.67 ± 3.13, the mean VAS pain score was 1.36 ± 0.50, and the mean difference in ankle dorsiflexion angle between sides was 6.06 ± 3.27 degrees. Two patients developed delayed healing of the anterior ankle incision used for distal locking screws, which healed after dressing changes, and one patient developed an infection at the tibial shaft fracture site and was treated with implant removal and antibiotic-loaded bone cement. Among the 98 patients with complete follow-up, no obvious articular redisplacement or fixation failure was observed on the available follow-up radiographs. Conclusion: This retrospective case series summarized the four types of adjunctive screw corridors actually used when spiral tibial fractures involving the distal tibial articular surface were treated with intramedullary nailing combined with adjunctive screw fixation, and described the fixation target of each corridor. Representative images are used to illustrate, but do not systematically analyze, the relationship between the adjunctive screws and the intramedullary nail. These results provide descriptive information on the adjunctive fixation technique used in this cohort, and their value for guiding preoperative planning and surgical decision-making requires further validation.
SN - 2296-875X
ER -