{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T14:27:49Z","timestamp":1794580069918,"version":"4.9.1"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","funder":[{"name":"PerfectCircle LLC","award":["1"],"award-info":[{"award-number":["1"]}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Intramedullary nailing (IMN) is the standard treatment for tibial shaft fractures; however, postoperative malalignment remains a relevant complication. Deviations in distal nail position can influence tibial alignment, and eccentric drilling during distal interlocking screw placement may alter fracture reduction and length. The purpose of this study was to quantify the effect of intentionally eccentric distal interlocking screw placement on tibial alignment in a controlled cadaveric model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Ten paired, formalin-fixed, human-cadaveric tibias underwent standardized IMN via suprapatellar approach after reaming of 1.5 mm over nail diameter. A simulated comminuted distal tibia\u2013fibula fracture was created using a 2-cm defect 4-cm proximal to the plafond. A 10-mm IMN was then seated and secured with a 60-mm interlocking screw, placed in the medial-to-lateral proximal oblique hole. Crossing K-wires were placed in the coronal and sagittal planes to serve as markers for angular and axial displacement. Using fluoroscopic \u201cperfect-circles\u201d technique, 3 surgeons performed standardized, intentional, eccentric-drilling with proximal-to-distal trajectory. Distal screw placement was performed in the medial\u2013lateral plane and then removed and repeated in the anterior\u2013posterior plane. Coronal and sagittal angulation and axial length were measured by digital goniometer and calipers after screw insertion, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      For medial\u2013lateral screws, proximal-to-distal eccentric drilling yielded a mean coronal angulation of 6.0\u00b0 induced valgus (SD = 3.8 degrees, R: 1.5\u00b0\n                      <jats:sub>min<\/jats:sub>\n                      -12.2\u00b0\n                      <jats:sub>max<\/jats:sub>\n                      ). While for anterior\u2013posterior screw placement, proximal-to-distal eccentric drilling yielded a mean of 5.8-degree procurvatum (SD = 2.0\u00b0, R: 2.8\u00b0\n                      <jats:sub>min<\/jats:sub>\n                      -8.5\u00b0\n                      <jats:sub>max<\/jats:sub>\n                      ). Translational distraction in the coronal plane was 3.0 mm (SD = 2.2 mm, R: 0.05mm\n                      <jats:sub>min<\/jats:sub>\n                      \u20137.8mm\n                      <jats:sub>max<\/jats:sub>\n                      ), and distraction in the sagittal plane was 3.9 mm (SD = 3.0 mm, R: 1.1mm\n                      <jats:sub>min<\/jats:sub>\n                      \u20139.8mm\n                      <jats:sub>max<\/jats:sub>\n                      ).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Eccentric distal interlocking screw placement produced radiographically appreciable angular and axial changes in distal tibial IMN constructs. Deviations during the \u201cperfect-circles\u201d technique can generate malalignment, or alternatively, be used to fine tune reduction in theory. Precise distal screw trajectory and strategies to minimize drilling eccentricity may reduce postoperative malalignment, particularly in distal tibial fractures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/bot.0000000000003256","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T12:58:41Z","timestamp":1786625921000},"page":"e295-e298","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Quantifying the Effects of Eccentrically Drilled Distal Interlock Screws in Cadaveric Tibias"],"prefix":"10.1097","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9574-1711","authenticated-orcid":false,"given":"Casey","family":"McDonald","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cameron","family":"Atkison","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Ni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katerina","family":"Papanikolaou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raja","family":"Ullah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4192-4192","authenticated-orcid":false,"given":"Thomas L.","family":"Hand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"R1-20261113","doi-asserted-by":"crossref","first-page":"406","DOI":"10.5435\/00124635-200607000-00003","article-title":"Surgical treatment of nonarticular distal tibia fractures","volume":"14","author":"Bedi","year":"2006","journal-title":"J Am Acad Orthop Surg."},{"key":"R2-20261113","doi-asserted-by":"crossref","first-page":"736","DOI":"10.1097\/BOT.0b013e318213f709","article-title":"Randomized, prospective comparison of plate versus intramedullary nail fixation for distal tibia shaft fractures","volume":"25","author":"Vallier","year":"2011","journal-title":"J Orthop Trauma"},{"key":"R3-20261113","doi-asserted-by":"crossref","first-page":"389","DOI":"10.3390\/medicina58030389","article-title":"Malunion of the tibia: a systematic review","volume":"58","author":"Patel","year":"2022","journal-title":"Medicina (Kaunas)"},{"key":"R4-20261113","doi-asserted-by":"crossref","first-page":"316","DOI":"10.1007\/s00423-003-0396-0","article-title":"The fracture gap size influences the local vascularization and tissue differentiation in callus healing","volume":"388","author":"Claes","year":"2003","journal-title":"Langenbecks Arch Surg."},{"key":"R5-20261113","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1186\/s13018-023-04232-3","article-title":"Risk factors and healthcare costs associated with long bone fracture non-union: a retrospective US claims database analysis","volume":"18","author":"Vanderkarr","year":"2023","journal-title":"J Orthop Surg."},{"key":"R6-20261113","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.bonr.2017.03.002","article-title":"Bone fracture healing in mechanobiological modeling: a review of principles and methods","volume":"6","author":"Ghiasi","year":"2017","journal-title":"Bone Rep."},{"key":"R7-20261113","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1302\/0301-620X.88B2.16456","article-title":"Factors affecting fracture healing after intramedullary nailing of the tibial diaphysis for closed and grade I open fractures","volume":"88","author":"Drosos","year":"2006","journal-title":"J Bone Joint Surg Br"},{"key":"R8-20261113","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1097\/00005131-200108000-00006","article-title":"Rates and odds ratios for complications in closed and open tibial fractures treated with unreamed, small diameter tibial nails: a multicenter analysis of 467 cases","volume":"15","author":"Gaebler","year":"2001","journal-title":"J Orthop Trauma"},{"key":"R9-20261113","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1007\/s00264-012-1505-x","article-title":"Critical analysis of tibial fracture healing following unreamed nailing","volume":"36","author":"Salem","year":"2012","journal-title":"Int Orthop."},{"key":"R10-20261113","doi-asserted-by":"crossref","first-page":"754","DOI":"10.1177\/107110070302401004","article-title":"Supramalleolar osteotomy for the treatment of distal tibial angular deformities and arthritis of the ankle joint","volume":"24","author":"Stamatis","year":"2003","journal-title":"Foot Ankle Int."},{"key":"R11-20261113","doi-asserted-by":"crossref","first-page":"722","DOI":"10.1302\/0301-620X.78B5.0780722","article-title":"Degenerative changes at the knee and ankle related to malunion of tibial fractures. 15-year follow-up of 88 patients","volume":"78","author":"van der Schoot","year":"1996","journal-title":"J Bone Joint Surg Br"},{"key":"R12-20261113","first-page":"607","article-title":"Treatment of closed tibial fractures","volume":"52","author":"Schmidt","year":"2003","journal-title":"Instr Course Lect"},{"key":"R14-20261113","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1016\/S0736-0266(02)00044-X","article-title":"The effect of mechanical stability on local vascularization and tissue differentiation in callus healing","volume":"20","author":"Claes","year":"2002","journal-title":"J Orthop Res."},{"key":"R15-20261113","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1097\/BOT.0000000000002345","article-title":"A critical analysis of lateral versus central endpoint in distal tibia nailing: does it affect alignment?","volume":"36","author":"Brodke","year":"2022","journal-title":"J Orthop Trauma"},{"key":"R16-20261113","doi-asserted-by":"crossref","first-page":"e62","DOI":"10.5435\/JAAOS-D-20-00309","article-title":"Staying out of trouble with intramedullary nailing of distal tibia fractures","volume":"29","author":"Lee","year":"2021","journal-title":"J Am Acad Orthop Surg."},{"key":"R17-20261113","doi-asserted-by":"crossref","first-page":"6615776","DOI":"10.1155\/2021\/6615776","article-title":"Outcome analysis of intramedullary nailing augmented with poller screws for treating difficult reduction fractures of femur and tibia: a retrospective cohort study","volume":"2021","author":"Guo","year":"2021","journal-title":"Biomed Res Int."}],"container-title":["Journal of Orthopaedic 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