Do Poller screws effect union in tibial shaft fractures treated with intramedullary nailing?. Issue 10 (October 2021)

• Record Type: Journal Article
• Authors: Peat, Fidel; Ordas-Bayon, Alejandro; Krkovic, Matija
• Is Part Of: Injury. Volume 52:Issue 10(2021)
• Page Start: 3132
• Page End: 3138
• Publication Date: 2021-10
• Subjects: Tibia fractures -- Union -- Poller screw -- Trauma -- Intramedullary Nail; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.02.040
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: Poller screws can be utilised to aid fracture reduction and improve mechanical stability in tibial fractures treated with intramedullary nailing. We describe a novel technique of placing 2 Poller screws equidistant across the fracture site to minimise shearing forces and generate inter-fragmentary compression. Risk factors for tibial delayed/non-union include infection, open fractures, operative time, junior grade of operating surgeon and the absence of Poller screw supplementation. The addition of Poller screws can be considered in tibial fractures with risk factors for delayed/non-union as a method of increasing mechanical stability. Abstract: Introduction: Tibial shaft fractures are a commonly encountered challenge presented to orthopaedic trauma surgeons. Intramedullary nailing (IMN) is often the treatment of choice and whilst effective, complications of delayed and/or non-union can cause significant morbidity and necessitate additional operative procedures. The use of Poller screws during IMN are a recognised way of aiding fracture reduction, however the clinical benefits of this are debated. This study evaluated the outcome of tibial shaft fractures treated with IMN with or without the addition of Poller screws. Methods: Retrospective cohort study of all patients undergoing IMN following tibial shaft fractures over a 5-year period. 154 operated tibial shaft fractures were identified, with patients divided into 3 groups - Group 1: IM nailing alone, Group 2: IMN + 1 conventional Poller screw, or Group 3: IMN + 2 Poller screws placed Epicentrically across the fracture site. Data collected included demographics, length of stay, fracture type, position and AO classification grade, operative time, and operating surgeons' grade. Primary outcome measure was the incidence of delayed and/or non-union. Secondary outcomes were differences in rates of infection and additional orthopaedic procedures between the 3 groups. Results: Overall 139/154 fractures (90.3%) achieved a timely union. There was a statistically significant difference (p = 0.05) in fracture union between the 3 groups, with 75/88 fractures healing in group 1 (IMN alone) compared to 44/46 in Group 2 (IMN + 1 Poller screw) and 20/20 in group 3 (IMN + 2 Poller screws). There was no statistical difference in the incidence of superficial infection, (p = 0.95) additional procedures (p = 0.23) or deep infection (p = 0.65) between the 3 groups. Conclusion: The addition of Poller screws appear to be a safe and effective adjunct in the treatment of tibial shaft fractures via IMN. Further prospective randomised trials are needed to fully elucidate both the role and potential benefits of Poller screw augmentation in acute lower limb fracture management.