An intuitive and simple technique for accurate insertion point selection and precise Poller (blocking) screw insertion
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TRAUMA SURGERY
An intuitive and simple technique for accurate insertion point selection and precise Poller (blocking) screw insertion Yong‑Cheol Yoon1 · Chang‑Wug Oh2 · Jong‑Keon Oh3 Received: 22 November 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Although indirect reduction with intramedullary (IM) nailing is the gold standard for long bone fractures, IM nailing in meta-diaphyseal fractures often results in malalignment. Placement of Poller (blocking) screws is an attractive and useful technique in these situations; however, the selection of accurate placement points and the placement process itself are often complicated. This paper proposes an intuitive, simple, and clear technique for selecting the location of Poller screw placement that can be used in either the anteroposterior or lateral view regardless of the fracture type and discusses techniques for Poller screw placement that enable displacement correction. Keywords Long bone shaft fracture · Meta-diaphysis · Malalignment · Poller screw
Introduction The treatment of choice for long bone shaft fractures is intramedullary (IM) nailing, which is a biomechanically excellent technique that allows early weight-bearing and yields high union rates and low complication rates [1, 2]. However, IM nailing for the fixation of fractures in the metadiaphysis often results in varus/valgus or anterior/posterior angulation [3, 4]. This can occur when the reduction of the metaphysis of the wide medullary canal is attempted using a nail that passes through the narrow diameter of the diaphysis. This discrepancy in size limits the range of movement of the nail, and it is not easy to reduce deformities along the fracture line or muscle attached to the fragment using the nail alone [5, 6]. The most commonly used method to overcome this problem is the insertion of a Poller (blocking) screw into the * Jong‑Keon Oh [email protected] 1
Orthopedic Trauma Division, Trauma Center, Gachon University College of Medicine, Namdong‑gu, Incheon, Korea
2
Department of Orthopedic Surgery, Kyungpook National University Hospital, Daegu, Korea
3
Department of Orthopedic Surgery, Guro Hospital, Korea University College of Medicine, 148, Gurodong‑ro, Guro‑gu, Seoul 08308, Korea
margin of the nail to alter the direction of the nail. In this method, a percutaneous indirect reduction method is used to correct the malalignment and enhance the stability of the implant within the fracture when the Poller screw is inserted close to the nail [7]. Previous studies have demonstrated the usefulness and effectiveness of Poller screw insertion, and this technique has been used clinically [8–10]. However, the methods proposed for Poller screw insertion to date have not clearly identified the location for Poller screw insertion as well as the effective and precise insertion techniques for correcting the deformity that occurs after nail insertion during surgery. Therefore, we devised an intuitive, clear, and straightforward method for selecting the location of Polle
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