title: How many distal bolts should be used in unreamed intramedullary nailing for diaphyseal tibial fractures?
abstract: BACKGROUND
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  For type 42 AO tibial fractures treated with Expert Tibial UIMN, distal blocking should be performed with only two bolts.
authors.affiliation: Department of Orthopaedic Surgery and Traumatology, Hospital Costa del Sol, University of Malaga, Marbella, Malaga, Spain. lramosg@eresmas.com
authors.forename: Laura
authors.initials: L
authors.lastname: Ramos
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Bertrand
authors.forename: Nicolás
authors.initials: N
authors.lastname: Benitez-Parejo
authors.forename: Enrique
authors.initials: E
authors.lastname: Guerado
mesh_terms: D000328:Adult; D001858:Bone Nails; D003362:Cost-Benefit Analysis; D018483:Diaphyses / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000191:economics / Q000379:methods*; D017102:Fracture Healing; D017759:Fractures, Malunited / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011859:Radiography; D013030:Spain; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome; D016474:Weight-Bearing