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Therefore, we suggest 1 2 mm space between the blocking screw and the nail.
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The aim of this manuscript is to present a detailed review of the common patterns of deformities that occur during limb lengthening and deformity correction using ILN, to present a systematic approach to the appropriate use of blocking screws and to introduce the "reverse rule of thumb" as a quick reference for surgeons to know the ideal location(s) and the number of blocking screws.
Deformities of the proximal tibial metaphysis are treated in the same way with insertion of a directional blocking screw to guide the trajectory of the reamer ensuring a proper correction of the malalignment.
Varus angulation requires a blocking screw medial to the IM nail in the proximal fragment and often in the distal fragment close to the osteotomy site.
Lateral radiograph (c) and the intraoperative fluoroscopic lateral view (d) show one posterior blocking screw in the distal fragment near the osteotomy site used to prevent procurvatum deformity.
Hannah et al. [21] described placing the blocking screw in the acute angles formed between the long axis of the bone segment and the fracture plane in oblique fractures.
The blocking screw abuts the intramedullary nail preventing unwanted movement of the bone around the nail.
Deformities of the distal femur metaphysis are best corrected by first placing the blocking screw, then reaming, and then passing the nail.
A blocking screw that impinges on the nail as the nail tries to slide in the bone could produce too much resistance to lengthening and may jeopardize the distraction process.
If the nail is not centered in the bone fragment, either near the osteotomy site or away from the osteotomy site, then only one blocking screw is used at the displaced end of the bone fragment.
One blocking screw placed posterior to the nail in the distal fragment is critical.
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