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Treatment of Diaphysio-Metaphyseal Fracture of Tibia by Intramedullary Nail in Combination with Poller Screw

Objectives: The Poller Screw has been used to supplement intramedullary interlocking nailing in treatment of long bones fracture in order to keep the nail in the desired position and stabilize the fracture. Our aim was to study the mechanical effects of Poller screw (blocking screw) in addition to stability after fixation with interlocked intramedullary nails in the fracture of proximal and distal tibial shaft.

Methods: We retrospectively analyzed clinical and radiological outcomes of 60 tibial fractures, 24 proximal third and 36 distal third who underwent treatment with Poller screws from July 2008 to June 2012. Mean follow up was 12 months.

Results: In all fractures healing was obvious radiologically at a mean of 5.6 ± 2.3 months (3 to 12). Postoperatively 57 cases had <5° valgus or varus deformity; 3 cases had 8° valgus deformity. The only complication related to the procedure was one case of irritation of anterior tibial tendon. The clinical outcome, according to knee rating scale of the Hospital for Special Surgery, was excellent in 15% good in 40%, satisfactory in 35% and fair in 10% and was not influenced by previous or associated injuries.

Conclusion: The use of poller (blocking) screws in combination with an intramedullary nail has been found an important additional option that can be used to improve and maintain reduction and fixation of long-bone fractures at the diaphysio-metaphyseal junction, where there is strong tendency for axial displacement. The Poller screw has been observed to work as nail stabilizer and thus enhances fracture stability. However, the retrospective study with small number of cases and without a control group has raised limitations on the outcome analysis.


Ram Kewal Shah and Shyam Babu Shah

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