The Usefulness of Poller Screw with Antegrade Nailing in the Initial Treatment of Infraisthmal Femur Shaft Fracture

Jeong-Hyun Yoo; Hyoung-Soo Kim; Chang-Geun Kim; Ho-Il Kwak; Sang-Heon Song

doi:10.12671/jkfs.2015.28.4.230

Journal List > J Korean Fract Soc > v.28(4) > 1038037

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Yoo, Kim, Kim, Kwak, and Song: The Usefulness of Poller Screw with Antegrade Nailing in the Initial Treatment of Infraisthmal Femur Shaft Fracture

Original Article

Journal of the Korean Fracture Society 2015; 28(4): 230-236.

Published online: 19 October 2015

DOI: https://doi.org/10.12671/jkfs.2015.28.4.230

The Usefulness of Poller Screw with Antegrade Nailing in the Initial Treatment of Infraisthmal Femur Shaft Fracture

Jeong-Hyun Yoo, M.D., Ph.D., Hyoung-Soo Kim, M.D., Ph.D., Chang-Geun Kim, M.D., Ho-Il Kwak, M.D., Sang-Heon Song, M.D., Ph.D.

Department of Orthopedic Surgery, Myongji Hospital, Seonam University College of Medicine, Goyang, Korea.

Address reprint requests to: Sang-Heon Song, M.D., Ph.D. Department of Orthopedic Surgery, Myongji Hospital, Seonam University College of Medicine, 55 Hwasu-ro 14beon-gil, Deogyang-gu, Goyang 10475, Korea. Tel: 82-31-810-5424, Fax: 82-31-969-0500, sh.gabriel.song@gmail.com

Received 15 June 2015 Revised 6 July 2015 Accepted 24 July 2015

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to evaluate the radiologic and clinical outcomes after intramedullary nailing with Poller screw insertion at initial stage in infraisthmal femur shaft fractures.

Materials and Methods

Seven consecutive patients (7 femurs) treated with antegrade intramedullary nailing with Poller screw insertion for the infraisthmal femur shaft fracture were reviewed retrospectively. There were 4 male and 3 female patients. Mean age was 46.1 years (20-72 years). Operative time including Poller screw insertion, time for union, malalignment, and range of motion were evaluated.

Results

All 7 cases had primarily healed successfully. Mean time for radiologic union was 19.1 weeks (16-24 weeks) postoperatively. One case had 5 degree valgus malalignment. One case of 15 mm shortening was reported and he required shoe lift orthosis. All cases had a full range of motion in hip and knee joint.

Conclusion

Antegrade intramedullary nailing with Poller screw insertion is useful in the initial treatment of infraisthmal femur shaft fracture, because it could provide additional stability. An additional 20 minutes were required but a Poller screw should be considered according to the anatomic location of a femur shaft fracture.

Keywords: Femur, Fracture fixation, Intramedullary nailing, Poller screw

Figures and Tables

Fig. 1

(A) Three-dimensional-reconstructed computed tomography image shows a fragmented wedge fracture at the femur shaft infraisthmal area. (B) Intra-operative C-arm images show the sequence of Poller screw insertion. (C) Postoperative radiograph shows a well reduced femur with good positioned Poller screws.

Fig. 2

A 20-year-old male was poly-traumatized after a traffic accident. (A) Anteroposterior radiograph shows an irregular complex femur shaft fracture with a non-displaced fracture of the ipsilateral femoral neck. (B) He underwent damage control-external fixator application at the time of brain surgery in the neurosurgery department. (C) After 3-weeks, he underwent antegrade nailing with two Poller screws after closed reduction with preservation of fracture site biology. Serial radiographs (D: initial postoperative, E: postoperative 2 month, F: postoperative 4 months) show bridging callus progression until radiologic healing.

Fig. 3

(A) Three-dimensional-reconstructed computed tomography images at postoperative 5 months show full consolidation of a complex femur shaft fracture including neck fracture component. (B) However standing lower extremity scanogram shows a limb length discrepancy of 15 mm.

Table 1

Patient Demographics Related with Injury Type, Mechanism and Fracture Classification

^*AO-OTA classification. F: Female, M: Male, TA: Traffic accident.

Table 2

Clinico-Radiological Results Showing Poller Screw Fixation Time, Whole Operative Time, Time for Union (Radiologic, Clinical) and Clinical Remarks

Notes

^{Financial support} None.

^{Conflict of interest} None.

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