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Zhou AK, Jou E, Lu V, Zhang J, Chabra S, Krkovic M. The evolution of poller screws. EFORT Open Rev 2024; 9:252-263. [PMID: 38579780 PMCID: PMC11044090 DOI: 10.1530/eor-23-0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
Compared to other techniques, poller screws with intramedullary nailing are technically simple, practical, and reproducible for the fixation of metaphyseal fractures. In addition, poller screws do not require special instruments or hardware and are minimally invasive. This review takes a historical perspective to evaluate poller screws holistically. A non-systematic search on PubMed was performed using 'Poller screw' or 'Blocking screw' to find early use of poller blocking screws. Relevant references from these primary studies were then followed up. In 1999, Krettek et al. first coined the term poller screws after the small metal bollards that block and direct traffic. Poller screws were introduced as an adjunct to aid the union of metaphyseal long bone fractures during intramedullary nailing. However, as more evidence was published, the true effectiveness of poller screws was not appreciated, leading to split opinions. Through our research, we have built upon our understanding of poller screws, and we present a novel classification of poller screws over the years while exploring our novel technique and what we believe to be the fourth generation of poller screws. Currently, there is a paucity of research focussing on poller screws. However, studying the original evidence regarding poller screws through the most recent articles has demonstrated a confusion of research in this field. Therefore, we suggest a more organised approach to classify the use of poller screws.
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Affiliation(s)
- Andrew Kailin Zhou
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
- West Hertfordshire Hospitals NHS Trust, London, United Kingdom
| | - Eric Jou
- Kellogg College, University of Oxford, Oxford, United Kingdom
| | - Victor Lu
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
- James Paget University Hospitals NHS Foundation Trust, Great Yarmouth, Norfolk, United Kingdom
| | - James Zhang
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
- Basildon and Thurrock University Hospitals NHS Foundation Trust, Basildon, Essex, United Kingdom
| | - Shirom Chabra
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
- School of Clinical Medicine, University of Cambridge, Cambridge, United Kingdom
| | - Matija Krkovic
- Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, United Kingdom
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Horoz L, Cakmak MF, Kircil C. Stable elastic nail application with poller K-wire for Irreducible distal radius metaphyseal-diaphyseal Junction fractures in preadolescents: a new operative technique. BMC Musculoskelet Disord 2024; 25:228. [PMID: 38509566 PMCID: PMC10956287 DOI: 10.1186/s12891-024-07358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 03/13/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Surgical treatment of irreducible distal radius diaphyseal- metaphyseal junction fractures involves difficulties as the fracture remains too proximal for K-wire fixation and too distal for the elastic stable intramedullary nail. Our study aims to present the clinical results of applying an elastic stable intramedullary nail with a poller K-wire to achieve both reduction and stable fixation. PATIENTS AND METHODS A retrospective analysis was performed on 26 patients who underwent ESIN with a poller K-wire for distal radius diaphyseal-metaphyseal region fracture. Reduction parameters such as residual angulation and alignment were evaluated on postoperative follow-up radiographs. Changes in angular and alignment parameters on follow-up radiographs were recorded. Wrist and forearm functions were evaluated at the last follow-up. RESULT There were 17 male and nine female patients with an average age of 10.9. The residual angulation in coronal and sagittal planes on immediate postoperative radiographs was 4.0 ± 1.62° and 3.0 ± 1.26°, respectively. The mean translation rate on immediate postoperative radiographs was 6.0 ± 1.98% and 5.0 ± 2.02% in the coronal and sagittal planes, respectively. No change was observed in translation rates in the last follow-ups. The mean angulation in the coronal and sagittal planes measured on 6th-week radiographs was 4.0 ± 1.72°and 3.0 ± 1.16°, respectively. No significant difference was observed in angular changes in the sagittal and coronal planes at the last follow-up (p > 0.05). No tendon injury or neurovascular injury was observed in any of the patients. CONCLUSION In the surgical treatment of pediatric DRDMJ fractures, applying ESIN with poller K-wire is an effective, safe, and novel method for achieving reduction and stable fixation.
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Affiliation(s)
- Levent Horoz
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kırşehir Ahi Evran University, Kirsehir, Turkey.
| | - Mehmet Fevzi Cakmak
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kırşehir Ahi Evran University, Kirsehir, Turkey
| | - Cihan Kircil
- Faculty of Medicine Orthopedics and Traumatology Clinic, Kırşehir Ahi Evran University, Kirsehir, Turkey
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Batar S, Söylemez MS, Bozdağ SE, Yaman E, Kemah B, Poyanlı OS. Biomechanical comparison of distal femoral fracture fixation: Polyaxial vs. uniaxial locking screws with different blocking screw configurations in retrograde femoral nailing. Orthop Traumatol Surg Res 2024; 110:103695. [PMID: 37783426 DOI: 10.1016/j.otsr.2023.103695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/27/2023] [Accepted: 09/27/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION Clinical studies have indicated reduced reliance on blocking screws with the introduction of polyaxial locking nails, yet the biomechanical superiority of polyaxial locking over blocking screws remains unverified, specifically for distal dia-metaphyseal femur fractures. HYPOTHESIS We hypothesized that the combination of multiaxial locking using three screws and parallel locking reinforced by two blocking screws would result in superior outcomes compared to utilizing only parallel locking with two screws and one blocking screw. MATERIALS AND METHODS Third-generation custom-made femur models representing AO/OTA 32 A1.2 dia-metaphyseal comminuted oblique fractures were divided into four groups (n=10/group). Group A employed distal fixation with three 4.5-mm polyaxial screws. Group B used two parallel locking screws and two blocking screws, Group C used two parallel locking screws and one blocking screw, and Group D used only two parallel screws. Specimens underwent axial and torsional load testing to assess fatigue strength, ultimate strength, axial stiffness (N/mm), torsional stiffness (N/mm/deg), axial load to failure (N), torsional load to failure (N/mm), coronal and sagittal angulations, and fracture site collapse. RESULTS Group C exhibited statistically superior torsional stiffness compared to Groups B and D (p=0.039 and p=0.034, respectively). Axial load to failure was highest in Group B and lowest in Group D (p=0.032). Group C demonstrated the highest torsional strength, while Group B exhibited the lowest (p=0.006). Coronal displacement was greatest in Group B, while Group A showed the highest resistance (p=0.009). Group A demonstrated the greatest resistance to fracture site collapse, with the weakest specimens observed in Groups B and C (p=0.01). DISCUSSION The performance of a single laterally positioned blocking screw is comparable to using two blocking screws. Medial positioning of a second blocking screw is unnecessary for stability enhancement. Multiaxial locking prevents fracture site collapse and coronal plane angulation more effectively than other methods. Multiaxial locking and/or parallel screws with a single laterally positioned blocking screw provide superior stiffness and stability for treating unstable dia-metaphyseal distal femoral fractures. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Suat Batar
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd., 34764 Ümraniye/İstanbul, Turkey
| | - Mehmet Salih Söylemez
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd., 34764 Ümraniye/İstanbul, Turkey.
| | - Süreyya Ergun Bozdağ
- Faculty of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Enis Yaman
- Faculty of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Bahattin Kemah
- Department of Orthopaedics and Traumatology, Umraniye Training and Research Hospital, Elmalıkent, Adem Yavuz Cd., 34764 Ümraniye/İstanbul, Turkey
| | - Oğuz Sukru Poyanlı
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Medeniyet University, Süleyman Yalçın City Hospital, Istanbul, Turkey
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Bradshaw F, Wakefield E, Zhang J, Tandon A, Krkovic M. Poller Screws and Post-Operative Pain Relief in Tibial Fractures. Cureus 2024; 16:e54811. [PMID: 38529468 PMCID: PMC10962009 DOI: 10.7759/cureus.54811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/27/2024] Open
Abstract
Introduction Poller screws optimise fracture alignment in those fractures managed with intramedullary (IM) nails. They enhance stability, control nail insertion, and prevent translation. Indications encompass acute fractures, delayed unions/non-unions, and deformity. Classified into four generations, they've shown positive outcomes: improved alignment, reduced complications, and shorter healing. However, their pain management impact is understudied. This retrospective cohort study aimed to compare opioid medication needs in tibial fractures managed with IM nails with and without poller screws. Methods Between January 2015 and December 2022, a retrospective analysis was conducted on tibial fractures treated at a major trauma centre. Patients primarily treated with IM nails were included. Patient and operation notes as well as radiographs, were reviewed to identify poller screw utilisation. Opioid medication data was collected and converted to "coverage" (days) and "strength" (morphine milligrams equivalent or MME). Two-tailed independent samples T-tests were performed to determine differences between patients treated with (n=205) and without poller screws (n=540). Results Patients with poller screws had fewer days with opioid prescriptions in the second post-operative month (6.8 vs. 8.9 days, p=0.038) and significantly lower opioid strength requirements across the first post-operative year (688.4 vs. 1295.4 MME, p=0.001), except the first month. Conclusion There is limited research on the connection between poller screws and pain. This study discusses their potential to reduce post-operative pain in tibial fractures. The results highlight the importance of using poller screws alongside IM. This combination appears to be effective in improving post-operative pain management and enhancing overall patient outcomes.
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Affiliation(s)
- Florence Bradshaw
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
| | - Edward Wakefield
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
| | - James Zhang
- Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
| | - Ansh Tandon
- School of Clinical Medicine, University of Cambridge, Cambridge, GBR
| | - Matija Krkovic
- Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, GBR
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Acevedo D, Rizzo MG, Constantinescu D, Heng M. The Use of Blocking Wires in Fibular Intramedullary Nailing of an Ankle Fracture with Hardware Failure: A Case Report. Cureus 2023; 15:e47737. [PMID: 38022253 PMCID: PMC10676240 DOI: 10.7759/cureus.47737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
A 24-year-old male, with a body mass index (BMI) of 31.7 and a previous open reduction and internal fixation (ORIF) of the left ankle seven years ago, presented to the emergency department with a peri-implant, comminuted fibula fracture with broken hardware and syndesmotic injury. The nature of the revision surgery made proper guidewire placement during fibular nailing difficult. Blocking wires assisted in ensuring proper guidewire placement. The patient was successfully managed with revision ORIF, fibular nailing, and syndesmotic fixation. Blocking wires are a helpful tool for achieving proper fracture alignment and stability during intramedullary nailing procedures and may be considered in fibular nailing situations.
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Affiliation(s)
- Daniel Acevedo
- Orthopaedic Surgery, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Davie, USA
| | - Michael G Rizzo
- Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - David Constantinescu
- Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
| | - Marilyn Heng
- Orthopaedic Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, USA
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DeBaun MR, Barei DP, Ricci WM, Campbell ST. Updated Blocking Techniques for Lower Extremity Medullary Nailing: Beyond the Concavity of Deformity. J Am Acad Orthop Surg 2023; Publish Ahead of Print:00124635-990000000-00720. [PMID: 37294617 DOI: 10.5435/jaaos-d-22-00243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 04/01/2023] [Indexed: 06/11/2023] Open
Abstract
Modern blocking techniques are useful to achieve anatomic alignment and stable fixation during end-segment nailing. Whether with screws or drill bits, blocking implants can correct both angular and translational deformities. Understanding the biomechanics of blocking implants allows the surgeon to properly plan their placement based on principles rather than dogma. We use case examples to highlight updates in blocking techniques during acute surgical fixation and chronic deformity correction.
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Affiliation(s)
- Malcolm R DeBaun
- From the Department of Orthopaedic Surgery, Duke University, Durham, NC (DeBaun), Department of Orthopaedics and Sports Medicine, Harborview Medical Center, Seattle, WA (Barei), Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY (Ricci), Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, CA (Campbell)
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Krettek C, Edwards E. Avoiding deformity in proximal tibial nailing: risk factors, deformity rules, tips, and tricks. OTA Int 2023; 6:e257. [PMID: 37533440 PMCID: PMC10392440 DOI: 10.1097/oi9.0000000000000257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/29/2022] [Indexed: 08/04/2023]
Abstract
Malalignment is one of the most common problems linked to nailing of proximal tibial fractures. This review will cover technical aspects of intramedullary nailing and will help explain the various risk factors. Deformity rules aid in identifying the likely deformity and help to develop management strategies. Various tools and techniques are discussed which can help optimize the outcome. Level of Evidence Therapeutic Level V.
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Affiliation(s)
- Christian Krettek
- Department of Traumatology, Hannover Medical School, Hannover, Germany; and
| | - Elton Edwards
- Orthopaedic Surgeon, Alfred Hospital, Victoria, Australia
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Tan J, Yang Y, Wang M, Huang X, Ouyang H, Zhao D, Huang G, Deng Y, Huang W. In silico biomechanical analysis of poller screw-assisted small-diameter intramedullary nail in the treatment of distal tibial fractures. Front Bioeng Biotechnol 2023; 11:1172013. [PMID: 37229497 PMCID: PMC10203470 DOI: 10.3389/fbioe.2023.1172013] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/26/2023] [Indexed: 05/27/2023] Open
Abstract
Objective: To evaluate the biomechanical effects of Poller screws (PS) combined with small-diameter intramedullary nails in the treatment of distal tibial fractures at different locations and on different planes. Methods: Nine finite element (FE) models were used to simulate the placement of the intramedullary nail (IMN) and the PS for distal tibial fractures. Structural stiffness and interfragmentary motion (IFM) through the fracture were investigated to assess the biomechanical effects of the PS. The allowable stress method was used to evaluate the safety of the construct. Results: With the axial load of 500 N, the mean axial stiffness of IMN group was 973.38 ± 95.65 N/mm, which was smaller than that at positions A and B of the coronal group and sagittal group (p < 0.05). The shear IFM of the IMN group was 2.10 ± 0.02 mm, which were smaller than that at positions A and B of the coronal group and sagittal group (p < 0.05). Under physiological load, the stresses of all internal fixation devices and the nail-bone interface were within a safe range. Conclusion: In the treatment of distal tibial fractures, placing the PS in the proximal fracture block can obtain better biomechanical performance. The IMN fixation system can obtain higher structural stiffness and reduce the IFM of the fracture end by adding PS.
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Affiliation(s)
- Jinchuan Tan
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for the Translation of Medical 3D Printing Applications, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Yang Yang
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for the Translation of Medical 3D Printing Applications, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Mian Wang
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for the Translation of Medical 3D Printing Applications, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
| | - Xuecheng Huang
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for the Translation of Medical 3D Printing Applications, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
| | - Hanbin Ouyang
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for the Translation of Medical 3D Printing Applications, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
| | - Dongliang Zhao
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
- Drug Discovery Center, State Key Laboratory of Chemical Oncogenomics, School of Chemical Biology and Biotechnology, Peking University Shenzhen Graduate School, Shenzhen, Guangdong, China
| | - Gang Huang
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Yuping Deng
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for the Translation of Medical 3D Printing Applications, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
- Institute of Biomedical Engineering, Shenzhen Bay Laboratory, Shenzhen, Guangdong, China
| | - Wenhua Huang
- National Key Discipline of Human Anatomy, Guangdong Provincial Key Laboratory of Medical Biomechanics, Guangdong Engineering Research Center for the Translation of Medical 3D Printing Applications, School of Basic Medical Sciences, Southern Medical University, Guangzhou, China
- Department of Orthopedics and Traumatology, Integrated Hospital of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
- Orthopedic Center, Affiliated Hospital of Guangdong Medical University, Guangdong Medical University, Zhanjiang, China
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Xu Z, Li Z, Li J, Zhang Y, Wang M, Zhang Y. Extra-articular Blocking Technique to Resolve Severe Acetabular Bone Defect in Developmental Dysplasia of the Hip. Orthop Surg 2023; 15:1187-1195. [PMID: 36846951 PMCID: PMC10102295 DOI: 10.1111/os.13688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 01/16/2023] [Accepted: 01/30/2023] [Indexed: 03/01/2023] Open
Abstract
OBJECTIVE The reconstruction of acetabular bone defect in developmental dysplasia of the hip (DDH) is a great challenge. Although several successful solutions have been raised, their efficacy and reliability have not been fully substantiated. This work aims to present a simple, economic and effective acetabular reconstructive technique to resolve the massive acetabular bone defect in DDH scenario. METHODS This is a case series and observational study investigating the effectiveness and safety of extra-articular blocking technique in patients diagnosed as DDH of Crowe type II-III and Hartofilakidis B. Sixteen consecutive patients indicated for extra-articular blocking and treated with total hip arthroplasty were enrolled in this series from January 2019 to August 2020. The outcome measures included the surgical indicators such as acetabular coverage, prosthesis position, operational time, medical cost, and short-term follow-up indicators such as complications profile, patient-reported functional scales, overall recovery after surgery, and radiographic bone integration and remodeling. Their medical documentation and follow-up records were carefully reviewed with ethical approval. RESULTS The mean values of postoperative acetabular component inclination and anteversion were 42.3° ± 2.1° and 16.4° ± 1.8°, with an average acetabular coverage of 92.1%. The mean cost reduction for patients treated with this technique compared with those treated with trabecular metal augmentation was 15.3%. The mean time until walking under full-weight bearing decreased by 3.5 weeks compared with patients treated with autologous bone grafting. Within an average observational period of 18 months, the mean improvements in Harris hip score and WOMAC score were 31 and 22 points, respectively, which were identical to those with bone graft and metal augmentation techniques. No complications such as dislocation, acetabular loosening, periprosthetic joint infection, and limb length discrepancy were recorded. No signs of translucent line formation, third-party reaction, and wear-associated osteolysis were identified. CONCLUSION The extra-articular blocking can work simply and effectively to address acetabular bone defect in DDH patients of Crowe II-III and Hartofilakidis B, as evidenced by cost-effectiveness and instant weight-bearing advantages, low failure rate, and early osteointegration and remodeling.
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Affiliation(s)
- Zhonghua Xu
- Joint Disease & Sport Medicine Center, Department of Orthopedic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Ziqiang Li
- Department of Orthopedics, People's Hospital of Linshui, Guang'an, China
| | - Jie Li
- Joint Disease & Sport Medicine Center, Department of Orthopedic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yiling Zhang
- Department of Technology, Longwood Valley MedTech, Beijing, China
| | - Min Wang
- Joint Disease & Sport Medicine Center, Department of Orthopedic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
| | - Yuan Zhang
- Joint Disease & Sport Medicine Center, Department of Orthopedic Surgery, Xinqiao Hospital, Army Medical University, Chongqing, China
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Optimal blocking screw placement for retrograde IM nail fixation of distal femur fracture: a standardized biomechanical study of "osteoporotic" synthetic bone. Arch Orthop Trauma Surg 2022; 142:3827-3835. [PMID: 34981191 DOI: 10.1007/s00402-021-04280-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/24/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Intramedullary (IM) nail use for metaphyseal fracture management is problematic in long bones like the femur because the larger medullary cavity allows increased fracture motion and potentially increased implant failure and malunion/nonunion risk; Achieving effective distal femur fracture fixation is even more difficult in osteoporotic bone. Blocking screws to control IM nail movement are known to be effective for tibia fracture management. Few studies have evaluated IM nail and blocking screw use efficacy for distal femur fracture fixation in osteoporotic bone. METHODS This study used an osteoporosis simulation synthetic bone model to evaluate retrograde IM nail fixation of a standardized non-comminuted, extra-articular distal femur fracture with and without blocking screws. The hypothesis was that use of one or two blocking screws would increase IM nail fixation stability as evidenced by greater peak IM nail load and lesser movement. A servohydraulic device under displacement control collected loading force versus movement deflection data. Shapiro-Wilk tests confirmed data normality. One-way analysis of variance and Tukey post hoc tests were used to compare condition specific loading force and movement differences. RESULT In the coronal plane, blocking screw conditions displayed greater loading ranges (38.3 ± 2 vs. 19.1 ± 2 N, 100.5% difference) (p < 0.0001) and lesser movement (2.0 ± 0.3 vs. 6.86 ± 0.4 mm, 243% difference) (p < 0.0001). In the sagittal plane, the two blocking screw condition displayed a significantly greater loading magnitude (29.9 ± 6 vs. 20.8 ± 2.3 N, 43.8% difference) than the identical control condition without blocking screws (p = 0.018); however, movements were comparable (p = 0.82). Long-axis rotational loading failed to reveal load magnitude differences (p = 0.28); however, two different blocking screw conditions displayed decreased movement (1.32 ± 0.2 vs. 2.05 ± 0.3 mm, 53.8% difference) compared to other conditions (p ≤ 0.018). CONCLUSIONS Use of one or two blocking screws on the medial and lateral sides of the IM nail decreased coronal plane movement in the intramedullary canal. Combining retrograde IM nail implantation with blocking screws reduced medial-lateral IM nail movement and increased fracture stability. These characteristics may help prevent fixation failure, malunion, and even nonunion in patients with a distal femur fracture in osteoporotic bone.
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11
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Effect of Different Reduction Intramedullary Nails on Spiral Fracture of Middle and Lower Tibia. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:4716978. [PMID: 35414802 PMCID: PMC8979711 DOI: 10.1155/2022/4716978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/10/2022] [Accepted: 03/17/2022] [Indexed: 11/17/2022]
Abstract
Objective To compare the efficacy of different reduction and intramedullary nailing in the treatment of spiral fracture of middle and lower tibia. Method A total of 96 patients with spiral fractures of middle and lower tibia treated with intramedullary nails were retrospectively analyzed. The patients were divided into closed functional reduction group, open anatomical reduction group, and closed anatomical reduction group according to different treatment methods. The operation time, intraoperative blood loss, intraoperative fluoroscopy times, fracture healing time, fracture nonunion, wound complications, and healing conditions of the three groups were compared. Results The operation time and intraoperative fluoroscopy times of patients in the closed anatomical reduction group were significantly increased compared with those in the closed functional reduction group, while the fracture healing time was significantly reduced. However, patients in the open reduction group had significantly more intraoperative blood loss than those in the closed reduction group. The mean follow-up duration of patients was 15.81 ± 3.25 months. Open anatomical reduction was found to have a higher complication rate during follow-up. Specifically, a total of 3 cases recovered after 2 times of surgical treatment. 6 cases showed a small gap at the fracture end which did not affect the function. Conclusion In the treatment of middle and lower spiral fracture of tibia, closed anatomical reduction and intramedullary nail internal fixation have shorter fracture healing time, less blood loss, and fewer complications, which can act as the first surgical choice. However, open reduction and intramedullary nailing have a high complication rate, which is not recommended.
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12
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Qi L, Zhang W, Chen H. Treatment of ipsilateral femoral neck and shaft fracture by augmented fixation via modified anterior approach: A case report. Trauma Case Rep 2022; 39:100650. [PMID: 35571578 PMCID: PMC9092491 DOI: 10.1016/j.tcr.2022.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2022] [Indexed: 11/28/2022] Open
Abstract
Case A 39-year-old man with obsolete fracture of the left femoral neck (AO/OTA31B2.3, Pauwels III) and segmental fracture of the ipsilateral shaft (AO/OTA32C2) caused by traffic accident was treated by a hybrid augmented fixation technique, long reconstruction intramedullary nail combined with medial anatomical buttress plate and poller screws. All procedures were carried out via the modified anterior approach with a good exposure of the fracture site. Conclusion The hybrid augmented fixation technique via the modified anterior approach could improve fracture reduction and mechanical stability for ipsilateral femoral neck and shaft fractures.
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Affiliation(s)
- Lin Qi
- Chinese PLA Medical School, No.28 Fuxing Road, Haidian, Beijing 100853, China
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing 100853, China
| | - Wei Zhang
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing 100853, China
| | - Hua Chen
- Department of Orthopaedics, the First Medical Center, Chinese PLA General Hospital, No.28 Fuxing Road, Haidian, Beijing 100853, China
- Corresponding author at: No.28 Fuxing Road, Haidian, Beijing 100853, China.
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Zhang CM, Sun L, Wang Q, Huang Q, Lin H, Duan N, Zhang CC, Ma T, Xue HZ, Zhang K, Li Z. A New Technique for Placement of Blocking Screws and its Mechanical Effect on Stability of Tibia Fractures with Distal Fragments after Insertion of Small-Diameter Intramedullary Nails. Orthop Surg 2021; 13:2127-2136. [PMID: 34596359 PMCID: PMC8528988 DOI: 10.1111/os.13149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 11/27/2022] Open
Abstract
Objective To design a novel blocking screws (BSs) geometry and insertion method to treat distal tibia fracture with nailing and comparison of mechanical properties of novel and traditional screws. Methods Twenty‐one synthetic left tibiae were sectioned to obtain 21 distal segments measuring 55 mm. Intramedullary (IM) 9‐mm tibial nails were advanced to 6 mm from the ankle joint. Two transverse and one anterior–posterior (AP) locking screws were inserted. Both medial–lateral (ML) BSs were placed 10 mm from the topmost interlocking screw. A custom‐made jig assisted in placing the novel and traditional BSs. The time spent in placing each BS was recorded. All the samples were repaired with an IM nail and without BSs, with two traditional BSs, and with two novel BSs. An initial loading from −150 to +150 N was applied to specimens in the ML direction at 185 mm from the nail end, followed by cyclic loading of the same for 10,000 cycles with failure‐to‐test loading of 350 N in the ML direction. The maximum displacement was measured at 80 mm from the nail end and recorded under initial loading. The damage of two kinds of BSs to the nail was recorded. Results Compared with average 5.21 min of the time of placing a traditional BS, the time spent in positioning a novel BS on the fracture model was 2.53 min. In the distal bone–implant constructs (BICs), the addition of traditional BSs decreased the maximum displacement of the BICs by 26.2%. The addition of the novel BSs decreased the displacement by 28.9%. All constructs survived 10,000 cycles without hardware deformation. The failure rate of the control group was significantly greater than that of the traditional group; however, the novel group was similar to the traditional group. The damage of the traditional BS to the nail was greater than that of the novel one. Conclusions The novel and traditional BSs are comparably effective for increasing the primary mechanical stability of distal metaphyseal fractures after nailin. However, compared to the placement of a traditional BS, implanting a novel BS took more less time and caused less damage to the nail. Additionally, the most obvious advantage of the novel BS design and insertion technology was that the pressure and distance between it and the IM nail could be controlled by rotating the screw. These advantages of the novel BS will be beneficial for clinical application.
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Affiliation(s)
- Cong-Ming Zhang
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Liang Sun
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Qian Wang
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Qiang Huang
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Hua Lin
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Ning Duan
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Chen-Chen Zhang
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Teng Ma
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Han-Zhong Xue
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Kun Zhang
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
| | - Zhong Li
- Department of Orthopaedics and Traumatology, Xi'an Jiaotong University College of Medicine, Hong-Hui Hospital, Xi'an, China
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Peat F, Ordas-Bayon A, Krkovic M. Do Poller screws effect union in tibial shaft fractures treated with intramedullary nailing? Injury 2021; 52:3132-3138. [PMID: 33627250 DOI: 10.1016/j.injury.2021.02.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/04/2021] [Accepted: 02/15/2021] [Indexed: 02/02/2023]
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.
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Affiliation(s)
- Fidel Peat
- Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road CB2 0QQ Cambridge, Cambridgeshire, United Kingdom.
| | - Alejandro Ordas-Bayon
- Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road CB2 0QQ Cambridge, Cambridgeshire, United Kingdom.
| | - Matija Krkovic
- Department of Trauma and Orthopaedic Surgery, Cambridge University Hospitals NHS Foundation Trust, Cambridge Biomedical Campus, Hills Road CB2 0QQ Cambridge, Cambridgeshire, United Kingdom.
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Poller (blocking) screw with intramedullary femoral nailing for subtrochanteric femoral non-unions: clinical outcome and review of concepts. Eur J Trauma Emerg Surg 2021; 48:1295-1306. [PMID: 33835188 DOI: 10.1007/s00068-021-01651-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/21/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Surgery to treat nonunion resulted from malalignment is challenging since correction and bone union should be achieved simultaneously. To report the clinical outcomes achieved through reconstruction of sub-trochanteric femoral fractures by femoral nailing using a poller screw and to review the current concepts. MATERIALS AND METHODS Fourteen patients (11 men and 3 women; mean age 56.4 years) who were diagnosed with non-union of subtrochanteric femoral fractures and who underwent intramedullary nailing with blocking screws between August 2013 and March 2019, with at least 1 year follow-up, were analyzed retrospectively. The preoperative and postoperative Centrum-Collum-Diaphyseal angle and anterior angulation angle were measured. Bone union time, position and number of poller screws used, and complications were analyzed. Functional assessment was performed by evaluating the Harris hip score. The related literature was searched, and 14 clinical studies on the treatment of sub-trochanteric non-union were analyzed. RESULTS Bone union was achieved in 12/14 cases (85.7%) at the final follow-up within a mean of 6.52 (3-12) months. Bone union was also achieved in two patients lacking bone union at the final follow-up through bone grafting and augmented plating. No cases developed complications, including infection and bone necrosis, and the varus deformity and anterior angulation significantly improved from a preoperative mean of 12.4° and 9.4° to postoperative mean 3.8° and 2.4°, respectively. The mean Harris hip score at the final follow-up was 87.07 (73-98) points. Analysis of published literature revealed high rates of bone union (78-100%) through various fixation methods. CONCLUSION Correction with blocking screws and rigid fixation with intramedullary nailing to treat sub-trochanteric-non-union-caused malalignment can yield good clinical and radiological outcomes.
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Outcome Analysis of Intramedullary Nailing Augmented with Poller Screws for Treating Difficult Reduction Fractures of Femur and Tibia: a Retrospective Cohort Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6615776. [PMID: 33869628 PMCID: PMC8035000 DOI: 10.1155/2021/6615776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 02/23/2021] [Accepted: 03/21/2021] [Indexed: 11/17/2022]
Abstract
Purpose Poller screws may serve as an adjunctive reduction tool and aid fracture reduction while augmented with intramedullary (IM) nailing for treating diaphyseal or metaphyseal fractures of the femur and tibia. However, there is no consistent conclusion about whether the method of using IM nailing augmented with poller screws is more advantageous than using IM nailing alone. Methods A total of 96 patients who received IM nailing with or without supportive poller screw for treating long-bone fractures in lower limbs and who experienced difficulties in performing reduction or IM insertion during the surgical process were included in this retrospective cohort study (33 patients with poller screws in group A versus 63 patients without poller screws in group B). Patient demographics including age, gender, and body mass index; injury-related data including fracture location, classification, and injury mechanism; operation-related data including American Society of Anesthesiologists, duration of operation, poller screw time, method of anesthesia, and volume of intraoperative hemorrhage; outcomes including fracture healing time; and incidence of outcomes of nonunion, malunion, infection, and secondary surgical procedures were evaluated. Results Fracture healing time of patients in group A was significantly shorter than that of group B (18.3 ± 4.8 weeks versus 24.3 ± 3.0 weeks, p = 0.023). Union rate was higher (100.0% versus 87.3%, p = 0.048), and malunion rate and secondary surgical procedure rate were lower (both are 3.0% versus 19.0%, p = 0.031) in group A than that of group B. Conclusion Poller screw augmentation of IM nailing is a favourable option to shorten fracture healing time and to reduce complication rates in terms of nonunion, malunion, and secondary surgical procedure in the treatment of both diaphyseal/metaphyseal fractures of the femur or tibia while compare with those treated by IM nailing alone.
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