title: Evaluation of the effectiveness of the angular stable locking system in patients with distal tibial fractures treated with intramedullary nailing: a multicenter randomized controlled trial.
abstract: BACKGROUND
  Angular stable locking of intramedullary nails has been shown to enhance fixation stability of tibial fractures in biomechanical and animal studies. The aim of our study was to assess whether use of the angular stable locking system or conventional locking resulted in earlier full weight-bearing with minimum pain for patients with a distal tibial fracture treated with an intramedullary nail.
  
  
  METHODS
  A prospective multicenter, randomized, patient-blinded trial was conducted with adults who had a distal tibial fracture. Patients' fractures were managed with an intramedullary nail locked with either an angular stable locking system or conventional locking screws. Outcomes were evaluated at six weeks, twelve weeks, six months, and one year after surgery. Time to full weight-bearing with minimum pain was calculated with use of daily entries from patient diaries. Secondary outcomes included pain at the fracture site under load, quality of life, gait analysis, mobility, radiographic findings, and adverse events.
  
  
  RESULTS
  One hundred and forty-two patients were randomly allocated to two treatment groups: seventy-five to the group receiving intramedullary nailing with the angular stable locking system and sixty-seven to the group receiving conventional intramedullary nailing. No clinically important differences were found for either the primary or secondary outcome parameters between the groups during the entire follow-up period.
  
  
  CONCLUSIONS
  Use of an angular stable locking system with intramedullary nailing did not improve the outcome compared with conventional locking screws in the treatment of distal tibial fractures.
authors.affiliation: Berufsgenossenschaftliche Unfallklinik Tübingen, Schnarrenbergstrasse 95, D-72076 Tübingen, Germany.
authors.forename: Dankward
authors.initials: D
authors.lastname: Höntzsch
authors.affiliation: Centrum fur Muskuloskeletale Chirurgie, Campus Verchow-Klinikum, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, D-13353 Berlin, Germany.
authors.forename: Klaus-Dieter
authors.initials: KD
authors.lastname: Schaser
authors.affiliation: Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Friedrich-Schiller-Universität Jena, Erlanger Allee 101, D-07740 Jena, Germany.
authors.forename: Gunther O
authors.initials: GO
authors.lastname: Hofmann
authors.affiliation: Klinik für Unfall-, Hand- und Wiederherstellungschirurgie, Universität des Saarlandes, Kirrberger Strasse, D-66421 Homburg/Saar, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Pohlemann
authors.affiliation: Sykehuset I Vestfold HF Tønsberg, Halfdan Wilhelmsens allé 17, Postboks 2168, N-3103 Tønsberg, Norway.
authors.forename: Einar Sturla
authors.initials: ES
authors.lastname: Hem
authors.affiliation: Klinik und Poliklinik fur Unfallchirurgie, Universitätsmedizin Mainz, Langenbeckstrasse 1, D-55131 Mainz, Germany.
authors.forename: Erik
authors.initials: E
authors.lastname: Rothenbach
authors.affiliation: Unfallchirurgische Klinik, Medizinische Hochschule Hannover, Carl Neuberg Strasse 1, D-30625 Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Krettek
authors.affiliation: Universitätsklinik für Unfallchirurgie und Sporttraumatologie, Medizinische Universität Innsbruck, Anichstrasse 35, A-6020 Innsbruck, Austria. E-mail address: rene.attal@uki.at.
authors.forename: René
authors.initials: R
authors.lastname: Attal
mesh_terms: D000328:Adult; D000368:Aged; D001858:Bone Nails; D001863:Bone Screws; D005260:Female; D005500:Follow-Up Studies; D005594:Fracture Fixation, Intramedullary / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D016037:Single-Blind Method; D013978:Tibial Fractures / Q000601:surgery*; D016896:Treatment Outcome