Abstract
Purpose Poller screws may serve as an adjunctive reduction tool and aid fracture reduction while augmented with intramedullary (IM) nailing for treating diaphyseal or metaphyseal fractures of the femur and tibia. However, there is no consistent conclusion about whether the method of using IM nailing augmented with poller screws is more advantageous than using IM nailing alone. Methods A total of 96 patients who received IM nailing with or without supportive poller screw for treating long-bone fractures in lower limbs and who experienced difficulties in performing reduction or IM insertion during the surgical process were included in this retrospective cohort study (33 patients with poller screws in group A versus 63 patients without poller screws in group B). Patient demographics including age, gender, and body mass index; injury-related data including fracture location, classification, and injury mechanism; operation-related data including American Society of Anesthesiologists, duration of operation, poller screw time, method of anesthesia, and volume of intraoperative hemorrhage; outcomes including fracture healing time; and incidence of outcomes of nonunion, malunion, infection, and secondary surgical procedures were evaluated. Results Fracture healing time of patients in group A was significantly shorter than that of group B (18.3 ± 4.8 weeks versus 24.3 ± 3.0 weeks, p = 0.023). Union rate was higher (100.0% versus 87.3%, p = 0.048), and malunion rate and secondary surgical procedure rate were lower (both are 3.0% versus 19.0%, p = 0.031) in group A than that of group B. Conclusion Poller screw augmentation of IM nailing is a favourable option to shorten fracture healing time and to reduce complication rates in terms of nonunion, malunion, and secondary surgical procedure in the treatment of both diaphyseal/metaphyseal fractures of the femur or tibia while compare with those treated by IM nailing alone.
Highlights
Intramedullary (IM) nail fixation has become the preferred choice of operative management of long-bone fractures of the lower limb due to its numerous advantages such as minimally invasive, limited soft tissue dissection, short hospital stay, and early weight bearing, making it superior compared to plates and screws [1,2,3]
To prevent axial deformities in proximal or distal third tibia fractures during IM nailing, “poller screw” was firstly described by Krettek in 1999 [14], which was similar to the metal devices designed to block or guide traffic
Patients were retrospectively assigned to two groups according to their treatment: group A of patients using IM nailing augmented with poller screws and group B of patients received IM nail treatment alone
Summary
Intramedullary (IM) nail fixation has become the preferred choice of operative management of long-bone fractures of the lower limb due to its numerous advantages such as minimally invasive, limited soft tissue dissection, short hospital stay, and early weight bearing, making it superior compared to plates and screws [1,2,3]. One of the major limitations with the “standard” practice of IM nailing in the treatment of metaphyseal fractures is different sizes between the nail diameter and the metaphyseal diameter, making the bone-implant contact small, which decreases biomechanical stability and frequently result in malalignment and nonunions and requires reoperations [4,5,6,7,8,9,10,11,12]. Due to the advantages that they do not require special hardware and no need for excessive soft tissue dissection, a number of previous studies have shown that IM nailing augmented with poller screws may help in reducing deformity in axis, controlling angular deformity, and effectively aiding fracture reduction by directing the IM nail during insertion [3, 5, 15,16,17,18,19]
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