Aim. To evaluate the clinical use of blocking screws as a supplement to stability in distal tibial metaphyseal fractures treated with statically locked intramedullary nail. Main Outcome Measurement. Alignment and reduction preoperatively, postoperatively, and at healing were the main outcome measured with an emphasis on maintenance of initial reduction on followup. Patients and Methods. This was a prospective study of 20 consecutive cases of distal tibial metaphyseal fractures treated with statically locked intramedullary nailing with supplementary blocking screw between August 2006 and September 2007 with a maximum followup of 3 years. Medullary canal diameter was measured at the levels of fracture and isthmus. Results. The mean diameter of tibia at the level of isthmus was 11.9？mm and at the fracture site was 22.9？mm. Mean length of distal fracture segment was 4.6？cm. Mean varus/valgus alignment was 10.3？degrees preoperatively and 1.7？degrees immediatly postoperatively and was maintained till union. Using Karlstrom-Olerud score the outcome was excellent to good in 90%. Conclusion. We conclude that the use of blocking screw as a supplement will aid in achieving and maintaining the reduction of distal tibial metaphyseal fractures when treated with intramedullary nailing thereby extending the indication of intramedullary nailing. 1. Introduction Treatment of metaphyseal fractures of tibia remains a challenge. The goals of surgical management include correction and maintenance of sagittal and coronal alignment, establishment of length and rotation, and early functional range of movements of knee and ankle. Interlocking nailing of tibial fractures is desirable because this technique allows some load sharing, spares extra osseous blood supply, avoids extensive soft tissue dissection, and is familiar to most surgeons. Nailing of metaphyseal fractures with short distal fragment is associated with an increase in malalignment particularly in coronal plane, nonunion, and need for secondary procedures to achieve union. The cause has been attributed both to displacing muscular forces and residual instability [1]. As there is a mismatch between the diameters of the nail and the medullary canal, with no nail-cortex contact, the nail may translate laterally along coronally placed locking screws and increased stress is placed on the locking holes to maintain fracture alignment after surgery [1]. Various techniques have been recommended to improve nailing the metaphyseal fractures including blocking screws (poller screw), temporary unicortical plating, percutaneous
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