Poller Screws Research Articles

English

English

The use of blocking screws with internal lengthening nail and reverse rule of thumb for blocking screws in limb lengthening and deformity correction surgery.

Internal lengthening nail (ILN) is a recent development in limb lengthening and deformity correction specialty. The ILN has the distinct advantage of combining acute deformity correction with gradual lengthening of bone. While using ILN, the short metaphyseal bone fragment may develop a deformity at the time of osteotomy and nail insertion or during bone lengthening because of the wide medullary canal. These deformities are typically predictable, and blocking screws (Poller screws) are helpful in these situations. This manuscript describes the common deformities that occur in femur and tibia with osteotomies at different locations while using ILN in antegrade and retrograde nailing technique. Also, a systematic approach to the appropriate use of blocking screws in these deformities is described. In addition, the “reverse rule of thumb” is introduced as a quick reference to determine the ideal location(s) and number of blocking screws. These principles are applicable to limb lengthening and deformity correction as well as fracture fixation using intramedullary nails.

Challenge to treat hypertrophic nonunion of the femoral shaft: the Poller screw augmentation technique.

The management of a femoral nonunion after intramedullary nailing is challenging. Exchange nailing or plate augmentation has been used to treat hypertrophic nonunions previously. The Poller screw augmentation technique is a simple procedure that can be performed in the outpatient surgery. In this study, we highlight the method of hypertrophic nonunion management according to the specific indication including our Poller screw augmentation technique.

An Outcome Analysis to Determine the Uses of Poller Screw in Treatment of Displaced Proximal and Distal Shaft Metadiaphyseal Fractures of Tibia Treated With Intramedullary Nailing

An Outcome Analysis to Determine the Uses of Poller Screw in Treatment of Displaced Proximal and Distal Shaft Metadiaphyseal Fractures of Tibia Treated With Intramedullary Nailing

Intramedullary nailing in proximal third tibial fractures

Intramedullary nailing is the gold standard in the treatment of shaft tibial fractures. When in the past proximal tibial fractures had to be treated by nailing, it became difficult to control the large metaphyseal fragment, which led to a high risk of malalignment, iatrogenic fractures and anterior knee pain. The reduction forceps and “poller screw” techniques are useful to control the fracture site. In our experience, we started to practice tibial intramedullary nailing through a suprapatellar approach, in order to try a more proximal entry point and obtain a good alignment with the tibial axis. In our institute we also treated proximal tibial fractures involving the articular surface using nailing through a suprapatellar approach. The first step involved reduction of the articular fracture line using lag cannulated screws; after percutaneous osteosynthesis, we practiced an intramedullary nailing in the semi-extended knee position.

Results of Dynamic Interlock Nailing in Distal Tibial Fractures

A study was performed in adults to determine the efficacy of closed reduction and intramedullary nailing in dynamic mode on union, implant failure and incidence of malalignment in patients who sustained an extra-articular fracture of the distal tibia. Methods: Between January 2007 and December 2013, one hundred and twelve patients of distal tibia that involved the distal 6 cm of the tibia were treated at our hospital with reamed intramedullary nailing with use of two distal interlocking screws and one proximal screw in dynamic mode. The augmentation was done with poller screws whenever it was necessary. The nailing of fibular fractures was done in 27 cases. There were 85 males and 27 females with a mean age of 30.9 (range: 20 to 72). Eighty fractures were closed whereas 32 were grade 1 open fractures. Results: The average time to union of the closed fracture was 15.4 weeks (range: 12 – 28 weeks). The healing times for the primarily nailed compound Grade I averaged 17.8 (range: 15 - 34 weeks). After minimum follow-up of one year, rate of primary union was in 97.32%. One case of broken nail required revision surgery. There were three cases of delayed union and two cases of non union. In one case there was deep infection which required exchange nailing with antibiotic impregnated nail. There was breakage of interlocking screws in three cases but fracture had united. In twenty two cases acceptable malalignment of the tibia was observed after union. The outcome was determined at a minimum of one year in our study based on the criteria of Johner and Wruhs. Out of 112 patients, 79 patients had excellent results, 29 had good results and 4 had fair results. Conclusions: The dynamic osteosynthesis of distal tibia by interlocking nail and judicious use of poller screws is an effective alternative for the treatment of distal metaphyseal tibial fractures.

The Usefulness of Poller Screw with Antegrade Nailing in the Initial Treatment of Infraisthmal Femur Shaft Fracture

230 Copyright c 2015 The Korean Fracture Society. All rights reserved. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Received June 15, 2015 Revised July 6, 2015 Accepted July 24, 2015 Address reprint requests to: Sang-Heon Song, M.D., Ph.D. Department of Orthopedic Surgery, Myongji Hospital, Seonam University College of Medicine, 55 Hwasu-ro 14beon-gil, Deogyang-gu, Goyang 10475, Korea Tel: 82-31-810-5424ᆞFax: 82-31-969-0500 E-mail: sh.gabriel.song@gmail.com

A novel technique for accurate Poller (blocking) screw placement

Achieving good results with intramedullary nailing of oblique long bone fractures at the metaphyseal–diaphyseal junction can be difficult. There is a strong tendency for axial displacement and an association with characteristic malalignment of the short fragment. Poller or blocking screws have been shown to be effective in aiding fracture reduction. While several papers describe methods for screw placement, these are confusing to understand, difficult to follow in clinical practice and not always applicable. Here we describe a new, simple, reproducible and easy to use method for ensuring accurate Poller screw placement, in order to maximise the benefits of their use and achieve good overall results.

Intramedullary Nailing Supplemented with Poller Screws for Proximal Tibial Fractures

Intramedullary Nailing Supplemented with Poller Screws for Proximal Tibial Fractures

Sa4.9 Technique to achieve appropriate reduction with provisional K wires instead of poller screws for diametaphyseal fractures of distal femur, proximal and distal tibia

Sa4.9 Technique to achieve appropriate reduction with provisional K wires instead of poller screws for diametaphyseal fractures of distal femur, proximal and distal tibia

Use of the Schanz screw as a joystick and the Poller screw in intramedullary nailing for subtrochanteric or proximal femoral fracture

We read with great interest the article titled ‘‘Use of blocking screws in intramedullary fixation of subtrochanteric fractures’’ by Amin et al. [1]. We congratulate the authors on their success in using intramedullary nailing in conjunction with the placement of blocking screws to treat six patients with subtrochanteric fractures. All their patients demonstrated satisfactory results, with alignment and bony union maintained at the final radiographic followup. These types of fractures present with characteristic musculature-induced difficulties to control reduction. The abductors and short external rotators insert over the greater trochanter, and the lesser trochanter is the insertion site for the iliacus and psoas hip flexors. These muscles cause the proximal fragment to develop a flexed, abducted and externally rotated position after a fracture [2]. This deformity cannot be resolved with traction on the fracture table with traction, and it is difficult to find a precise point of entry and achieve excellent reduction. Sadighi et al. [3] reported that percutaneously placed Schanz screws used as joysticks could facilitate closed reduction. Kim et al. [4] described a procedure in which they reamed the proximal fragment progressively up to 13 mm, selected a nail that was 2–3 mm smaller than the estimated diameter of the isthmic portion, and inserted the nail into the proximal fragment and manipulated it in an extended, adducted, and internally rotated direction to achieve good reduction and cross the fracture site. Otherwise, the proximal fragment would have a larger canal diameter compared with the distal fragment, and inadequate alignment with translation would be noted if the proximal reamed canal deviated toward the medial or lateral cortex. Krettek et al. [5] described the clinical application of Poller screws to prevent axial deformities during intramedullary nailing for proximal and distal tibial fractures during intramedullary nailing. Amin et al. [1] termed these screws ‘‘blocking screws’’ and applied them to the proximal femoral fragment, separately targeting the medial one-third and posterior one-third. We developed a simple synthesized technique using the Schanz screw as a joystick and the Poller screw for treatment of subtrochanteric or proximal femoral fractures. With the injured limb under traction on the fracture table, one Schanz screw is inserted over the proximal fragment under fluoroscopic guidance and pushed to cause proximal fragment adduction. It is convenient to find a precise entry point for the nail. A ball-tip guide wire is inserted into the proximal canal after using an awl to create the entry point. The Shanz screw is unscrewed until the lateral third of the canal is occupied as Poller screw. The Schanz screw is maintained in position to keep the make medial cortex contact (extended, adducted, and internally rotated), and the guide wire is progressed across the fracture site. This is C.-Y. Chen K.-C. Lin (&) S.-W. Yang Y.-W. Tarng C.-J. Hsu J.-H. Renn Department of Orthopaedics, Kaohsiung Veterans General Hospital, 386 Ta-Chung 1st Road, Kaohsiung, Taiwan e-mail: orthokcl@gmail.com

Commentary: Intramedullary Nailing Supplemented with Poller Screws for Proximal Tibial Fractures

is challenging owing to the relatively high chance of displacement during nail insertion. The stability of the proximal fixation is inferior because of the wider diameter of the intramedullary canal in the metaphysis. This has led to the use of Poller screws for additional blocking during intramedullary fixation of proximal or distal tibial fractures.1 The effects of Poller screw is two-fold. First, fracture reduction is better maintained during nail insertion, which reduces the chance of malunion. Second, the stability achieved by additional Poller screws enables quicker fracture union. Stability can be further enhanced by modifying nail design and locking options,2 such as increasing the number of locking screws inserted into the metaphyseal fragment, and using angularly stable locking screws that diminish the amount of nail wobble in the screw hole.3 Commentary: Intramedullary nailing supplemented with Poller screws for proximal tibial fractures

Intramedullary Nailing Supplemented with Poller Screws for Proximal Tibial Fractures

To evaluate outcome of intramedullary nailing supplemented with Poller screws for proximal tibial fractures using small diameter nails. 50 men and 20 women (75 fractures) aged 18 to 65 (mean, 33) years underwent intramedullary nailing supplemented with Poller screws for acutely displaced fractures (n=60) or for delayed union (n=10) or mal-union (n=5) of the proximal metadiaphyseal tibia. 88% of the fractures were caused by road traffic accidents. 54 cases had closed fractures and 21 had grade I or II compound fractures. Clinical and radiological outcome was evaluated. In 69 cases, healing occurred after a mean of 4.2 (range, 3-9) months. In 5 cases, there was non-union, which was resolved by bone grafting. One case was mal-united. 63 patients recovered a full range of knee motion (0º-130º), and the remaining 7 attained flexion of 0º to 90º. According to the knee rating scale of the Hospital for Special Surgery, outcome was excellent in 50 patients, good in 14, poor in 3, and failed in 3 at month 12, and remained so after a mean follow-up of 30.8 months. Postoperatively, 74 cases had <5º of varus or valgus malalignment, and only one developed varus of +7º. 65 cases exhibited no deformity, 7 had a deformity of <3º, and 3 had a deformity of 4º to 9º. Poller screws help maintain fixation of intramedullary nailing and alignment of fractures.

A25 A five year experience in using poller screws in lower limb im nailing in a military hospital in Greece

A25 A five year experience in using poller screws in lower limb im nailing in a military hospital in Greece

Mechanical performance of poller and blocking screws in distal metaphyseal fractures of the tibia

Mechanical performance of poller and blocking screws in distal metaphyseal fractures of the tibia

Computer-assisted orthopaedic fracture reduction

Background The goal of this study was to evaluate a new second generation of computer-assisted fluoroscopic navigation software for fracture reduction (SGFR) of long-bone fractures. The new software allows simultaneous tracking of two moving bone fragments. Methods Between 2005–2007, patients with isolated, extra-articular long-bone fracture of either the femur or tibia were considered for computer-assisted fluoroscopic fracture reduction surgery. The operative tasks were: (1) fracture reduction; (2) determination of the entry point, and; (3) Poller screw insertion, when needed. Fracture reduction was achieved by one of two methods: (1) fracture edges or (2) medullary canal recognition. Fracture reduction was considered successful if the guide wire was introduced through the fracture without further radiation. Results We treated 38 patients (27 men and 11 women); with 15 femoral and 23 tibial fractures, with intramedullary nail fixation. In all patients, the point of entry was navigated successfully. In four patients, the insertion of the blocking screw was planned and executed without further radiation. All fractures were successfully reduced using the SGFR system. In nine patients, we used method 1, in 22 patients method 2, and in six a combination of both. The number of fluoroscopic images was dramatically reduced to four to six images. Conclusions Fracture reduction was reliably achievable in all patients using the SGFR. A key conclusion is that only a small number of fluoroscopic images are required. Although timing was not an objective of this study, we believe that there was a noticeable reduction of intraoperative time.

Technique for precise placement of poller screws with intramedullary nailing of metaphyseal fractures of the femur and the tibia

Intramedullary nailing is the accepted treatment of femoral and tibial shaft fractures. Improvements in surgical techniques and implant designs have extended indications for nailing to metaphyseal fractures of the proximal tibia, distal tibia and the distal femur. Malalignment can still occur with intramedullary nailing of these fractures. Among many techniques that have been described, the use of a ‘poller screw’ or ‘blocking screw’ is one of the methods that may be used to aid in satisfactory fracture reduction and biomechanical stability. To our knowledge, the use of a Steinman pin as the initial step in poller screw insertion has not been reported in the English literature. We report a new technique of poller screw using Steinman pin localisation with tibial and femoral nailing of metaphyseal fractures.

Computerised navigation for closed reduction during femoral intramedullary nailing

Intramedullary nailing is the most commonly used technique for fixing femoral shaft fractures. 17 Winquist R.A. Hansen Jr., S.T. Clawson D.K. Closed intramedullary nailing of femoral fractures: a report of five hundred and twenty cases. J Bone Joint Surg Am. 1984; 66: 529-539 PubMed Google Scholar Use of a fluoroscopy based computerised navigation system can improve the nailing technique by locating the entry point of the nail, inserting locking and Poller screws and providing accurate nail and screw measurements. These tasks then can be performed with markedly reduced radiation exposure. 5 Kahler D.M. Virtual fluoroscopy, a tool for decreasing radiation exposure during femoral intramedullary Nailing. Stud Health Technol Inform. 2001; 81: 225-228 PubMed Google Scholar , 7 Khoury A, Liebergall M, Weil Y, Mosheiff R. Navigation assisted intramedullary nailing – the first generation. In: The 19th Annual Meeting of the Orthopaedic Trauma Association [abstract]. Salt Lake City, Utah, USA; 2003. p. 124. Google Scholar , 14 Suhm N. Messmer P. Zuna I. et al. Fluorsocopic guidance versus surgical navigation for distal locking of intramedullary implants. A prospective controlled clinical study. Injury. 2003; 35: 567-574 Abstract Full Text Full Text PDF Scopus (64) Google Scholar However, fracture reduction in vivo has not been achieved by computerised navigation systems, since dynamic imaging of two separate anatomic sites, such as fracture fragments, has not yet proved feasible.

The Use of Poller Screws in Nonunion of Femoral Shaft Following Intramedullary Nailing of Femoral Shaft Fracture: A Case Report

As intramedullary nailing became more common in the treatment of femur shaft fractures, the incidence of nonunion increased which led to various treatment modalities for this complication. Accurate diagnosis of the etiology of nonunion and appropriate treatment is essential. Poller screws can help in preventing possible sagittal malalignment after intramedullary nail fixation and also be a minimally invasive method to treat hypertrophic nonunion derived from bone fragment mobility. We report 1 case along with literature review for the treatment of hypertrophic nonunion in femur.

The Logic and Clinical Applications of Blocking Screws

Stedtfeld, Hans-Werner MD, PHD; Mittlmeier, Thomas MD; Landgraf, Peter MD; Ewert, Andreas MD Author Information