Intramedullary Nailing Supplemented with Poller Screws for Proximal Tibial Fractures

Kulkarni, Shreyas; Varshneya, Ankit; Kulkarni, Shreenath; Kulkarni, Govind S; Kulkarni, Milind G; Kulkarni, Vidhisha S; Kulkarni, Ruta M

doi:10.1177/230949901202000308

Cited by 41 publications

(31 citation statements)

References 12 publications

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“…With the development of IMN design and adjunctively surgical techniques, surgeons began to apply these methods, like angle‐stable and multi‐directional distal screw or blocking screw in distal tibia fractures to maintain reduction, alignment and prevent malunion. A multi‐center pilot study conducted by Höntzsch showed that this technique help improve the stability in axial and torsional loading, which is statically and dynamically higher than conventional IMN.…”

Section: Discussionmentioning

confidence: 99%

Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta‐Analysis

Liu

Xue

et al. 2019

Orthopaedic Surgery

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To evaluate the application, safety and efficacy of the patients treated with intramedullary nailing (IMN) and minimally invasive plate osteosynthesis (MIPO) in distal tibia fractures. Following the Preferred Reporting Items for Systematic Reviews and Meta Analysis (PRISMA) guidelines, we searched databases PubMed, Cochrane library, EMBASE and Web of Science from inception of the database up to 10 October 2018, using the keywords “distal tibia fractures”, “plate”, “intramedullary nailing” and “RCT” to identify randomized clinical trials about distal tibia fractures. The included studies were assessed by two researchers according to the Cochrane risk‐of‐bias criteria. The primary outcome of measurement included operation time, malunion rate, nonunion/delayed union rate, and wound complication. Data analysis was conducted with Review Manager 5.3 software. A total of 10 RCTs involving 911 patients fulfilled the inclusion criteria with 455 patients in the IMN group and 456 patients in the MIPO group. There were no significant differences in radiation time, nonunion or delayed union rate, union time and operation time between the two groups. Patients treated with MIPO had lower incidence of malunion compared with IMN (RR = 1.85, 95%CI: 1.21 to 2.83, P = 1.00), while IMN seemed to have lower surgical incision complications whether in closed or opening fractures (RR = 0.49, 95%CI 0.33 to 0.73, P = 0.43). But in patients classified as 43A, the result of subgroup analysis suggested that there was no significant inwound complication between the two groups. MIPO was superior in preventing malunion compared with IMN, and intramedullary nailing appeared to have lower wound complications. However, in patients with 43A distal tibial fractures, MIPO was more recommended for its prevention of malunion. No matter which method we choose, we should notice and prevent the associated complications.

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Section: Discussionmentioning

confidence: 99%

Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta‐Analysis

Liu

Xue

et al. 2019

Orthopaedic Surgery

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“…Krettek et al [ 4 ] reported that with the use of Poller screws (blocking screws) with small-diameter IM nails in metaphyseal tibial fractures for supplemental stability, the mean loss of reduction was 0.5° in the frontal plane and 0.4° in the sagittal plane. Similarly, various authors have described the use of interlocking intramedullary nail in combination with blocking screws in metaphysis of long bones to improve reduction, prevent secondary displacement, and to augment and maintain the alignment and stability [ 10 – 14 ]. The use of blocking screws has also been reported to hasten the bone healing in fractures [ 15 ] and nonunions [ 16 ] as well as to reduce the risk of implant failure [ 17 ].…”

Section: Discussionmentioning

confidence: 99%

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

Muthusamy¹,

Rozbruch²,

Fragomen³

2016

Strategies in Trauma and Limb Reconstruction

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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.

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“…Blocking screws are designed to guide the intramedullary nail to the desired direction by narrowing the intramedullary canal and obtaining better reduction [ 18 , 19 ]. In our cases, we inserted a 2.4 mm K-wire into the fragment from lateral to medial to prevent a hyperextension deformity and guided the intramedullary nail using the Poller screw technique.…”

Section: Discussionmentioning

confidence: 99%

“…To achieve anatomical reduction of supracondylar fractures, in 1999 Krettek et al [ 16 , 17 ] reported the Poller (blocking) screw technique as an important adjunct for intramedullary nailing. This technique has subsequently been shown to be effective in aiding fracture reduction [ 18 , 19 ], but there have been no reports of this technique being applied specifically for the reduction of periprosthetic supracondylar fracture. Here we report 2 cases of such fracture treated with intramedullary nailing and the blocking screw technique that achieved excellent reduction.…”

Section: Introductionmentioning

confidence: 99%

Retrograde Intramedullary Nailing with a Blocking Pin Technique for Reduction of Periprosthetic Supracondylar Femoral Fracture after Total Knee Arthroplasty: Technical Note with a Compatibility Chart of the Nail to Femoral Component

Tonogai

Hamada

Goto

et al. 2014

Case Reports in Orthopedics

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Periprosthetic fractures after total knee arthroplasty (TKA) present a clear management challenge, and retrograde intramedullary nails have recently gained widespread acceptance in treatment of these fractures. In two cases, we found a blocking screw technique, first reported by Krettek et al., was useful in the reduction of the fractures. Both patients attained preinjury mobility after intramedullary nailing. Moreover, we present a chart summarizing the notch designs of various femoral components because some prosthetic knee designs are not amenable to retrograde nailing. We hope this will be helpful in determining indications for retrograde nailing in periprosthetic fractures after TKA.

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Intramedullary Nailing Supplemented with Poller Screws for Proximal Tibial Fractures

Abstract: Poller screws help maintain fixation of intramedullary nailing and alignment of fractures.

Cited by 41 publications

References 12 publications

Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta‐Analysis

Intramedullary Nailing Versus Minimally Invasive Plate Osteosynthesis for Distal Tibial Fractures: A Systematic Review and Meta‐Analysis

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

Retrograde Intramedullary Nailing with a Blocking Pin Technique for Reduction of Periprosthetic Supracondylar Femoral Fracture after Total Knee Arthroplasty: Technical Note with a Compatibility Chart of the Nail to Femoral Component

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