Retrospective Cohort Study Comparing Rates of Symptomatic Implants Requiring Removal between Standard versus Low-Profile Tibial Nail Interlocking Screws

This study aimed to compare the rates of symptomatic implants requiring removal between intramedullary tibia nails using standard (SD) versus low-profile (LP) screws. We hypothesize that LP screws will demonstrate lower rates of symptomatic screw removal compared with SD interlocking screws with no difference in secondary outcomes. We performed a retrospective cohort study of all patients 18-89 years old who underwent IMN of tibia fractures from November 2018 to February 2023 at a single, academic level one trauma center. The primary outcome analyzed was symptomatic screws requiring removal. Secondary outcomes analyzed include the incidence of superficial and deep infection, screw backout/failure, nonunion and quality of reduction. A total of 358 tibia fractures were reviewed and 179 met inclusion criteria. 138 cases utilized SD screws and 41 utilized LP screws. The average patient age was 42.8 years with mean follow-up of 20.6 months. There was no difference in the rate of symptomatic screws requiring removal (2.22% vs. 7.32%, P = 0.1082), screw backout/failure (4.35% vs. 9.76%, P = 0.1855) and nonunion (10.14% vs. 19.51%, P = 0.1087). The rates of superficial infection (10.87% vs. 24.39%, P = 0.0283) and deep infection (9.42% vs. 21.95%, P = 0.0319) were decreased in the SD group. The reduction quality was marginally better in the LP cohort. Our study demonstrates LP screws have similar rates of symptomatic screws requiring removal with minimal difference in secondary outcomes except for superficial and deep infection.