A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails

Christian Emmanuel Marbella Fontanilla; Romer Ariel Minor Santos

doi:doi:10.11648/j.ijbecs.20220801.13

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A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails

Christian Emmanuel Marbella Fontanilla, Romer Ariel Minor Santos

Published in International Journal of Biomedical Engineering and Clinical Science (Volume 8, Issue 1)

Received: 22 March 2022 Accepted: 11 April 2022 Published: 20 April 2022

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Abstract

The Surgical Implant Generation Network (SIGN) produces solid and straight intramedullary nails used for femoral or tibial fractures. These utilize interlocking screws with proximal and distal threads to purchase at the cortices. When SIGN interlocking screws are unavailable, 4.5 mm, fully threaded, stainless steel, cortical screws are sometimes used to lock the nails. This study compared the alignment, fracture healing, and screw failure rates between cases which solely used SIGN interlocking screws and those which incorporated fully threaded, cortical screws. The SIGN census from January 2018 to August 2021 was reviewed. 79 cases were included in this study. 59 solely used SIGN interlocking screws and 20 incorporated fully threaded, cortical screws. The former group had acceptable alignment in 91.5%, 3-4 bridging cortices by the 12th week in 81.4%, and no screw failure in 96.8%. The latter group had acceptable alignment in 90.0%, 3-4 bridging cortices by the 12th week in 80.0%, and no screw failure in 95.0% of cases. The chi-square test showed no significant difference in outcomes between the two groups with p= .836 for fracture alignment, p= .894 for fracture healing, p= .745 for screw failure. This study concluded that 4.5 mm, fully threaded, stainless steel, cortical screws may be incorporated to lock SIGN nails when SIGN interlocking screws are unavailable.

Published in	International Journal of Biomedical Engineering and Clinical Science (Volume 8, Issue 1)
DOI	10.11648/j.ijbecs.20220801.13
Page(s)	12-14
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

SIGN, Nail, Screw, Femur, Tibia, Fracture

References

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[3]	Bong MR, Kummer FJ, Koval KJ, Egol KA. Intramedullary nailing of the lower extremity: Biomechanics and biology. J Am Acad Orthop Surg. 2007; 15 (2): 97–106.
[4]	Shih KS, Hsu WH, Fan CY, Hou SM. Stress analysis of locking screws for femoral antegrade and retrograde nailing constructs. J Chinese Inst Eng Trans Chinese Inst Eng A/Chung-kuo K Ch’eng Hsuch K’an. 2005; 28 (5): 837–48.
[5]	S C, SS P, DA S, RJ F. Treatment With the SIGN Nail in Closed Diaphyseal Femur Fractures Results in Acceptable Radiographic Alignment. Clin Orthop Relat Res [Internet]. 2015 Jul 8 [cited 2021 Aug 3]; 473 (7): 2394–401. Available from: https://pubmed.ncbi.nlm.nih.gov/25894807/
[6]	P S, K O, L Z, A J. Femoral fracture fixation in developing countries: an evaluation of the Surgical Implant Generation Network (SIGN) intramedullary nail. J Bone Joint Surg Am [Internet]. 2011 Oct 5 [cited 2021 Aug 3]; 93 (19): 1811–8. Available from: https://pubmed.ncbi.nlm.nih.gov/22005867/
[7]	Acharya BM, Tamrakar R, Devkota P, Thakur AK, Shrestha SK. Outcome of tibial diaphyseal fracture fixation with Surgical Implant Generation Network (SIGN) nail. J Patan Acad Heal Sci [Internet]. 2019 Dec 31 [cited 2021 Aug 3]; 6 (2): 5–11. Available from: https://www.nepjol.info/index.php/JPAHS/ article/view/27206
[8]	Khan I, Javed S, Khan GN, Aziz A. Outcome of intramedullary interlocking sIGN nail in tibial diaphyseal fracture. J Coll Physicians Surg Pakistan [Internet]. 2013 [cited 2021 Aug 3]; 23 (3): 203–7. Available from: https://pubmed.ncbi.nlm. nih.gov/23458044/
[9]	AO U, A B, A M, GS D, L Z, A von K. Clinical Outcomes and Complications of the Surgical Implant Generation Network (SIGN) Intramedullary Nail: A Systematic Review and Meta-Analysis. J Orthop Trauma [Internet]. 2019 Jan 1 [cited 2021 Aug 3]; 33 (1): 42–8. Available from: https://pubmed.ncbi.nlm. nih.gov/30277978/
[10]	Kinast C, Frigg R, Perren SM. Biomechanics of Interlocking Screws.pdf. Arch Orthop Trauma Surg. 1990; 109: 197–204.
[11]	Bell A, Templeman D, Weinlein JC. Nonunion of the Femur and Tibia: An Update. Orthop Clin North Am [Internet]. 2016; 47 (2): 365–75. Available from: http://dx.doi.org/10.1016/j.ocl.2015.09.010
[12]	Zirkle LG. Technique Manual of SIGN IM Nail & Interlocking Screw System Insertion & Extraction Guide. Washington; 2012. 47 p.
[13]	Bhandari M, Fong K, Sprague S, Williams D, Petrisor B. Variability in the definition and perceived causes of delayed unions and nonunions: A cross-sectional, multinational survey of orthopaedic surgeons. J Bone Jt Surg - Ser A. 2012; 94 (15): e109 (1).
[14]	Squyer ER, Dikos GD, Kaehr DM, Maar DC, Crichlow RJ. Early prediction of tibial and femoral fracture healing: Are we reliable? Injury [Internet]. 2016; 47 (12): 2805–8. Available from: http://dx.doi.org/10.1016/j.injury.2016.10.036
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APA Style

Christian Emmanuel Marbella Fontanilla, Romer Ariel Minor Santos. (2022). A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails. International Journal of Biomedical Engineering and Clinical Science, 8(1), 12-14. https://doi.org/10.11648/j.ijbecs.20220801.13

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ACS Style

Christian Emmanuel Marbella Fontanilla; Romer Ariel Minor Santos. A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails. Int. J. Biomed. Eng. Clin. Sci. 2022, 8(1), 12-14. doi: 10.11648/j.ijbecs.20220801.13

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AMA Style

Christian Emmanuel Marbella Fontanilla, Romer Ariel Minor Santos. A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails. Int J Biomed Eng Clin Sci. 2022;8(1):12-14. doi: 10.11648/j.ijbecs.20220801.13

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@article{10.11648/j.ijbecs.20220801.13,
  author = {Christian Emmanuel Marbella Fontanilla and Romer Ariel Minor Santos},
  title = {A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails},
  journal = {International Journal of Biomedical Engineering and Clinical Science},
  volume = {8},
  number = {1},
  pages = {12-14},
  doi = {10.11648/j.ijbecs.20220801.13},
  url = {https://doi.org/10.11648/j.ijbecs.20220801.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijbecs.20220801.13},
  abstract = {The Surgical Implant Generation Network (SIGN) produces solid and straight intramedullary nails used for femoral or tibial fractures. These utilize interlocking screws with proximal and distal threads to purchase at the cortices. When SIGN interlocking screws are unavailable, 4.5 mm, fully threaded, stainless steel, cortical screws are sometimes used to lock the nails. This study compared the alignment, fracture healing, and screw failure rates between cases which solely used SIGN interlocking screws and those which incorporated fully threaded, cortical screws. The SIGN census from January 2018 to August 2021 was reviewed. 79 cases were included in this study. 59 solely used SIGN interlocking screws and 20 incorporated fully threaded, cortical screws. The former group had acceptable alignment in 91.5%, 3-4 bridging cortices by the 12th week in 81.4%, and no screw failure in 96.8%. The latter group had acceptable alignment in 90.0%, 3-4 bridging cortices by the 12th week in 80.0%, and no screw failure in 95.0% of cases. The chi-square test showed no significant difference in outcomes between the two groups with p= .836 for fracture alignment, p= .894 for fracture healing, p= .745 for screw failure. This study concluded that 4.5 mm, fully threaded, stainless steel, cortical screws may be incorporated to lock SIGN nails when SIGN interlocking screws are unavailable.},
 year = {2022}
}

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TY - JOUR
T1 - A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails
AU - Christian Emmanuel Marbella Fontanilla
AU - Romer Ariel Minor Santos
Y1 - 2022/04/20
PY - 2022
N1 - https://doi.org/10.11648/j.ijbecs.20220801.13
DO - 10.11648/j.ijbecs.20220801.13
T2 - International Journal of Biomedical Engineering and Clinical Science
JF - International Journal of Biomedical Engineering and Clinical Science
JO - International Journal of Biomedical Engineering and Clinical Science
SP - 12
EP - 14
PB - Science Publishing Group
SN - 2472-1301
UR - https://doi.org/10.11648/j.ijbecs.20220801.13
AB - The Surgical Implant Generation Network (SIGN) produces solid and straight intramedullary nails used for femoral or tibial fractures. These utilize interlocking screws with proximal and distal threads to purchase at the cortices. When SIGN interlocking screws are unavailable, 4.5 mm, fully threaded, stainless steel, cortical screws are sometimes used to lock the nails. This study compared the alignment, fracture healing, and screw failure rates between cases which solely used SIGN interlocking screws and those which incorporated fully threaded, cortical screws. The SIGN census from January 2018 to August 2021 was reviewed. 79 cases were included in this study. 59 solely used SIGN interlocking screws and 20 incorporated fully threaded, cortical screws. The former group had acceptable alignment in 91.5%, 3-4 bridging cortices by the 12th week in 81.4%, and no screw failure in 96.8%. The latter group had acceptable alignment in 90.0%, 3-4 bridging cortices by the 12th week in 80.0%, and no screw failure in 95.0% of cases. The chi-square test showed no significant difference in outcomes between the two groups with p= .836 for fracture alignment, p= .894 for fracture healing, p= .745 for screw failure. This study concluded that 4.5 mm, fully threaded, stainless steel, cortical screws may be incorporated to lock SIGN nails when SIGN interlocking screws are unavailable.
VL - 8
IS - 1
ER -

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Author Information

Christian Emmanuel Marbella Fontanilla

Department of Orthopaedics, East Avenue Medical Center, Metro Manila, Philippines
Romer Ariel Minor Santos

Department of Orthopaedics, East Avenue Medical Center, Metro Manila, Philippines

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APA Style

Christian Emmanuel Marbella Fontanilla, Romer Ariel Minor Santos. (2022). A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails. International Journal of Biomedical Engineering and Clinical Science, 8(1), 12-14. https://doi.org/10.11648/j.ijbecs.20220801.13

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ACS Style

Christian Emmanuel Marbella Fontanilla; Romer Ariel Minor Santos. A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails. Int. J. Biomed. Eng. Clin. Sci. 2022, 8(1), 12-14. doi: 10.11648/j.ijbecs.20220801.13

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AMA Style

Christian Emmanuel Marbella Fontanilla, Romer Ariel Minor Santos. A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails. Int J Biomed Eng Clin Sci. 2022;8(1):12-14. doi: 10.11648/j.ijbecs.20220801.13

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@article{10.11648/j.ijbecs.20220801.13,
  author = {Christian Emmanuel Marbella Fontanilla and Romer Ariel Minor Santos},
  title = {A Retrospective Cohort Study on Using Fully Threaded, Cortical Screws in Locking SIGN Intramedullary Nails},
  journal = {International Journal of Biomedical Engineering and Clinical Science},
  volume = {8},
  number = {1},
  pages = {12-14},
  doi = {10.11648/j.ijbecs.20220801.13},
  url = {https://doi.org/10.11648/j.ijbecs.20220801.13},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijbecs.20220801.13},
  abstract = {The Surgical Implant Generation Network (SIGN) produces solid and straight intramedullary nails used for femoral or tibial fractures. These utilize interlocking screws with proximal and distal threads to purchase at the cortices. When SIGN interlocking screws are unavailable, 4.5 mm, fully threaded, stainless steel, cortical screws are sometimes used to lock the nails. This study compared the alignment, fracture healing, and screw failure rates between cases which solely used SIGN interlocking screws and those which incorporated fully threaded, cortical screws. The SIGN census from January 2018 to August 2021 was reviewed. 79 cases were included in this study. 59 solely used SIGN interlocking screws and 20 incorporated fully threaded, cortical screws. The former group had acceptable alignment in 91.5%, 3-4 bridging cortices by the 12th week in 81.4%, and no screw failure in 96.8%. The latter group had acceptable alignment in 90.0%, 3-4 bridging cortices by the 12th week in 80.0%, and no screw failure in 95.0% of cases. The chi-square test showed no significant difference in outcomes between the two groups with p= .836 for fracture alignment, p= .894 for fracture healing, p= .745 for screw failure. This study concluded that 4.5 mm, fully threaded, stainless steel, cortical screws may be incorporated to lock SIGN nails when SIGN interlocking screws are unavailable.},
 year = {2022}
}

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