Use of Poller Screws in Proximal and Distal Metaphyseal Fractures of Tibia: A Prospective study

Mugundhan, M S (2008) Use of Poller Screws in Proximal and Distal Metaphyseal Fractures of Tibia: A Prospective study. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION: Treatment of metaphyseal fractures of tibia remains a challenge. The goals of surgical management include correction and maintenance of sagittal and coronal alignment, establishment of length and rotation and early functional range of movements of knee and ankle. Treatment options include medullary implants, half pin, thin wire or hybrid external fixation, plate fixation or combination techniques. Interlocking nailing of tibial fractures are desirable because this technique allows some load sharing, spares extraosseous blood supply, avoids extensive soft tissue dissection and is familiar to most surgeons1. Nailing of metaphyseal fractures with short proximal or distal fragment is associated with an increase in malalignment particularly in coronal plane, non union and need for secondary procedures to achieve union. The cause has been attributed both to displacing muscular forces and residual instability. Various techniques have been recommended to improve nailing the metaphyseal fractures including blocking screws (poller screw), temporary unicortical plating, different nail designs with different proximal bends (proximal third fractures) and fibular plating (distal third fractures). AIM: To evaluate the clinical use of poller screws as a supplement to stability in metaphyseal fractures of tibia treated with statically locked intramedullary nail. MATERIALS AND METHODS: This was a prospective study of 20 cases of tibial metaphyseal fractures treated with statically locked intra medullary nailing with supplementary poller screws between August 2006 and September 2007 at Kilpauk Medical College. Inclusion Criteria - Displaced tibial metaphyseal fractures of proximal or distal third in adults treated with intramedullary nailing were included in the study. The fractures included were acute fractures and delayed union. Both open and closed fractures were included in the study. Exclusion Criteria - Tibial diaphyseal fractures were excluded from the study. Metaphyseal fractures treated with statically locked intramedullary nails but with additional procedures like fibular plating were excluded from the study. RESULTS: All the relevant data were analysed. All the fractures eventually united in a mean period of 11.5 weeks (95% LCL 10.11weeks and 95%UCL 12.88 weeks). Karlstrom-Olerud score was excellent in 13 fractures (65%), good in 6 patients (25%) and fair in 2 patients (10%). The mean ratio of fracture segment to the nail length (i.e the length of tibia) was 15%. The poller screw related complication was encountered in one case where we had new fracture lines while introducing the nail after placement of poller screw. But the alignment was achieved and maintained and the fracture united within 12 weeks. Complications which were not related to poller screw were encountered in three cases. Two patients had deep infection and both of them went in for delayed union of which one required dynamisation to achieve union. In one patient tibialis anterior tendon was found cut at the time of open reduction of the fracture and was repaired. He was given cast support for four weeks. No complications of nerve injury or compartment syndrome were encountered. There were no incidences of breakage of nail, locking screw or blocking screw. CONCLUSION: We conclude that Poller screws, when supplemented the intramedullary nailing of metaphyseal fractures of tibia, 1. Were effective in achieving the fracture alignment, acting as a reduction tool. 2. Improved the stability of the bone – implant construct, by functionally reducing the medullary width. 3. Maintained the fracture alignment till union, preventing loss of initial reduction.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Poller Screws ; Proximal and Distal Metaphyseal Fractures ; Tibia ; prospective study.
Subjects: MEDICAL > Orthopaedics
Depositing User: Subramani R
Date Deposited: 16 Sep 2017 18:01
Last Modified: 17 Sep 2017 15:29
URI: http://repository-tnmgrmu.ac.in/id/eprint/2973

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