title: Clinical and radiologic outcomes associated with the use of dynamic locking screws (DLS) in distal tibia fractures.
abstract: BACKGROUND
  The locked screw plate construct is often cited as being too rigid and prolonging healing in patients with metaphyseal fractures. The newly introduced dynamic locking screws (DLS) allow 0.2 mm of axial motion, which should optimize healing near the near cortex. The purpose of this study was to analyze the clinical results of dynamic locking screws in distal tibia fractures.
  
  
  METHODS
  Data were acquired retrospectively. Only distal meta-diaphyseal tibia fractures treated with minimally invasive plate osteosynthesis and DLS were evaluated. Cortical and locking head screws were used for distal plate fixation to minimize soft tissue irritation over the medial malleolus, and DLS were used in the proximal plate fixation. Clinical and radiographic data were evaluated after 6 weeks, 3 months, 6 months and 1 year until fracture union.
  
  
  RESULTS
  Twenty-two patients were treated with minimally invasive plate osteosynthesis and DLS. Six patients could not be evaluated because they returned to a foreign residence after the procedure. Fourteen fractures healed after a mean of 3.1 months. Two fractures with insufficient reduction showed delayed union and healed after 9 and 9.5 months, respectively. The callus index peaked at 6 months.
  
  
  CONCLUSIONS
  Dynamic fracture fixation might be a promising concept to reduce the frequency of metaphyseal non-unions in distal tibia fractures. But nevertheless, the dynamic construct cannot compensate for insufficient reduction.
authors.affiliation: Kantonsspital Graubünden, Loestr. 170, 7000, Chur, Switzerland. yvespascal.acklin@gmail.com.
authors.forename: Y P
authors.identifier: http://orcid.org/0000-0003-3751-7639
authors.initials: YP
authors.lastname: Acklin
authors.affiliation: Berufsgenossenschaftliche Unfallklinik Tübingen, Schnarrenbergstr. 95, 72076, Tübingen, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Stöckle
authors.affiliation: Kantonsspital Graubünden, Loestr. 170, 7000, Chur, Switzerland.
authors.forename: C
authors.initials: C
authors.lastname: Sommer
mesh_terms: D000328:Adult; D000368:Aged; D001860:Bone Plates; D001863:Bone Screws; D005260:Female; D005594:Fracture Fixation, Intramedullary / Q000379:methods*; D017102:Fracture Healing; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging*; D013978:Tibial Fractures / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome
keywords: DLS; Distal tibia fracture; Dynamic fracture fixation; Dynamic locking screws; Fracture union