Painful locking screws with tibial nailing, an underestimated complication

  • Philip BeakEmail author
  • Shyam Moudhgalya
  • Thomas Anderson
  • Caroline B. Hing
Original Article • LOWER LIMB - FRACTURES



Tibial fractures represent approximately 3–4% of reported fractures. Locked, intramedullary nails are commonly used to restore length and alignment and provide rotational stability. Few studies have assessed the complication rate of locking screws.

Materials and methods

We conducted a retrospective observational study of all patients who underwent tibial nailing at our institution between the 01/01/15 and 30/06/17. All patients were followed up for at least 1 year post-operatively. For inclusion, patients had to be over 16 years of age and had undergone tibial nail fixation following a traumatic fracture. Post-operative radiographs were used to assess the configuration and features of locking screws.


One hundred and twenty-six individuals underwent tibial nailing over the 30-month period, with 95 followed up at least 1 year. Twenty-seven per cent of individuals reported pain attributed to locking screws at follow-up. Upon radiographic assessment, no significant difference was seen between symptomatic and asymptomatic cohorts in terms of proud screw heads proximally (7% vs 5%, p > 0.99) or distally (14% vs 17%, p > 0.99), long screw tips proximally (52% vs 48%, p = 0.81) or distally (51% vs 50%, p > 0.99), or tibiofibular joint penetration proximally (31% vs 23%, p = 0.60). However, there was a higher incidence of distal tibiofibular joint penetration in symptomatic versus asymptomatic individuals (4% vs 25%, p = 0.025).


Twenty-seven per cent of patients with a tibial nail report painful locking screws. Patients with symptomatic distal locking screws had a higher incidence of radiographic distal tibiofibular joint penetration.


Tibial fractures Surgery Fracture fixation Intramedullary Complications Intramedullary nailing 



CB Hing reports personal fees from Elsevier, Grants from Orthopaedic Research UK, Grants from Arthrex, Grants from Stryker, Grants from NIHR, outside the submitted work.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest to disclose.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Trauma and OrthopaedicsSt George’s Hospital, St George’s University Hospitals NHS Foundation TrustLondonUK
  2. 2.St George’s, University of LondonLondonUK

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